A collection of detailed EMR implementation engagements

1. Ambulatory and
Acute Care
Implementation
Biographies
Steven L Fritz
November 2012

2. Acute Care Hospital Implementations
South Nassau Communities Hospital
Meaningful Use and enterprise data modeling. Allscripts was a green field (new)
implementation encompassing acute care, ambulatory EMR, and Emergency Department
solutions.
Responsible for the development of the tactical planning to install the full Allscripts application suite. The
engagement was accomplished in one phase.
The initiative targeted the primary hospital functions. Additionally the emergency department was included to
provide a seamless information patch into the hospital. The entire group of ambulatory clinics were deployed and
integrated into the enterprise solution. AllScripts EMR utilized at the MOB and Clinic level including independent
practices with admitting privileges – Allscripts MyWay (a.k.a. Aprima). Access to the data repository hosted by the
Long Island Patient Information Exchange (LIPIX) was made available to the provider community.
Significant workflow analysis was required to support the new applications and business objectives of the executive
management team.
Continuum Health Partners
Meaningful Use, Multiple version catch ups, Patient Safety Initiatives, and enterprise data
modeling all culminated in this full scale project.The largest GE Healthcare Centricity
Enterprise implantation in North America.
Responsible for the development of the strategic and tactical planning to upgrade the GE Centricity Enterprise
application from 4.x to 6.7. Four distinct phases guided the management of the initiative.
Phase ones target was to develop a technical environment that would endure jumping three version of the GE
application. Primarily to provide a platform where meaningful use features and functions of the application could be
launched. De-customize the current implementation into one where GE’s professional support team could take
ownership of the core. Seamlessly integrating AllScripts EHR utilized at the MOB and Clinic level, into the
Hospital solutions.
Phase two provided an enterprise view of the care and accounting transactions as the corporation managed its
portfolio of applications, and their individual twilight and transformation agendas and timelines. Fully engaging a
PMO approach towards the GE implementation.
Phase three implemented a disaster recovery, downtime, and business continuity environment. Utilizing real-time
transaction capture and cloning technology, co-location infrastructure, downtime procedures datasets and training,
and rigorous SLA, Performance monitoring, and predictive stress analysis.
Phase four provided a sound set of interface standards to enable device integration directly into the patient MPI.
Middleware remodeling, traffic management, time-of-day peak analysis, coupled with nightly process scheduling
provided a well communicated base of expectations.
1|Page Steven L Fritz

3. University Physician Associates
The Centricity Initiative was coordinated with the deployment of AllScripts Enterprise EHR
Using a pilot deployment model the endeavor accomplished three objectives. First was the re-deployment of the
core practice management function of the GE Centricity application. Customizations established an unstable
support environment. Executive management was realigned to support a closer adherence to an out-of-the-box
configuration.
Second was the implementation of additional modules to allow better account controls such as the Bad Debt
systems. Revenue Cycle management processes in concert with data mining and business intelligence dashboards
(via Cognos) provided Line of Business and executive tool sets.
Lastly was the development of a rollout / deployment framework to meet merger & acquisition and internal
expansion strategies. Long term technology growth forecasts became reliable, predictable, and achievable.
The 80 ambulatory clinics were re-deployed within the 12 month timeline
Working interactively and collaboratively with the AllScripts Enterprise HER team, the collective team worked
synergistically to achieve reduced implementation costs and resources, lower projected sustaining support
requirements and an enterprise view of records data as they meet meaningful use targets.
Dignity Healthcare (p.k.a Catholic Healthcare West)
The Centricity Initiative was managed in three phases.
Phase One:
Implement the EWS environment – 1.1. Transitioning to the Web involved extensive regression testing and a light
amount of process workflow remodeling. Most of this work centered on the development of an enterprise
workspace. I architected one workplace for each role to minimize the customizations needed in security plus.
Permissions to scripts, screens, HTBs, VTBs, and functions were encapsulated in one secure place. Exceptions were
held to a minimum and provided a cleaner support platform.
The rollout was divided into front office and back office. Prior to real-world performance metrics and to allow the
deferral of training, the back office staff remained on the character cell system until phase three.
Screen flow customizations were kept to a minimum to provide for a cleaner set of regression tests for phases two
and three.
Implement the PCM system 1.2. The Payer Contract Module focused on the six core payers representing 80% of the
revenue stream. The remaining twenty payers were added at a slower pace – three months. The fee schedule
updates were changed from manual entry to updates using GE’s semi-automatic service.
The catalyst for implementing PCM was the CFO’s desire to have more tools and controls on reimbursement rules
and timelines. We went from 85 days to the sub-50 range in three months.
Phase I time line – 4 months from launch through transition to production.
Phase Two:
Upgrade to version 4. This phase required an extensive study of the as-is configuration. A clean up and
simplification sub-project was initiated to lower the regression test failure rates.
Ninety percent of the testing issues were associated with the GE applications functionality between 3 and 4. We
found several compatibility problems which were resolved by GE.
The use of a third party forms printing company required the upgrade of oneancillary system – Global Works.
2|Page Steven L Fritz

4. Phase Three:
Implement ETM 3.1. The Task Management system was chosen to provide for a singular control prompter.
Extensive analysis of as-is workflow and manual task management provided the foundation to the dictionary and
configuration work of this module. The complexity of other enterprise applications in this clinical environment
made interfaces (20+) a key success factor. This project came on the heels of the implementation of the
AllScriptsTouchWorks EMR solution. Data flows between 8major applications, and the core MPI, Enterprise Index
(EI) provided measurable ROI from ETM. Well managed tasks provided very swift drops out of TES into BAR.
Organized rejection /denial workflows were controlled my ETM.
Implement AVM 3.2. The Visit Management system was integral to the changes in the company’s practice
management structure. With 22 clinics using the Centricity application, patient visits and scheduling became a
critical control point. To meet the objectives of acquisition and expansion plans without a parallel expansion of IT
infrastructure, AVM and ETMwerecrucial.
Module Inventory
AP BAR BAR-NPI BAR-PCM DBMS EDI
EDI-BAR EDI-MCA EDI-NPI EDI-270/271 ICWEB MCA
PCS Security+ TES EWS PCM ATM
ETM
Sub System Inventory for SH
Claims/Rcpt Open Referrals Statements Interfaces
Medtronic Corporation – MiniMed Division - Durable Medical Equipment
The Centricity Initiative was an application
replacement and operations remodel project
Design the DME module. The insulin pump division of
a DME company - embarked on an initiative creating a
new module for GE Centricity. The Durable Medical
Equipment (DME) module was surrounded by the full
suite of Centricity modules, including Informatics. At
the core of the system is the TES module controlled by
ETM. A complete interface-based coupling of
Centricity and SAP was design, build, and deployed.
My team of interface and applications experts completed
this endeavor.
The business objective was to provide a seamless, single
sourced, order-to-cash solution across the entire
organization.
In addition to complex design and configuration of the
Centricity system, sophisticated data transport systems
were required. This diagram illustrates the application
landscape upon which the DME module was rooted.
Module Inventory
AP BAR DBMS DME * ETM EWS MCA
PCS Security+ TES
Sub System Inventory
Claims/Rcpt Open Referrals Statements Informatics Interfaces
* Durable Medical Equipment (DME)
3|Page Steven L Fritz

5. Module details
DME
The Order-To-Cash initiative at Medtronic led to the creation of a new module for the Centricity
application suite. Durable Medical Equipment (DME). A deep understand of the functionality and architectural
core of Centricity (p.k.a. IDX,FlowCast) was required to engineer this system. The general description of this
module is that it provided for the sale of equipment to patients. Prospecting, sales, manufacturing, warranties,
returns, upgrades, continuation of therapy, and shipping logistics are all business functions of this module. One
extension to the DME module is the recurring pharmaceutical products module. The automated replenishment of
consumables to the end user. Ties to the SAP ERM system provides a closed-loop supply chain. One additional
extension provided a web portal for customer based order placement and management tools.
Informatics (BI, Data Warehouse)
A key component of the DME Centricity implementation was the ability to implement management tools
that measured against the business realization metrics.
Two extensions were implemented to broaden the use of Business Intelligence (BI) data. First was the
integration of Business Objects resident in the Data Warehouse. The cubes were remodeled to change from the data
mart in SAP, to the databases in Centricity. Second was the implementation of the full Cognos application. The
limited Cognos provided by GE too narrowly focused on GE data. With several other enterprise applications in use,
a broader data pool was required.
ETM
SH as well as DME focused on the functionality of task management. A great deal of configuration
through dictionaries was completed. In the revenue cycle arena; claims to contract to payment to reconciliation to
GL posting required sophisticated workflow analysis.
AVM
With a number of clinical locations in the greater Sacramento area, managing provider schedules, cross
facility appointments, and complex patient-payer-guarantor relationships, AVM play a key role in achieving a good
economy-of-scale with the scheduling and reception staffs.
EDI
The EDI module played a key role at SH in building interface data models. Eligibility and claims
management assisted in the revenue cycle.
DBMS
Many reports and data pulls were extracted using the DMBS module. The sustaining support team in
collaboration with the project teams cataloged and fine-tuned the report library.
MPI (EI)
I was on the MPI consul for SH. I have a deep knowledge of clean-up initiatives. I’ve implemented
sophisticated patient registration and check-in systems to reduce duplicates, errors, and John Doe’s.
4|Page Steven L Fritz

6. Ambulatory EMR/EHR Implementations
Client: Community Hospital (450 bed) and Ambulatory Practices – New
York
Sponsors: Ambulatory DO Chief
VP of HIM & EMR
Chief Information Officer
Vice President of Clinical Care
Physician Advisory Group
Project SubManagers: Hospital Practice Management EMR deployment manager
Behavioral Health Director
Physician Billing Director
Desktop deployment and management
Level 2/3 sustaining operations support manager
Primary Objective: Deployment for the Allscripts Enterprise EHR solution across the
enterprises ambulatory practices
Secondary Objectives: Develop a model implementation of EHR at three sites
 Collaborate with the inpatient deployment of Allscripts Eclipsys
 Create a deployment / rollout model for independent PC’s on Long
Island
 Develop forms management and workflow interaction department
 Document all charge and claim systems
Budget: $30M. Rollout modeling, Training curriculum development, Helpdesk
support planning, Infrastructure upgrade and deployment (Practice sites,
LAN, Desktop)
Timeline – 13 Months: Enterprise deployment planning, layered in two phases, Go-live
and 30 day fine-tuning, Transition to production, sustaining support.
5 |Page Steven L Fritz

7. Staff Levels: Strategic planning: 3
Tactical planning: 4
Deployment and training planning: 4
Deployment: 6
Transition to sustaining support: 6
FTE SME headcount – front-end and back-end: 14
The data interchange complex was redesigned from its prior state (shown below) to an enterprise
view (not shown). This allowed for lowered error log management requirements and corrective
activities.
The institution utilized a semi-centralized billing landscape. The prior state (shown below) was
re-engineered to a streamlined, scalable, resilient, and optimized CBO. The benefits realization
and return on investment was achieved by lowering the manual processing, adding fail-over to
electronic transfer engines, and enterprise standards for structure and timing. Built-in rejection
analytics provided self-learning re-submission process management
6 |Page Steven L Fritz

8. Client: Practice Healthcare Organization – Suburban Philadelphia Pennsylvania
Sponsors: Office of the CIO
Enterprise Applications Manager
Project SubManagers: Data Center Director
Practice Management
Practice Administration Director
Desktop deployment and management
Level 2/3 sustaining operations support manager
Primary Objective: Strategic and tactical planning for the enterprise rollout of the Siemens NextGen
EHR solution across the 120 ambulatory practices and clinics for Practice
Healthcare Organization
Secondary Objectives:  Study the pilot implementation of the NextGen EHR at three practices
 Research the enterprise deployment of the NextGen practice management
Create a deployment / rollout model for enterprise wide utilization
Budget: $10M. Rollout modeling, Training curriculum development, Helpdesk support
planning, Infrastructure upgrade and deployment (Practice sites, LAN, Desktop)
Timeline - 3Months: Enterprise deployment planning, layered in four groups, Go-live and 30 day fine-
tuning, Transition to production, sustaining support Service Level Agreement
management.
Staff Levels: Strategic planning: 2
Tactical planning: 6
Deployment and training planning: 4
Deployment: 25
Transition to sustaining support: 4
FTE SME headcount – front-end and back-end: 2
7 |Page Steven L Fritz

9. Client: Clinical Healthcare Organization – Sacramento California Region
Sponsors: Scott W. – OCIO
Sue H. – CFO
Dag J. – COO
Executive Team: Mark M. – Site Executive
Dr. L. S. – Hospital physician consultant
Dr. M. K. – Foundation physician consultant
Project Sub Managers: Loretta S. – Practice Management – Workflow reengineering
Jeff E. – Interface and integration management
Mike W. – Desktop deployment and management
Randy B. – Regional Server Farm management
Joe F. – Server Farm management
Ryan M. – Regional LAN / WAN management
Patricia A. – Level 2 sustaining operations support manager
Trisha R. – Level 2 sustaining support
Eduardo A. – Level 2 sustaining support
Primary Objective: Implement the AllScripts TouchWorks EMR solution across the 22 ambulatory
clinics for the Clinical Healthcare Organization in the Greater Sacramento region
Secondary Objectives: Link the clinical data to 5 hospitals via the regional MPI database
Develop a disaster recovery / fail over strategic plan
Create and deploy a user interface integrating all front end systems
Engineer an enterprise data model through the middleware ELT toolset
Create a deployment / rollout model for enterprise wide utilization
Budget: $4.3M. Application Deployment, Workflow development, Rollout modeling,
Infrastructure upgrade and deployment (WAN, Storage, Server, Desktop,
Scanner)
Timeline - 18Months: Needs analysis, vendor selection, pilot deployment, enterprise deployment
planning, layered deployment in 6 groups, Go live and 30 day fine-tuning,
Transition to production, operational performance deployment, sustaining
support SLA management: Jan 2006 through June 2007
Staff Levels: Needs analysis through vendor selection: 8
Deployment and training planning: 12
Application configuration and interface development (Core): 26
Deployment: 20
Transition to sustaining support: 10
FTE SME headcount – front-end and back-end: 6
Project milestones
8 |Page Steven L Fritz

10. The original needs analysis was performed by the Clinical Healthcare Organization Sacramento
management groups. A consul of people created the RFP materials along with the decision analytics for
the vendor selection. This process took approximately 6 months.
Following the selection of AllScripts as the vendor, the team transitioned into an application
configuration and deployment strategy group. They created a project success matrix to grade the
effectiveness of the applications
deployment. It was used as the root of
the scope management documentation
set.
A key success factor of deploying the
EMR application across 22 clinics and
integrating with 5 hospitals was the
technology infrastructure. WAN
bandwidth, desktop performance,
application monitoring, and storage
planning were the basis of the
technology infrastructure initiative.
This resulted in the deployment of
1500 high performance desktops and
400 document scanners. The LAN
was upgraded to a gigabit network.
The WAN was upgraded to a 45 mb
pipe. Additionally, the server farm processor set was expanded by 11 servers, each averaging 8 processors
with 32 gb of memory. Redundancy was provided by wireless and split sub-net management, servicing
critical work centers. Two independent WAN providers were acquired for each major hub, one in a
dormant state awaiting failure. The primary application servers were set up in a clustered configuration.
The Network Attached Storage (NAS) was configured to stay pace with the disk consumption projections
– 35gb a week. Monitoring tools to track application, WAN, and server utilization were implemented as
part of the original tactical plan.
A model office was established to draw on the subject matter experts within the many diverse operating
areas. They made up the core development consultants interfacing with the vendor’s technical team. As a
collective, they ensured that the application met the scope criteria. Additionally, they were responsible for
the UAT activities and the go-live support group.
Scope management proved to be critical to keep rework to a minimum, timelines manageable, and cost
containment possible. There was approximately 15% overruns due to initial requirements oversights.
Strong management of vendor performance and sub-contractor utilization allowed the overall budget to
stay below the $4.3 cap.
The total inventory of interfaces numbered 22. Merger and acquisition activities while the project was in-
flight posed significant challenges, but were met within budget guidelines and delivered on time. Most
notably was the purchase of an imaging center which needed to be integrated into the workflows and data
movements. This one collection point replaced 5 smaller dissimilar systems. The net impact to the
timeline was negligible.
Weaknesses surfaces with the selection of the document scanning equipment. Additional homework could
have been performed with regard to the scanning strategy. Initial go-live scanning requirements exceeded
equipment failure (Mean Time Between Failure) thresholds. The remedy was to purchase higher capacity,
9 |Page Steven L Fritz

11. better duty-cycle equipment. Long term planning recommended the establishment of scanning centers
specifically suited to one-time bulk document management.
Vendor management was important in controlling deliverables and deadlines. With 22 interfaces to be
written, HL7 specifications along with custom extensions provided an enterprise view of the data. Extra
time was invested to allow simpler future modifications possible. Approximately 30% data growth
impacted development. This planed-to-actual was expected, and was represented in the project plan. An
enterprise middleware redesign initiative was spawned from this project.
The main lesson learned was the amount of time required for the laboratory integration points. It should
have been 300% of the original estimate. Additionally, coordination with a separate server/application
upgrade team could have been more transparent. They added 2 man-months of effort but did not affect the
AllScripts go-lives.
The total population of providers (concurrent seats) was set at 700. The supporting staff accounted for an
additional 1800 people. The benefits realization metrics was to quantify a 30% increase in patient visit
counts with no appreciable increase in patient-facing headcount. That was achieved. Additionally,
significant intra-clinic data shareability, reduced duplicate MRN creation, and single application
integrated records access was accomplished.
A rollout model was authored to act as a new-site deployment kit. The technology and application costs
were optimized to approximately 75% of expected. Standards for users, desktops, workflows, and
backend turnover allow exceptional return on investment for new clinics, new builds or acquisition.
Enterprise data models provided smother data migration plans.
The project plan used to tract the tasks contained 1577 WBS items.
10 |Page Steven L Fritz