Electronic Health Records (EHR) ARPA SLFRF Quarterly Report (December 2022)

Summary

The Electronic Health Records (EHR) ARPA SLFRF Quarterly Report for December 2022 from the Virginia Department of Health (VDH), dated 12/31/2022. It states that over the last three months VDH made significant progress in developing a Request for Proposal (RFP) and submitted it to the Virginia Information Technology Agency and the Office of Attorney General for mandatory review. It says VDH will develop a change management plan once an EHR solution has been selected. The project budget table, as of December 2022, lists a total appropriation of $30,000,000, obligations to date of $2,400,000 and expenditures to date of $1,809,926.

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              ELECTRONIC HEALTH RECORDS (EHR)
American Rescue Plan Act (ARPA) State and Local Fiscal Recovery Fund (SLFRF)




                                12/31/2022
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
December 2022
Page 2 of 6


Table of Contents
Report Mandate ............................................................................................................................................ 3
Context for ARPA Initiatives .......................................................................................................................... 3
Executive Summary....................................................................................................................................... 3
Objective(s) ................................................................................................................................................... 4
Overview of Quarterly Progress (October – December 2022)...................................................................... 4
Anticipated Next Quarter Activities (January –March 2023) ........................................................................ 5
Risks and Risk Management ......................................................................................................................... 6
Change Management Considerations........................................................................................................... 6
Project Budget .............................................................................................................................................. 6
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
December 2022
Page 3 of 6


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
December 2022
Page 4 of 6


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, under the guidance of the VDH Office of Procurement General Services
(OPGS), VDH has made significant progress in developing the Request for Proposal (RFP) and has
submitted it to the Virginia Information Technology Agency (VITA) and the Office of Attorney General
(OAG) for their mandatory review. These steps have set VDH on the path to a successful implementation
of a state-of-the-art EHR system via competitive procurement.

Objective(s)
VDH aims to fully implement a state-of-the-art EHR system for use in Local Health Departments (LHDs)
across the Commonwealth:

●   Improve clinical efficiency and effectiveness of clinical services
●   Ensure delivery of high-quality care for patients by allowing rapid access to accurate, up-to-date
    information.
●   Reduce costs of care through decreasing duplication of testing, lab procedures, and medical visits
    especially for those that seek care in multiple locations often crossing health district.
●   Enhance transmission of EHR-related financial transactions including third party billing to maximize
    opportunities to earn revenue to help support essential public health services.
●   Improve the patient experience via reduced clinical cycle times, enhanced two-way communications,
    and a patient portal that holds the potential to promote greater ownership of their l health.
●    Fulfill programmatic reporting requirements for state and/or federally funded initiatives by more
    robust reporting capabilities.
●   Enhance employee morale, recruitment, and retention because an EHR is an expectation of
    healthcare staff in today’s clinical settings.
●   Align EHR to all of the Commonwealth’s rigorous Information Technology standards for a cloud based
    Commercial Off the Shelf (COTS) technology solution, and to ensure that it interfaces with all required
    internal and external data systems.

Overview of Quarterly Progress (October – December 2022)
VDH continued to build on the work conducted in SFY 2022 to refine the business and technical
requirements for the EHR solution. VDH also developed an EHR preparation and implementation timeline
that would enable the agency to meet ARPA deadlines for obligation and expenditure. Key activities
conducted over the past three months are outlined below in further detail:
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
December 2022
Page 5 of 6


Key Activities and Accomplishments
   o   RFP Development and Reviews by VITA/OAG
          ● On October 20, 2022, VDH submitted its Draft RFP to VITA/OAG for their review.
           ●   VDH received the feedback from both agencies in November 2022 and met with their
               representatives subsequently to clarify the feedback
           ●   VDH Executive Leadership approved the revised RFP and was resubmitted to VITA/OAG
               on December 22, 2022
           ●   VITA/OAG have another 30 business days to conduct this second RFP review VDH will be
               able to publicly issue the EHR RFP within 30 days after all the final reviews.

   o   Preparation Activities for the RFP Procurement
          • VDH will develop a detailed procurement schedule that will be updated as the EHR
              procurement progresses.
          • Other procurement activities include the process to identify the RFP Evaluation Team,
              develop vendor scoring sheets and plan the scripts for eventual vendor demonstrations.

   o   Pre-Implementation Plans
           ● Internal workgroups of VDH stakeholders have started to plan activities that VDH can
              undertake during the RFP to contract award time frame to prepare the Agency for
              implementation.

   o    VDH Participation in an interagency EHR workgroup

           ●   VDH has been an active participant in an interagency EHR workgroup that convened
               three times in the fall of 2022. Below is a link to the 2022 report: RD648 (Published
               2022) - Electronic Health Records Workgroup Report – 2022 (virginia.gov)

Anticipated Next Quarter Activities (January –March 2023)
The following outlines the activities and tasks planned from January through March 2023:

   o   Procurement and Pre-Implementation Activities
          ● Publicly post the RFP and conduct the required procurement steps.

           ●   Convene internal workgroups that enhance VDH’s EHR readiness for the EHR
               implementation phase.
Electronic Health Records (EHR)
ARPA SLFRF Quarterly Report
December 2022
Page 6 of 6


Risks and Risk Management
    o   Risk 1: If the EHR implementation is delayed by six months or more, then there is a risk of not
        completing the EHR solution implementation within the ARPA funding window

                Mitigation Strategy: VDH in partnership with VITA and the OAG has undertaken activities
                to expedite the RFP review and procurement process.

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 communications, engagement, and training
strategies to equip impacted stakeholders with the information and guidance that they need to support
and adopt the changes being implemented. In developing and executing a robust Organizational Change
Management (OCM) Strategy and Plan, VDH will identify targeted activities and interventions to enable
stakeholders to understand, prepare for, and adopt system and process changes associated with the
transition to an EHR system. This in turn will accelerate the impact of the EHR system, minimize
disruptions to daily operations, and reduce the risk of project delays. VDH will develop the plan and initiate
OCM activities once an EHR solution has been selected.

Project Budget
Budget, Obligations, and Actuals as of December 2022


Total                             Total                                Total
                   $   30,000,000 Obligations (To      $     2,400,000 Expenditures (To $        1,809,926
Appropriation
                                    Date)                                Date)


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