Transylvania Community Hospital Project Evaluation Plan

For the Federal Health Resources & Services Administration HRSA-08-004 Rural Health Network Development Implementation Grant (RHND) (Using HRSA and other materials)

Prepared by Rural Health IT Corporation

Transylvania Community Hospital Project Project Evaluation Plan

INTRODUCTION:

Rural Health IT Corporation (RHITC) has prepared this summary, dealing with the HRSA-08-004 Rural Health Network Development Grant (RHND) Program.

Note also that this summary is based upon Rural Health IT Corporation’s experience with its clients, extensive discussions with federal Health Resources & Services Administration (HRSA) and Agency for Health Research & Quality (AHRQ) officials, as well as a thorough review of HRSA and AHRQ’s official, written program guidance and its application forms packages.

The Transylvania Community Hospital Project includes:

1. Transylvania Community Hospital, a not for profit Critical Access Hospital (CAH) in Brevard, NC

2. Brevard Family Practice 187 Medical Park Drive Brevard, NC 28712 Timothy J. Shea, MD Caren Schau, Practice Manage (828) 884-9362, Ext 228 cschau@citcom.net Family Medicine

3.    Sylvan Valley OB/GYN 87 Medical Park Drive Brevard, NC 28712 Camelo A. Hernandez, MD Alise Corn, Office Manager (828) 884-8860, ext 108 OB/GYN

4.    Medical Associates of Transylvania 377 Gallimore Road Brevard, NC 28712 James Shaw, MD Katie Curtis, Administrator (828) 862-6218 matpakatie@citcom.net Family Medicine

I. SHORT DESCRIPTION OF THE PROJECT:

Rural Health IT Corp. can create for the Transylvania Community Hospital Project a workable model to integrate, or impose interoperability on, legacy Information Technology (IT) systems. These IT systems are typical of rural, as well as of other, healthcare organizations.

Under its current AHRQ Regional Health Information (RHIE) grant program operating at hospitals in Vermont and New Hampshire, Rural Health IT Corp. has identified a proven, mature IT solution that has a substantial track record in the real healthcare world. The solution, an Integration Engine and Clinical Portal, has the following advantages:

 It is essentially an “off the shelf” or “plug-and play” solution, which will overlay incumbent, legacy information systems, incorporating them into a framework that will be the basis for an Electronic Medical Record (EMR) system.

As a “plug-and-play” solution, there is no software development involved. No new software code needs to be written. All that is required is the ability to utilize existing messaging standards, primarily HL–7.

This Clinical Portal and Integration Engine system is appropriate for use in rural and other healthcare settings, to overlay what the Transylvania Community Hospital already has, to allow each of its current IT applications to communicate seamlessly, on the basis of existing information standards, particularly an HL–7 stream.

On the basis of the research and implementation efforts we have done thus far for our other clients, our company’s team is confident this Portal and Engine solution can be applied to Transylvania Community Hospital and then expanded to the project’s three (3) other primary care partners, Brevard Family Practice, Sylvan Valley OB/GYN and Medical Associates of Transylvania. Finally, this solution can be duplicated successfully throughout North Carolina and elsewhere, as the system is expanded in the future.

II. GOALS OF THE PROJECT:

• Anywhere, anytime provider access to medical records and information
• Portability to numerous common devices and interfaces
• Ultimate reduction in overall costs, by obviating the need for couriers, faxes, and other methods of transfer of paper records ␣
• Enhanced collaboration with healthcare organizations, government agencies, payers and other third parties
• Medication tracking and electronic ordering, to address medication errors and attendant adverse drug reactions and errors (ADE)
• Reduction of information-related errors in treatment and overall care
• Creation of a framework to allow for the installation of future technologies and addendums to the Electronic Medical Record (EMR) system
• Creation of a system which can be scaled up and duplicated repeatedly in other places, so that other partners may be added
• HIPAA compliance and dependable security of patient records
• Creation of a stringent, dependable back-up and disaster-recovery system
• Improved rates of clinician and other healthcare provider adoption, because they will be able to go to a single place to get all relevant information on a patient, rather than today’s system of having to open multiple applications. 
• Time savings to clinicians and other providers, because the portal's unified, "single-view" environment integrates and displays clinical data derived from multiple IT systems around the project.
• Clinicians and other providers will be able to view, update and add new data to multiple systems and applications from within a single user interface.
• A comprehensive view of each patient’s status and medical history will be gained from within one window, allowing for improved and timely clinical decisions.

III. GOALS OF THE EVALUATION:

The goals of the evaluation are to measure the technological and human impacts and the business case of the systems integration and Clinical Portal solution. Key stakeholders for the purposes of this evaluation are identified as the North Carolina Department of Health, the North Carolina State Office of Rural Health, Transylvania County Public Health, HRSA, the four (4) Consortium partners’ respective Boards of Directors and their Institutional Review Boards, other healthcare providers, and patients.

Technological Impacts:

1. Data will be available from both the current and potential IT systems to be accessed.

2. Data from all systems will be accurately displayed.

3. Data in all systems will be accurately synchronized.

4. Data in all systems will be synchronized and displayed in a timely manner.

5. Data synchronized and displayed in the Clinical Portal will be the correct data for the needs of authorized providers and patients in the formation of an Electronic Medical Record (EMR).

6. Data will remain secure in legacy systems and will also be secure in the Clinical Portal solution. The single sign-on feature will translate to all legacy systems, to reduce the number of passwords to be managed by providers. Data will be easily available from remote locations and will remain secure in those locations and everywhere else it will be accessed and displayed.

Human Impacts:

1. Provider adoption

2. Provider usability

3. Quality of images (such as in radiology, for example)

4. Provider satisfaction

5. Patient satisfaction

6. Reduced patient time in waiting rooms

7. More provider/patient interaction 

8. Reductions of the number of adverse drug events, by having accurate medication and allergy information available at the point of care

9. Decreased visit-cycle time

Business Case:

1. Reduction of duplications of patient registration in multiple systems during each visit

2. Reduced provider time-on-task

3. Elimination of duplicate costs for multiple interfaces, including elimination of reliance on vendors to program and maintain interfaces

4. Reduction in travel by Consortium partners

5. Reduction in time-on-task to manually scan records from one system to another

6. Reduced delays in billing because of notes remaining uncompleted while awaiting additional documentation, such as scanned documents, radiology reports, laboratory and test results, advanced directives, etc.

7. IncorporateHRSADiseaseManagementGoals:

IV. MAJOR EVALUATION GOALS and METRICS:

      Third HRSA-Required Evaluation Measurements (with baselines):

a) “Disease Management for Diabetes (DM):

 1. Average HbA1c for diabetic patients in the electronic patient registry system

2. Patients with blood pressure<130/80mm/Hg

3. Patients with LDL<100mg/dL

b) “Disease Management for Cardiovascular Disease (CVD):

1. Patients with blood pressure<140/90mm/Hg

2. Patients with LDL<130mg/dL

3. Patients who are current smokers