1. Clinical Decision Support Implementation Victoria Ferguson, COO - Program Manager Christopher Taylor, CIO – Business Owner Monica Kaileh, CMIO – Steering Committee Karen Carter, CMO/Director Clinical Services

2. Project Charter  Background  CDS Definition  Project Overview/Scope  Key Objectives  Benefits  Risks  Timeline  Training  Budget  Questions?

3. Background  Our organization has already successfully implemented EMR and CPOE.  The next phase of meeting EMR Meaningful Use standards set by the Office of the National Coordinator is to implement a Clinical Decision Support system to improve health outcomes of the patients within our hospital system.

4. What is Clinical Decision Support?  CDS is a clinical system, application or process that helps health professionals make clinical decisions to enhance patient care. It links health observations with health knowledge to influence choices made by clinicians for improved health care.  Determine diagnosis of patient  Alert Drug-drug interactions

5. Clinical Decision Support  Data mining may be conducted to examine the patient’s medical history in conjunction with relevant clinical research. Such analysis can help predict potential events, which can range from drug interactions to disease symptoms.

6. Project Overview/Scope  This project is expected to help our organization meet Meaningful Use standards upon full deployment of CDS.  The scope of the initial release of the CDS system will occur in the Family Practice clinic as a pilot project. The pilot project will involve front desk staff, medical assistants, nurses, providers, and ancillary services as needed.

7. KEY OBJECTIVES (4)  Decision support: Aid Physicians in the Support of clinical diagnosis and treatment plan processes and promote use of best practices, condition-specific guidelines, and population-based management.  Cost control: Monitor medication orders; avoid duplicate or unnecessary tests or radiographs.  Administrative: Support clinical coding and documentation, authorization of procedures, and referrals.  Manage clinical complexity and details: Manage/track patients on research or treatment protocols; track orders, referrals follow-up, and preventive care.

8. Benefits of CDS  Reduce The risk of medication errors.  Reduce misdiagnoses.  Provide care team with consistent information.  Improve efficiency and patient flow.  Access all information in one place.

9. Benefit (CMS Reimbursements)  HITECH Act, which stipulates that health care providers must demonstrate the meaningful use of health IT by 2015 or face reduced Medicare reimbursements beginning in 2016.  Under meaningful use, providers must implement one clinical decision support rule, including diagnostic test ordering, as well as the ability to track compliance with that rule. That rule, furthermore, should apply to a specialty or high-priority condition

10. Risks #Risk Area LikelihoodProject Impact-Mitigation Plan 1 Insufficient “end-user” input (e.g. physicians, clinicians, technology vendors). HIGH MEDIUM LOW Evaluate role and type of initiative participants; invite additional participants early in the initiative process to balance representation. 2 EHR vendors may resist opening their architectures to services integration. HIGH MEDIUM LOW Identify and communicate the benefits early in the process; ensure EHR vendors are represented in the initiative participants. As this initiative matures with deliverables, incorporation into MU2 and MU3 would likely be an incentive for vendors to come aboard. 3 Standards and solutions may not scale to small or specialty clinics. HIGH MEDIUM LOW Ensure that proposed standards and solutions are modular/scalable. 4 Proposed project timeline is significantly faster than what has traditionally been possible through participant effort alone. HIGH MEDIUM LOW Monitor and communicate timeline, deliverables and progress frequently to all stakeholders; identify and request increased or reallocated resources (as needed). 5 Clinical workflow may be negatively affected due to change in routine processing of patients. HIGH MEDIUM LOW Provide training for staff members on changes occurring from implementation. Develop workflow charts to ease patient processing. 6End-user resistance HIGH MEDIUM LOW Provide initial, follow-up, and ongoing training, as necessary, for clinical staff to ease the adoption and use. 7Data privacy and security concerns HIGH MEDIUM LOW Current EHR system meets all privacy and security standards set forth by HIPAA. Review privacy and security requirements for chosen CDS system to determine if additional standards must be met.

11. Timeline - 9 months Approval for CDS Implementation Vendor delivers CDS Software Initial roll-out begins in the Family Practice Clinic Initial roll-out complete – Monitor and evaluate CDS Lessons Learned from initial roll-out presented to Steering Committee July 24, 2013 Approval for CDS Implementation * April 15, 2013 Selection of CDS Vendor May 1, 2013 Software Purchased May 15, 2013 Vendor delivers CDS Software June 1, 2013 Initial roll-out in the Family Practice Clinic * June 15, 2013 Monitor and evaluate CDS July 15, 2013 First roll-out presented to Committee July 24, 2013 Full deployment begins * August 1, 2013 Roll-out done Monitor and evaluate CDS October 15, 2013 Training – Ongoing until contract ends * November 30, 2013 Final Report due to Steering Committee December 31, 2013

12. Training  The vendor will provide the training during the initial implementation and provide training materials for the organization to maintain.  All employees in the organization will receive training for their specific role related to the process. The program administrator will learn all roles in order to fill in when needed.  Additional training will be given to the other employees as a contingency plan. These employees will then be responsible for training new employees.

13. BUDGET  Capital Budget- -----------------------------------------------------$100,000  Hardware- ---------------------------------------------------------------$5,000  Software -----------------------------------------------------------------$25,000  Provider compensation and Temporary Staff- -------------$60,000  Incidentals- -------------------------------------------------------------$10,000

14. Questions?