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Assessing Readiness Pre-EHR Implementation

October 28, 2010
by Jennifer Prestigiacomo
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Interview: Amy Andres, Board Chairman of OHIP and Chief of Staff at the Ohio Department of Insurance

The Ohio Health Information Partnership (OHIP) is the regional extension center (REC) for 77 of Ohio’s 88 counties and also the statewide health information exchange (HIE). To help its target of 6,000 primary care providers adopting electronic health records (EHRs), OHIP contracted the EHR Prep-Select tool from medical diagnostic equipment maker Welch Allyn (Skaneateles Falls, N.Y.). The tool allows OHIP’s regional partners to assess the readiness of the practice, identify practice needs, create a plan, and guide them through the request for proposal (RFP) process. Amy Andres, chairman of the OHIP board and chief of staff at the Ohio Department of Insurance, spoke to HCI Associate Editor Jennifer Prestigiacomo about why they chose such a tool instead of building one in-house and how they plan on achieving sustainability.

HCI: Can you tell me a little about the background of the OHIP?

Amy Andres: OHIP is actually both the statewide HIE and the REC for 77 of Ohio’s 88 counties. Essentially, in Ohio, we made a strategic decision to put both programs together; we thought it made a lot more sense. Our state’s governor designated OHIP to be the entity to handle health information exchange. Also, we applied for the REC for the entire state, but the [Cincinnati-based] nonprofit HealthBridge had part of our state, and part of two other states[the REC covers southwestern Ohio, northern and northeastern Kentucky, and southeastern Indiana], so the feds split things up a bit and gave them their market, and gave us the balance of the state.

HCI: Why did you decide to add this assessment tool to your EHR adoption approach?

Andres: First, we went the route of having preferred vendors with a list of five different vendors [Allscripts (Chicago), eClinicalWorks (Westborough, Mass.), e-MDs (Austin, Texas), NextGen (Horsham, Pa.), and Sage (Tampa, Fla.)]. What we saw with the Welch Allyn tool was so unique. When you think about the task at hand, our target for our 77 counties is to bring 6,000 PCPs [primary care physicians] to meaningful use. It’s really important to assess if those physicians and practices are prepared to implement before they even select a particular software. Having them go through a really structured, formal process readies them for the significant task of adopting an EHR. We started off with the notion of trying to create something, but one expert on one of our committees suggested we look at this Welch Allyn tool. They had used it in a previous life and gotten a lot out of it. When we evaluated the tool it was very clear that it was better than anything we could have built on our own. It was pretty much a no-brainer to go this route and select a tool.

HCI: How is OHIP structured, and how did your staff adopt this tool?

Andres: Our thinking was not that OHIP as a body would be hiring a bunch of people and running around the state doing these EHR activities. When we applied for the grant, we had a regional structure with already existing players and infrastructure. So we have seven regional partners; they’re sort of like mini-RECs. They’re doing the actual milestone activity, whereas OHIP is more of an organizing, coordinating body.

So those folks have their own staffs or have hired consultants who will be using the tool and will be out with the physicians doing the assessments and talking through the results. Welch Allyn has provided training for several members in each of those regional partner organizations and then they train their consultants out there. It’s a high-quality hand-off. After the training, our staff actually shadows the Welch Allyn staff while they do one. Then they switch roles and Welch Allyn actually shadows and coaches our staff. We’ll be able to tell you in the next month how that works out.

HCI: How did you end up paying for this assessment tool?

Andres: Part of the money OHIP is subsidizing and we had some state funding that we put up as a match as a part of this grant. I know some RECs don’t have that luxury, but luckily we did. So we put up some of the money to pay for some of the maintenance costs and the training for all the regional folks who will be actually using the tool and providing the consulting services. So Welch Allyn provided all the training and we covered those costs. And the license costs come from the actual milestone payment. We’re not passing any of those costs on the physicians that would like to participate in the program. Now, for non PCPs there will be a cost. We’re actually one of the few RECs in the country who are not charging PCPs for any of the basic standard services. We’re completely subsidizing those with state and federal funds.

HCI: What are you goals besides connecting 6,000 providers?

Andres: Obviously, since we’re the HIE, another large goal for us is to bring the HIE onboard. We’re really looking to a different model for the HIE as well. We think that really getting to the widespread adoption of EHR and exchange of data that ultimately it will become a commodity. We’re in a space right now where we need to enable that to happen. Our long-term sustainability is very different from that of most of the models that have existed ‘til now. The thing we’re really doing for sustainability is to make our costs based on administrative data, mainly eligibility verification and coordination of benefits in earlier phases. Our thinking is that for folks using the other services or participating with the administrative data exchange, we’re going to make the exchange of health records free for everyone to use our system in Ohio. The goal has always been to create a model that allows for the exchange of health records to be free of charge. So we’re really looking for the sustainability model to be funded by the value-added services [which would include a master person index, record locator, and a master entity index] and that would reduce costs in the healthcare system. From day one we thought about this as a not so much a government program, but how is it going to sustain for the long haul. That’s also why it’s set up as a private/public partnership instead of a state agency.

HCI: Will the administrative data exchange be something similar to what the Utah Health Information Network (UHIN) has been doing?

Andres: Some of it will be similar. It was pure coincidence, but the gentleman that we happened to hire recently, his name is Fred Richards, our chief information officer and our chief operating officer. He comes to us from HTP, which was acquired by [the San Francisco-based] McKesson, and he was very involved with Utah projects, especially on the administrative data side. When we decided to go that route we really looked for someone with experience in that space. In Ohio, we have a very competitive insurance market , and a lot of the entities out there today that are providing those services are owned by insurance companies. So you can imagine competitors don’t want to give their data over to other competitors to manage the process. So they really look to us to provide Switzerland-type services to support that.

HCI: What have been the challenges so far?

Andes: The only caveat I give you is that the challenges are probably not the typical challenges you hear from other RECs, because we are an organizing body. There’s a reason why Ohio is a test market, a microcosm of the country. We’ve got rural areas, we have three large cities—Columbus, Cincinnati, Cleveland—and we also have five other cities that are fairly good sized, including Dayton, Toledo, and Youngstown, so we have that to deal with. Economically, we’ve been hit like the rest of the Midwest has, but we also have heavy rural make-up. The southeast part of the state is all Appalachia, and our northwest is very rural ‘corn country,’ so to speak, so we’re dealing with a lot of different environments here. So that challenge is the reason for using a regional structure, where the folks who are already working in those environments, and already understand those markets and needs of those populations, are better equipped to deal with it than we are. One challenge we have as do other RECs is that most of our practices are two to three doc practices, so it’s just a lot of touches [implementations].

We are like a lot of the country, in that there’s a lot of consolidation going on, and physicians are becoming part of larger organizations, whether it’s joining a hospital or large practice. We’re right in the middle of that transition, so we are also dealing with the implementation challenge. I’m not going to pretend that getting 6,000 PCPs to meaningful use by Feb. 8, 2012 is not going to be a challenge. It’s absolutely a tall order. But it’s definitely possible, and we’ve been thinking about what risks to mitigate. That was the reason to go with the preferred vendor program. Their criteria were around their ability to get to meaningful use and their likelihood of still being in the marketplace three years from now.

The one thing I’d like to add that is unique to us, and that has been our strength, is that we really thought through as a state and with all the stakeholders involved the best way to accomplish this. When I talk about OHIP, the initial founding members of the OHIP Board are made up of the Ohio State Medical Association[Hilliard], the Ohio Osteopathic Association [Columbus], the Ohio Hospital Association [Columbus], the state of Ohio, and BioOhio [a bioscience research nonprofit based in Columbus]. For this thing to truly happen, everyone must truly buy in. We’ve got everyone truly rowing in same direction here. When we expanded our board, it wasn’t an accident that we included payers, large hospitals, large employers, AARP—people that could really bring their communities along. I do think that’s unique. I think the closest to us is Colorado. And everyone else has a more fragmented approach, and I think that this approach is going to pay off in the long run for us.


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