1. Mike Gifford, MBA President & CEO, ARCW Anna Wuerth, MSW, LISW-S Director of Healthcare Operations, ARC Ohio Richard Womack, MSW, LCSW Executive Director, GO CARE Mandy Kastner, MPH Director of Quality Assurance, ARCW

2. Mike Gifford, MBA President and Chief Executive Officer AIDS Resource Center of Wisconsin

3.  The ‘new’ leading care delivery system  HIV patients’ needs go well beyond HIV  Many sources of data (lab, pharmacy, specialty care)  Patient contact information can change frequently  All care needs to be documented in one system & available to all providing care

4.  Greater patient choice  Greater efficiency in registering and caring for patients  Automated communication with patients  Patient involvement in care greatly expanding

5.  Focus on quantity is diminishing  Focus on quality is expanding  Easy access to data for process improvement  Funding tied to quality outcomes  Accreditation and recognition may be tied to EHR  Quality applications for EHRs may be within the system or an overlay

6.  Federal appropriations level at best  Private funding challenged by new and different priorities  ACA drives changes in public funding  Reimbursement funding is the future  Payment tied to quality outcomes

7. Anna Wuerth, MSW, LISW- S Director of Healthcare Operations AIDS Resource Center Ohio

8.  FY16 Annual Budget: $44 million 6 times our post-merger budget 4 years ago  13 offices in 10 cities  220 staff 3 times as many staff as post-merger 4 years ago  Providing medical care to roughly 1,400 patients  Assisting more than 5,000 HIV-positive individuals with services such as case management, behavioral health therapy, housing assistance, medical care and pharmacy services  Reaching more than 25,000 with community education, evidenced based prevention interventions and free HIV testing

9. Identified Organization’s Top 3 Requirements of an EHR:  Implementation Speed ARC Ohio Board of Directors Vote to Open a Medical Center and Pharmacy: Winter 2012 Opening Day: October 2012 (Only 8 months of planning time for ALL clinic/pharmacy opening activities!)  Cost of Service Needed something affordable  Comprehensive Service Options Billing, scheduling and electronic health record

11. Strengths  Fulfilled our day-one opening needs for necessary billing and charting activities  Provider progress note templates easily adaptable  Basic data was retrievable in excel format reports  Simple to use and learn  Web-based, requiring very little IT support prior to implementation Weaknesses  Was essentially a “paper chart” in an electronic format  Costly to establish lab interface  No onsite go-live support  Limited clinical decision making support  Task routing very limited  Monthly cost increased significantly over 2 year period

12.  Carecloud viewed as short-term solution  Clinical workflows and decision making support inadequate  ARC Ohio clinic #2 planning discussions began after year 1 of operations—marked ideal transition timing  Partnership exploration identified beneficial options  Sought a more robust system

14.  Robust system  Extensive onsite go-live support  Clinical decision making support  Improved workflow  Part of larger provider network  Improved reporting capabilities  More advanced billing capabilities  Well organized chart

15.  Premier Health not as advanced as some other Epic Vendors  Requests for changes or fixes are fulfilled slowly  Lack of report related training available to staff  ARC Ohio one of first clinic settings to need such extensive reports  Premier Health had not fully implemented two-way reminder call/text features  Not willing to develop interfaces

16.  Multiple systems fed into one creates thorough patient profiles  Quality/data team use data imports  Used for Ryan White related reporting  Clunky system

17.  Interview a variety of vendors and explore demos in depth.  Involve ALL necessary staff in selection process (finance, data, IT, providers, etc.)  Contact references and visit clinic sites to see the EHR in action.  Must understand reporting capabilities of system, vendor’s report development process as well as the methods of data extraction.  Federally Qualified Health Centers (FQHC) have special reporting requirements and billing needs. Must explore these considerations prior to committing to a system and a vendor.  TRY NOT TO RUSH THE SELECTION PROCESS.

18. Anna Wuerth, MSW, LISW-S Director of Healthcare Operations 1033 N. High Street Columbus, OH 43201 office: (614) 340-6754 annawuerth@arcohio.org AIDS Resource Center Ohio

19. Richard Womack, MSW, LCSW Executive Director GO CARE

20.  Founded in 1987, GO CARE provides prevention education and direct services to stop the spread of HIV disease and to assist those infected and affected by HIV/AIDS

21.  Located in the Northeastern Part of Louisiana  Serves 12 parishes.  Largest geographic public health planning area of the state  Has some of the poorest areas in the country.

22.  HIV Testing and Counseling  Non-Medical Case Management  Transportation  Housing  Outpatient Medical Care  Mental Health/Substance Abuse  Nutritional Counseling

23.  Up until 1/1/15, GO CARE subcontracted outpatient medical care to a local state supported hospital.  With the termination of that contract, GO CARE made the decision to embark on establishing its own outpatient clinic.  Our first clinic was held 6/1/15.  Current caseload: 115 patients receiving medical care 225 clients receiving other services such as nonmedical case management.

25.  Are you looking for a EMR or a Patient Management System or both?  What platforms will you be using?  How many providers will have access?  What are your IT capabilities?  What is your budget? Because when you ask…you will be bombarded with calls and offers! And all will promise you that their system is the best!

26.  Talk with other providers, not with salesmen  Get a sense from your medical providers if they have used or seen other EMRs that they would recommend  Talk about operating systems with your IT staff and if you don’t have an IT staff, find one you trust.  Know what you need before…EHR/PM and reporting requirements including HRSA for Part C entities.

27. PROS  Fairly easy to use  Runs on multi platforms  Web based  PM optional  Allows for Electronic population of lab  E-prescribes CONS  Templates for office visits not necessarily applicable to HIV care  Training was web based and by phone  PM costs more  Does not generate HRSA reports, so duplicate entry into CAREWARE.

28. Mandy Kastner, MPH Director of Quality Assurance AIDS Resource Center of Wisconsin

29.  Statewide medical, dental, and mental health, pharmacy and social services  10 offices  Over 3,500 people with HIV served  Over 2000 health care patients  NCQA Level III Patient-Centered Medical Home

30. ServiceRecord MedicalEpic Behavioral Health & AODA Epic Dental Scheduling, billing and ePrescribing in Epic; Clinical documentation in Dentrix Clinical PharmacyEpic Retail PharmacyQS-1; Access to Epic Social Services Service plans and progress logs in Provide Enterprise; Care coordination activities and billing in Epic

31.  Largest market share in the country  ARCW uses Ambulatory Care record  Care Everywhere – Health Information Exchange Module  MyChart – Electronic patient portal  Practice Management – Resolute (Billing) and Cadence (Scheduling)  Meaningful Use Certified EHR

32.  ARCW uses EPIC as our EHR supported through the Oregon Community Health Information Network (OCHIN), rather than through another healthcare facility  About OCHIN: One of the nation’s largest and most successful health information networks Nationally recognized for its innovative use of Health IT to improve the integration and delivery of health care services Emphasis on safety net clinics (FQHCs) and small practices as well as critical access and rural hospitals.

33.  Collaborative membership model  Offers other professional services and knowledge Workflows Interfaces Reporting  18 States  Over 4500 physicians  3,000,000 patient visits annually

34.  Contract with OCHIN for Epic, housed on their servers in Oregon  Participation in multiple workgroups  Account Manager  Assigned Epic Analyst  Reporting Subscription Service

35.  Startup costs – build out/customize software to the workflows of the organization.  Startup costs – interfaces – build whichever is needed (examples: Dentrix, Lab)  Monthly licenses – EMR and PM (Practice Management/Billing) visit  Per visit charge – EMR and PM visit  Hardware/software fee – per EMR and PM visit  Reporting license – must have one scheduler and one designer per organization visit count – fee to purchase, then a monthly maintenance fee  Reporting Subscription Service

36.  Able to bill all service lines – whether or not the service was recorded in Epic’s EHR.  System flexibility in setting defaults  Payer set up is flexible enough to set up specific payers for a specialized function  Billing review and edit structure allows for proactive error correction  System is very controlled or closed  Electronic remittance posting  User-friendly layout and functionality  Only Downside: Write offs need to be done on an individual basis vs. a batch write off

37.  Hundreds of pre-written reports  ARCW employees hold licenses to run reports from EPIC through Crystal Reports  Reporting Subscription Service  Acuere QOL  Population Manager (not through OCHIN)  ARCW has full time data analyst  NOT RSR Ready Utilize Crystal Reports to write reports to extract data, manually import into RSR Ready software (Provide Enterprise)

38. Benefits  OCHIN Epic Collaborative geared toward safety net clinics  Shared record among Medical, Behavioral Health; Interface with Dental  Interfaces with nearly all major medical centers (in WI)  Billing is efficient – bill for all service lines through Epic Average 35 days in AR  Robust Reporting Capabilities  User-friendly workflows Disadvantages  Not an RSR-ready EHR  Collaborative decision making  Requires dedicated time for participation in collaborative  Cost  Clunky Population Management capabilities

39. PopulationManager® allows each medical care team to:  Track the populations and measures based on several common chronic conditions (HIV, hypertension, diabetes, depression, hyperlipidemia)  Identify gaps in care  View the team's progress by quality measure and compare to other care teams  Gives a snapshot of each individual provider’s performance on quality indicators

41.  Type your questions into the Q&A box on the right hand side of your screen.  Send the questions to the “Webinar Host” and don’t forget to click submit!

42.  You will find slides from today’s webinar on our website: www.nationalhivcenter.orgwww.nationalhivcenter.org  Webinars are available on our website for on-demand viewing.  Please complete the evaluation at the end of the webinar.  Join us for our next two webinars: The Affordable Care Act: Building Health Equity for LGBT People Monday, December 7, 2015 @ 2:00 PM ET National HIV/AIDS Strategy 2020 and Federal Action Plan: Implications for ASOs, CBOs, and Health Centers Monday, December 14, 2015 @ 1:00 PM ET