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How a Health System Selected a Population Health Platform for Medicaid Program

emids helped a large healthcare organization select a new vendor and plan the implementation to meet New York State Medicaid requirements.

Overview

United Health Services (UHS) is an upstate New York integrated health system comprised of four hospitals, a senior residence, physician practices and a home health organization.

In 2016, the organization was in a pressing position to comply with New York Medicaid Health Home (MHH) program changes for managing patients with chronic conditions. UHS needed to implement a care management system to automate the health home processes in a short period of time. The IT requirements included documentation, alerts, reporting, integration and data sharing between an interdisciplinary team of providers and family caregivers. New York’s health home program requirements also included system integration with a regional health information exchange organization, enabling facilities to deliver prompt notification of an individual’s admission and/or discharge from an emergency room, inpatient or rehabilitation setting.

After attempting to select a product and manage a complex implementation, UHS realized some outside guidance and support was needed to meet an aggressive state-mandated deadline.

Solution

UHS came to us for help to find a vendor so they could get the project back on track. The project involved conducting a thorough vendor evaluation and selection process along with the pre-implementation planning work, in a short time frame. UHS selected us for the engagement given our vast knowledge and experience in software selection, planning and implementation. We have developed a methodology to conduct unbiased vendor evaluations and selection, which takes the burden off of clients and saves time. This also helps reduce project risk, as our expertise and approach identifies the best match for an organization’s needs.

The engagement included the following steps and services:

Results

We helped UHS identify Netsmart as the vendor of choice to meet the New York MHH program requirements. Netsmart began work in mid-June 2017, and the joint team completed the implementation for the state Medicaid program ahead of the Oct. 1 deadline.

“When we had to cancel the original vendor agreement, we were worried about meeting New York’s Medicaid deadlines,” said Annie DePugh, director, population health at UHS. “emids took charge immediately and guided us through a sensible and thorough process for selecting the best possible vendor. The Decision Day framework is a unique and effective way to complete milestones under tight windows.”

Updating systems to meet new industry requirements is always challenging. Our proven methodology for vendor selection and robust project management, change management and training processes helped UHS ensure ongoing Medicaid reimbursement revenue streams.

Fresenius Medical Care

Fresenius Medical Care is the world’s leading provider of products and services for people with chronic kidney failure. The company wanted to gain a deeper understanding of a major client group—nephrologists—and to apply the insight in developing solutions to address their needs.

In partnership with the Centers for Medicare and Medicaid Services in the United States, Fresenius Medical Care has furthered its innovation goals through tight coordination between dialysis clinics, nephrology practices and care-coordination staff. This operating model has improved patient outcomes and clinical quality, while reducing total cost of care for patients.

Opportunity

Nephrologists work in many locations and on multiple technology platforms. Fresenius Medical Care needed to observe these professionals up close, and wanted to work with an external company to get an unbiased study from an independent perspective. Enter Emids. Collaborative, efficient and with a team of highly experienced observational researchers, Emids possessed an impressive portfolio of healthcare clients and industry knowledge.

Project Detail

On-site Workshops

We conducted workshops before and after conducting research to ensure both teams were aligned.

Ethnographic Research

Research was conducted in 6 US Cities to give Fresenius an unbiased independent perspective.

Journey Maps

2 journey maps created to highlight insights gained from observing the team of nephrologists.

Persona Creation

4 different personas which profile archetypes of various members of the nephrology care team.

Approach

Emids began by holding a workshop with Fresenius Medical Care to understand project goals. Deliverables included journey maps that would chart a nephrologist’s workday in detail. Emids and Fresenius Medical Care then designed the research plan and protocols. Fresenius Medical Care wanted to rotate different staff in and out of the research team, so Emids prepared field kits to help inexperienced researchers get up to speed quickly.

The research team sat down with nephrologists prior to each session to discuss the upcoming day. During the session, researchers quietly observed and took notes, asking questions when appropriate and non-intrusive.

Privacy was paramount. Only patients who gave explicit permission would be observed. The team also blurred out identifiable features and information in all imagery, even if the patient had agreed to have their image recorded.

Following each interview, the researchers summarized the day’s minute-by-minute observations into meaningful, usable data. After the research was completed, Emids and Fresenius Medical Care team members reunited for a two-day workshop to analyze the results.

Results

Emids completed the project on budget and within a tight timeframe. Although the actual content of the research and findings is confidential, Fresenius Medical Care considered it invaluable, with significant strategic implications. Fresenius Medical Care also found the work offered an important opportunity to engage its clients and give them an end-to-end view of product development.

Creating a Provider Portal with Longitudinal Patient Medical History Using Data from Multiple Sources

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Top Healthcare Software Developer Creates Interoperable Portal to Help Physicians Make Timely, Informed Decisions for Patient Care

Overview

The client is a provider of the healthcare industry’s most comprehensive suite of consumer experience platforms. Its integrated software is used by payers and providers to positively impact consumer decision-making and health behaviors beyond the care setting through personalized, interactive engagement across multiple channels. Its products include a healthcare customer relationship management system, an enterprise health content management system, an enterprise patient portal and comprehensive care management technology. The company has helped more than 1,100 provider organizations influence consumers in a way that transforms financial and quality of care outcomes.

Business Opportunity

One of the client’s signature products is a web-based clinical portal used by physicians to access vital patient information stored across disparate, federated health information systems. Timely access to this data provides physicians with the insight they need to make faster, more informed decisions about how to diagnose and treat individual patients.

One of the selling points of the platform is its single sign-in that allows physicians to log into the portal and obtain a secure, comprehensive and real-time view of a patient’s health records, including information on allergies, medications, past hospitalizations, blood banks and more.

To retrieve this data, which is geographically dispersed between multiple electronic health records (EHRs), laboratory systems and other backend systems, and provide physicians with a unified view of the disparate information, the client needed to integrate patient records in the portal with more than 30 HIS systems. The multiple integration points and EHRs vendors that existed across these systems complicated this process, hampering the free flow of information and resulting in inconsistencies in the data exchanged. This caused patient records to be marred by missing data, duplicate records, gaps in treatment plans and inaccuracies—all of which had the potential to put patients at even greater risk if not corrected.

Solution

In 2015, the client enlisted emids’ help to solve these integration-related challenges. We brought broad clinical and technical expertise to the engagement, including knowledge in:

We conducted an in-depth study of the databases, schemas and data semantics used by the two primary EHR systems used—to deepen our understanding how to extract data from these systems. Then we built customized connectivity adapters for each HIS system, which included lab, pharmacy, radiology, transcription, imaging and admissions systems, to aggregate, normalize and harmonize clinical and patient data flowing between each source system and the portal. Adapters were both batch and real-time as well as bi-directional, sending out data as JSON and XML.

Interface engines, built on a Java/Spring/Hibernate framework that could be quickly configured and extended, provided secure exchange points between adapters, routing data back and forth between each HIS system and the portal as indicated in Figure 1.

 

Technologies Used

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Results

While our work with both of these engagements are ongoing, we have helped the client meet their initial deadlines for bringing these projects to fruition and transforming them from concepts into viable technologies ready for the first phase of internal testing. Our team of healthcare experience technologists, which included 50 people at peak, jumped into both projects quickly and have added value uniformly and quickly.

We understood what needed to be built to execute the projects and assembled teams with deep healthcare knowledge to help drive their development. With the population health project, we worked closely with the client to flesh out the engineering for the product and set its direction. We helped anticipate and resolve issues before they became problems, even taking the initiative to collaborate with the third-party analytics provider that came on board to keep the engagement proceeding smoothly. The client still raves about how the initial prototype of the product matched their vision and met their needs right out of the gate.

We have continued to deliver new functionality for these projects, overseeing production releases every two weeks. The NLP tool we are developing for the client has enabled them to quickly explore the impact of different scenarios for coding by changing the rules for the automatic capture of clinical data. This process used to take days, but we have helped the client shorten the turnaround to few hours.[/vc_column_text][/vc_column][/vc_row]

Developing Award-Winning EHR Technology for Care Transitions

Leading Long-Term Care Provider Develops Award-Winning Software Applications to Advance Their Mission

Overview

The client is a leading long-term care provider operating more than than 200 skilled nursing homes, assisted living facilities, Alzheimer’s centers and retirement communities across the U.S. Their facilities offer multiple levels of patient care, from skilled nursing to independent living, and also provide Alzheimer’s and dementia care, post-acute care, inpatient and outpatient therapy and on-site physicians. Campuses are centered around residents and provide a homelike environment that differs from more traditional long-term care settings

Business Opportunity

The provider was using a software bundle from a third-party vendor to manage clinical processes and all other activities related to resident care. The software was not intuitive and did not fit well with their mission or the overall processes the provider used to care for residents. The technology was also not scalable enough to support the volume of patients at each facility and the number of activities that needed to be processed on their behalf. Dependency on the vendor hampered the provider’s ability to easily and quickly customize, scale and update the software, and gaps in compliance with mandates led to increased costs. The company did not want the software to dictate how they cared for residents and wanted more control over their technology infrastructure, so they decided to develop their own suite of software applications piece by piece.

The provider faced several challenges in this endeavor, including:

Solution

emids came on board to help the long-term care provider develop their first software application: an incident management system that provided staff with a consistent process for tracking and addressing incidents that arose among residents. We set up a product engineering team to help the company with end-to-end development, rollout, support and maintenance of the application. We also introduced efficiencies into the process by adopting Agile product development methodologies and assembling an enterprise production support team.

After the successful deployment of the first application, company leaders envisioned more modules they wanted to create—and the engagement grew to include the development of applications for clinical, therapy and rehab systems.

Restrictions on proprietary software from the previous vendor made it difficult to obtain documentation from existing applications and apply it to new modules under development. Therefore, the development process required constant communication and collaboration between emids and the provider to ensure newly designed applications would meet the needs and expectations of the business.

The company also turned to emids for help developing a resident information and tracking application, user and patient portals, and an electronic medical record (EMR) for its physician group that met Meaningful Use (MU) requirements. We analyzed and delivered requirements for the new EHR application within a month, giving the client more time to prepare the business case and helping board members make the most informed decision.

Technologies Used

Results

Not only has emids helped the provider successfully build their own suite of integrated software applications, but we have also continued to upgrade, enhance and maintain these technologies, while keeping them aligned to the evolving needs of the company and changing regulatory environment in healthcare. Our partnership has helped the client accomplish their core mission of providing resident-centered care and break down barriers to innovation.

emids’ technology work with the provider has even resulted in award-winning recognition for the company, including McKnight’s Excellence in Technology gold award for care transitions technology in 2015. The award praised interoperability features in the provider’s EMR system that import essential clinical and care information from disparate systems outside the network into patient health records to ensure no medication, diagnoses or other vital information is missed or misinterpreted.

Migrating to Cloud Platform for EHR Vendor

The Challenge

The client’s legacy EHR application, which was initially developed to enable physician productivity and provide superior clinical experiences, needed to be migrated to a cloud-based environment that would support the client’s key business objectives, including: scale for growth, ease of access and integrations aligned with the growing business needs of the end-consumer. Unfortunately, bandwidth constraints hindered the client’s initial migration initiative, leading to missed go-to-market commitments and non-compliance with MU mandates.

Our Approach

We developed an extremely aggressive migration schedule for the EHR application, with a staggered go-to-market strategy and multiple releases in one year. The emids Healthcare Practice team achieved this goal by acting as the interim product owner, defining modules and sequencing throughout the project. The team updated the legacy EHR and practice management system to the latest .NET stack, with a configurable message exchange platform, allowing for more flexibility in integrations.

In 18 months, the team delivered a fully cloud-based EHR and a new interface engine that connected the client’s EHR with external systems. The resulting project management plan was also fully aligned with the client’s businesses priorities, especially regarding faster go-to-market.

Value Addition for the Customer