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The W.Va. Experience with RPMS
Jack L. Shaffer, Jr.
CIO Community Health Network ofWest Virginia
The trials and tribulations of the 1storganization outside of IHS and theTribal Sites to use the RPMS-EHR
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A word about The Community HealthNetwork of West Virginia
The Network is a tax-exempt, non-profit health center-controlledWest Virginia corporation formed in 2000.
The Network is primarily an application service provider (ASP)delivering centralized practice management, electronic medicalrecords (EMR), and technology services for its members.
The nineteen Network member health center organizationscollectively provide services to over 120,000 patients in 32 ofWest Virginias 55 counties each year, with 78 delivery sitesand nearly 400,000 patient encounters annually.
Our member health centers provided over $40 million in healthcare services last year, with 70% of this care to Medicare,Medicaid and uninsured patients.
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Topics to Cover Today -
Decision to pick RPMS Our Experiences Implementation
Challenges User Acceptance Return on Investment
Future Plans
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CHNWVs Open Source Odyssey
2002-Former Secretary of the Department Health and HumanServices Tommy Thompson began touting the transformativepower of electronic health information systems, along with thenNational Technology Coordinator David Brailer, a West Virginia
native. Much of the literature about electronic health informationsystems highlighted the accomplishments of the Department ofVeterans Affairs (VA) through use of its Veterans HealthInformation Systems and Technology Architecture (VistA)software system as a health improvement tool.
2003, the Bureau of Primary Health Care made grant fundingavailable for electronic health information systems under itsIntegrated Communications and Technology (ICT) grantprogram.
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CHNWVs Open Source Odyssey
The Network submitted an application and was awarded anICT grant, one of six nationally for this program by BPHC.
The Network application was unique, in that it was the first topropose an open-source or public domain solution based
upon a VistA-supported platform. 2004 2005 the Network collaborated with the BPHC in a
number of meetings with representatives of the Centers forMedicare & Medicaid (CMS) concerning the potentialadaptation of Vista for use in ambulatory care settings. As a
result of these meetings, the Network joined with BPHC andCMS in becoming members of the collaborative team fortesting and development ofCMS VistA-Office EHR (VOE). (Later to become WorldVistA-VOE)
VOE was not ready at that time based upon our review and
our specified timetable.
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CHNWVs Open Source Odyssey
In the evaluation of VistA and the work on the VOE project, theNetwork staff and members of the Clinical Committee becamefamiliar with the Resource and Patient Management System(RPMS) which is a VistA-based system utilized within Indian
Health Services. 2005, the Network entered into an informal agreement with IHSto use the FOIA version of RPMS and to become the firstorganization in the country to use RPMS outside of the IHSsystem.
This informal agreement was memorialized in a formalcollaborative agreement between IHS and the Network that wasexecuted in the spring of 2006.
Currently with 45+ clinical locations in production using thesystem 80 FTE providers 250 concurrent users.
6 More clinics to implement this year.
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Unfortunately, humans are visual creatures.
Our Experiences / UserAcceptance
RPMS has a great personality,but.
We had a lot of problems with user acceptance
of the RPMS-EHR mainly because it looks oldand clunky.
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Well, whats ugly about the RPMS-EHR?
General look and feel is way90s. Heavyclient install
Had to use Citrix to deploy
Too many hiddenfeatures Right click here, left click there Clicking on labels and headers Just not intuitive
Templates and Provider Notes fixed fonts Big impediment for providers RPMS-EHR Needs HTML font on notes!
Printed prescriptions Way too much roll and scroll
Context sensitive help is not helpful
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RMPS-EHR Clinical Notes
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Compared to eClinicalWorks.
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Even VistA can now do HTML chart notes..
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When you adopt someone elses system you also adopt their
business logic good or bad.
RPMS was designedfor.well, IHS! (not us!)
There were many features andfunctions of the RPMS-EHR whichwork fine in the IHS world;however, they cause majorproblems outside of the IHSenvironment.
Our Experiences / User
Acceptance
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Business logic differences? Why is that bad?
Medication management - #1 problem No Auto-finish!
RPMS-EHR designed where a pharmacist
finishes the medication order. Doesnt work in our world. Period. Custom code or we would have sunk
Lack of trade names
Pharmacies rejected printed prescriptions Had to completely redesign this Nurse practitioner and physician assistants had
different requirements No faxing capability
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Medication Management Problems
These caused serious patient safety issues andprovider backlash: Medication errors associated with unfamiliarity with
generic names so we added trade name todisplay
Renewed prescriptions were not beingdiscontinued
Prescriptions were finished without a drug nameto display when in the Medication tab Users had problems and wanted only active
prescriptions to display when a patient is firstaccessed
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No drug name displaysbecause no dispense
drug has been selected
Medication Management Problems
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We were also somewhat alonethats bad
We really cant get direct help from IHS Hard to get into IHS CAC training even with
special MOU
Had to compete for scarce resources with very limitedbudgets Competition forCACs heating up
Patch management is tough
Had to develop our own implementation and trainingmanuals along with procedures around the RPMS-EHR
Labcorp interface continues to be a chronic issue
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Open Source allows for the tool to evolve faster in arapidly changing environment than top down
development because of the diverse community of
developers.
The fact that we could crackopen the hood and work on
the engine was invaluable.
RPMS being a mostly open
source application makes it a veryaffordable solution fororganizations with limited budgets
Our Experiences / User
Acceptance
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You mean theres good things about RPMS??
(you beat it up pretty bad)
Very stable system from an IT perspective Highly configurable
Very little we cannot do with the system
Reminders/health factors, etc Focused on clinical outcomes Focused on chronic disease management Open source (for the most part)
Allows for rapid customizations Great for an industry in a disruption
CHNWV has proven that it WILL work, and work very welloutside ofIndianCountry
Great Value from a cost perspective
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Open Source enhancements
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Open Source enhancements
This option has aPharmacy Dispense
Drug automatically
selected. This selectionmay not always be themost appropriate.Therefore the disclaimer isnecessary.
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Open Source enhancements
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EHR Implementation Cost Comparison
Implementation CHNWV Health Affairs Commercial CHC installation in WV
Costs RPMS EHR Total Avg Cost Commercial EHR Total Cost for EHR
Hardware Estimated $49,700.00 $136,176.00 $155,554.67
Total Software $10,005.00 $125,576.00 $208,888.00
Installation, Training $80,570.67 $95,992.00 $100,000.00
Productivity Loss $36,000.00 $54,104.00 $111,110.67Internal Staff Time $60,680.00 $37,945.00
Other $0.00 $33,312.00
Total EHR Cost* $236,955.67 $483,105.00 $575,553.33
Total RPMS Savings vs. CommercialEHR - $246,149.33 51%
*Calculations based on 8 FTE Providers
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EHR Implementation Cost Comparison
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EHR Operations Cost Comparison
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EHR Cost Comparison ARRA funds
CHNWV RPMS Health Affairs
Costs EHR Total Avg Cost Commercial EHR
RPMS Avg Health Affairs
ARRA Funds (Medicare) $352,000 $352,000Implementation Cost $236,955 $483,105
Money in (or OUT) of your pocket $115,045 -$131,105
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Future Plans-
Roll out RPMS to 6more clinics iCare 2.0 Offer RPMS-EHR as
part of WVRHITEC Certification and
Meaningful use!
Enhance theapplication further New apps
New controls
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Introducing the
iRPMS beta
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iRPMS-EHR
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Thank you!!
(Questions)
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