Electronic Health Records (EHR) ARPA SLFRF Quarterly Report (June 2022)
Summary
A quarterly report dated 6/30/2022 on the Electronic Health Records (EHR) initiative of the Virginia Department of Health (VDH), funded through the American Rescue Plan Act (ARPA) State and Local Fiscal Recovery Fund (SLFRF). It states that VDH, VITA and the Office of the Attorney General considered contracting options and determined that issuing a request for proposals (RFP) best met the needs of the Commonwealth, and that VDH began the procurement process. It also lists activities planned for July through September 2022 and risks, including one on delay in drafting and issuing the RFP. The budget section gives a total appropriation of $30,000,000 and an FY22 appropriation of $10,000,000.
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“Electronic Health Records (EHR) ARPA SLFRF Quarterly Report (June 2022).”
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ELECTRONIC HEALTH RECORDS (EHR)
American Rescue Plan Act (ARPA) State and Local Fiscal Recovery Fund (SLFRF)
6/30/2022
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
June 2022
Page 2 of 8
Table of Contents
Report Mandate 3
Context for ARPA Initiatives 3
Executive Summary 3
Objective(s) 4
Overview of Quarterly Progress (April – June 2022) 5
Anticipated Next Quarter Activities (July – September 2022) 6
Risks and Risk Management 6
Change Management Considerations 7
Project Budget 8
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
June 2022
Page 3 of 8
Report Mandate
Chapter 1 Enactment Clause 1, paragraph B.2.P.5., of the amended 2021 Acts of Assembly states, “The
department shall communicate a detailed plan and implementation schedule to the Governor, the Chairs
of the House Appropriations and Senate Finance and Appropriations Committees, and the Director of the
Department of Planning and Budget by September 30, 2021. Additionally, the department shall report
quarterly to the Governor, the Chairs of the House Appropriations and Senate Finance and Appropriations
Committees, and the Director of the Department of Planning and Budget on progress made, with the first
progress report to be delivered not later than December 31, 2021.”
Context for ARPA Initiatives
The Virginia Department of Health (VDH) is excited about the opportunity presented by the appropriation
of ARPA State and Local Fiscal Recovery Funds in the August 2021 Special Session II of the General
Assembly to improve public health in Virginia. VDH views this investment as a once in a generation
opportunity and will work diligently to maximize use of funds to create and sustain these initiatives.
Simultaneously, VDH is fully engaged in responding to COVID-19 and protecting the health of Virginians.
Modifications to VDH’s plans will be reflected in future quarterly reports.
Executive Summary
Electronic Health Record (EHR) systems are patient-centered record systems that bring together key
information about a patient’s health to enable data-driven, comprehensive care delivery. EHR systems
can be used to efficiently collect data in a format that can be shared across multiple health care
organizations and leveraged for quality improvement, prevention activities, and public health reporting.
It is a critical need for the Virginia Department of Health (VDH) to obtain a comprehensive, interoperable
EHR solution that will facilitate the collection of clinical, laboratory, billing, scheduling, and other health
related information.
This need has been further accentuated by the COVID-19 public health response. The lack of a robust and
integrated technical infrastructure negatively impacted health outcomes by leading to a higher likelihood
of missed opportunities in timely public health interventions such as testing and contact tracing. Moving
forward, EHR systems have the potential to serve as a powerful tool to assess and improve population
health outcomes through real-time reporting and data analysis. These capabilities will better enable VDH
and other health partners to navigate the next pandemic.
VDH is seeking to identify a solution to replace its legacy patient demographic and billing system
(WebVISION). The agency seeks to interface with existing single programmatic solutions such as the
Virginia Information Immunization System (VIIS) and serve as the main repository of information across
multiple clinical services programs including family planning, maternity, STI, HIV, TB, and immunization.
This solution will offer strong data analytics for improving public health outcomes and comply with patient
safety and regulatory standards, including the Health Insurance Portability and Accountability Act (HIPAA)
of 1996. The goal is to deploy this capability across 120 clinic sites to serve over 250,000 patients and
support 400,000 clinical encounters per year.
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
June 2022
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Using an EHR system and health information exchanges (HIE), VDH can leverage health information
technology to efficiently collect and share data, reduce costs, and improve emergency response times.
Additionally, this technology will allow VDH to make timelier diagnoses of health conditions that not only
improve individual health, but also impact population health across various communities in the
Commonwealth.
Over the last three months, VDH has made significant progress in conducting an EHR solution review and
preparation for the next phase of work through pricing and reference reviews, requirement gathering and
validation, and detailing data migration and interface needs. VDH, VITA and Office of the Attorney General
considered contracting options and determined that issuing an RFP best met the needs of the
Commonwealth. Therefore, VDH began the procurement process including preparing to draft a request
for proposals (RFP). These accomplishments have set the EHR Initiative on the path to successfully
implement a state-of-the-art EHR system.
Objective(s)
VDH aims to fully implement a state-of-the-art EHR system for use across the Commonwealth and in Local
Health Districts (LHDs) in order to:
● Improve clinical efficiency and effectiveness of clinical services statewide.
● Enable delivery of safer, higher quality care for patients by allowing rapid access to accurate, up-to-
date, and complete information.
● Reduce costs of care through decreased duplication of testing, lab procedures, and medical visits
through access to relevant and complete medical information of patients, especially for patients that
seek care in multiple locations across the health district or across health district lines.
● Enhance transmission of EHR related financial transactions including third party billing to maximize
opportunities for funding of essential services.
● Improve the patient experience via reduced clinical cycle times, enhanced two-way communications,
and a patient portal to promote greater patient ownership of their overall health.
● Increase visibility and accountability for services provided at each LHD and fulfill programmatic
reporting requirements for state and/or federally funded initiatives through report generation.
● Positively impact employee morale as well as employee recruitment and retention given that the
availability of and access to an EHR is an expectation of healthcare staff in modern clinical settings.
● Ensure the EHR meets all the Commonwealth’s rigorous Information Technology standards for a cloud
based Commercial Off the Shelf (COTS) technology solution, and that it interfaces with all required
internal and external data systems.
● Fulfill reporting and compliance requirements for all VDH federal and state programs that use the
EHR.
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
June 2022
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Overview of Quarterly Progress (April – June 2022)
Since completing the demonstrations and sandbox sessions with the two vendors currently engaged by
the Commonwealth (Cerner) or Fairfax County (Patagonia Health), VDH completed the EHR Solution
Assessment by requesting and interviewing references as well as requesting pricing estimates. With the
decision to issue an RFP, in preparation of issuance VDH gathered and validated requirements, developed
a high-level implementation roadmap, cataloged data and interface needs, and drafted a workplan
detailing the activities and timeline associated with issuing and awarding the RFP. Additionally, VDH began
work to prepare public health programs and LHDs for implementation, including beginning to catalog
forms, assessments, and reports, as well as planning for an infrastructure assessment. Key activities
conducted over the past three months are outlined below in further detail:
Key Activities and Accomplishments
o EHR Solution Assessment
• Requested three public health references from both Cerner and Patagonia and conducted
interviews (6)
• Requested cost estimates based upon the functions and features identified through the
Visioning Session
• Summarized and presented the results of the EHR Solution Assessment to a joint Steering
Committee and Task Force meeting
o RFP Preparation
• Met with Procurement and VITA to detail next steps in obtaining an EHR tool
• Drafted a Requirements Traceability Matrix (RTM) with 1,031 business and technical
requirements
• Conducted 15 Requirement Validation Sessions with VDH subject matter experts to refine
and prioritize the requirements
• Developed a roles and responsibilities matrix to guide activity ownership across the
system development life cycle (SDLC) decision making
o Implementation Preparation
• Conducted 10 interviews of past Virginia IT implementation projects to gather lessons
learned
• Synthesized the results of the lessons learned interviews to inform scope development
and implementation planning
• Drafted an approach to the Infrastructure Assessment whose goal is to identify the
infrastructure required to effectively utilize an EHR in the health district clinical locations
• Developed a catalog of forms, assessments, and reports, including documentation
received during the current state assessment interviews, aligned with RTM requirements
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
June 2022
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• Reviewed and compared project management tools and selected to implement PlanView
and Enterprise One to both manage the RFP process and ultimately the entire EHR
implementation
o Governance
• Conducted weekly Task Force meetings which reviewed progress, made
recommendations, and provided inputs to work products
• Conducted Steering Committee meetings which reviewed progress, approved approach,
and made recommendations
• Hired and onboarded an Office of Information Management Technical Project Manager
who will be responsible for the VITA relationship and shepherd the RFP through issuance
Anticipated Next Quarter Activities (July – September 2022)
The following outlines the activities and tasks planned from July through September 2022:
o RFP Preparation
• Draft the EHR request for proposal
• Determine proposal scoring and review methodology
• Prepare for EHR vendor demonstrations and interviews
o Implementation Preparation
• Conduct a Public Health Services Operations Assessment to identify areas for
improvement that will increase the efficiency and effectiveness of the EHR
implementation by:
Conducting a Visioning Session to target assessment objects and gain health
district buy-in
Develop the Public Health Services Operations Assessment approach including
objectives, data capture, management, and analysis plan
Develop the project plan including timeline, resources involved, and deliverables
Initiate data capture and management as detailed in the approach
• Continue stakeholder engagement analysis and communications
Risks and Risk Management
• Risk 1: If drafting and issuing an RFP is delayed, then VDH may procure an EHR solution with
limited time for implementation before ARPA funds must be used.
Mitigation Strategy: VDH plans to develop a work plan to track progress and identify risks
to the timeline.
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
June 2022
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• Risk 2: If the selecting an of EHR vendor is rushed, then VDH may select a vendor which cannot
meet VDH's needs.
Mitigation Strategy: VDH plans to leverage lessons learned from the EHR Solution
Assessment to develop a proposal review timeline.
• Risk 3: If contract negotiations with EHR vendor are prolonged, then VDH is at risk for delaying
the implementation of the HER.
Mitigation Strategy: VDH plans to select a vendor that best fits the defined business and
technical requirements and needs of the health districts and programs.
• Risk 4: If the EHR implementation is delayed by a year or more there is a risk of the business
requirements changing thereby resulting in the need for a current state refresh.
Mitigation Strategy: Concurrently with drafting and issuing the RFP, VDH plans to
collaborate across internal stakeholder groups to advance the standardization and
preparation of the health district workflows to expedite the design phase of
implementation. VDH is continuing to assess and document the current state across the
Commonwealth, expanding standardization and understanding of health district needs.
Change Management Considerations
VDH understands that successful transformation initiatives rely on more than just the right technology,
processes, and resources. They also depend on effective change management, engagement, and training
strategies to equip impacted stakeholders with the information and guidance that they need to support
the changes being implemented.
In building and executing a robust Organizational Change Management (OCM) Strategy and Plan, VDH will
build support for the transition to EHRs and prepare stakeholders for this change, which will in turn
accelerate the new systems capability, minimize disruptions to daily operations, and reduce the risk of
project delays. The agency has begun to develop the necessary resources – including an initial analysis of
initiative stakeholders, identifying change champions, and a communication plan – that will serve as the
foundation for the OCM plan. The agency is also developing an EHR “Case for Change” that VDH Leaders
will use to effectively communicate with and engage stakeholders on the importance of the change.
Additional activities may include a change readiness assessment, launching a Change Champion network,
communication/engagement strategy, and a training plan to guide VDH in its efforts to prepare
stakeholders for adoption of the new technology.
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
June 2022
Page 8 of 8
Project Budget
The following appropriation is broken down by the project categories defined in the work plans submitted
on 9/30/2021.
Total Appropriation: $30,000,000
FY22 Appropriation: $10,000,000
Budget, Obligations, Actuals, and Remaining Spend as of June 15,2022
Project FY22 FY22 YTD FY22 YTD Current Period FY22 Remaining
Category Budget Obligations Expenditures* Expenditures* Spend
Phase 1 - One-Time
$ 9,800,000 $ 1,412,200 $ 662,500 $ 136,100 $ 9,137,500
Expenses
Phase 2 - One-Time $ -
$ - $ - $ - $ -
Expenses
Phase 3 - One-Time $ - $ -
$ - $ - $ -
Expenses
Recurring Expenses $ 200,000 $ - $ - $ - $ -
Total $ 10,000,000 $ 1,412,200 $ 662,500 $ 136,100 $ 9,137,500
* Expenditures represent transactions that have posted in Cardinal Web F&A as of 6/15/2022
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