Case Study for IT Strategic Planning

Organization Description
JAA is a multi-level CCRC organization located in Pittsburg, PA. In addition to skilled
nursing, outpatient rehab, assisted living, and memory care units, they offer home health,
hospice, palliative care, and a full complement of community services including a seniors’ day
club, kosher meal delivery and virtual community resource clearinghouse.
Project Description
JAA utilized a five-step process for crafting a transformative IT strategy, roadmap and
implementation plan. Internally, their criteria for an integrated system of care had to connect all
business units across the JAA continuum – from meal deliveries and day center operations, to
skilled nursing care and hospice. Externally, it was important to select a system with
interoperable exchanges linking to acute care partner providers.

Status before the Project Started

JAA’s journey began partly in preparation for ICD-10, which was originally slated for a
2014 deadline but has since been postponed until October 1, 2015. They noted a need to better
position the business office to accommodate changing revenue cycles, as their financial
systems at the time were unable to calculate cost per condition – a key reporting requirement
for bundled payments. Other future changes that JAA leadership strategically identified were
interoperability with Health Information Exchanges, value-based reimbursements, hospital
readmission and length of stay rates. Through their research, selection team members knew
that EMR best practices had been shown to improve patient/resident care quality and
operational efficiencies

Impact
Cost of Care and Return on investment (ROI) to Providers, Implementation Costs, Staff
Efficiencies Pittsburg-based Jewish Association on Aging (JAA) began their external search for
an electronic medical records (EMR) vendor by first looking inward. By integrating their
long-range strategic objectives into the product review process, they were able to make a
selection based on the direction the long-term care organization wanted to go, rather than
where they were at the time. The result was a set of stringent criteria that was applied to each
potential integrated EMR system that was evaluated. All products submitted for consideration
were required to incorporate clinical reporting, care coordination, financial management,
consumer relations and advanced analytics. Additionally, the successful system would support
specific strategic goals, including:
• Sharing of essential information across care settings
• Ensure secure, accurate real-time data transfer
• Position for future regulatory and reimbursement changes
• Present a highly functional and cost-effective solution

Project Type
 This study outlines the process undertaken by JAA to plan for, select, configure and
implement a comprehensive enterprise EMR system. Leadership at JAA, through their research
and preparation, knew that their technology decisions would play a critical role in their broader
strategic initiatives, which included care quality, revenue enhancement and operational
efficiencies. Key functionality included analytics and reporting capabilities of the selected vendor
system to document the positive impacts of JAA’s changes to referral partners.

Business Model
Though once considered a nearly non-competitive market, Pittsburgh’s healthcare
community has undergone a recent series of revolutionary changes that are creating broad
consumer choice for the first time. For a broadscope CCRC, such as JAA, the resulting
environment strongly favors strategic ties with insurers and referring health systems, placing
quality measures such as hospital readmission rates and medication management under even
greater focus.

Planning Philosophy/ Approach

For JAA, system selection was just the first mile marker on a longer journey. In addition
to aligning with guiding organizational principles and strategic goals, JAA leaders set forth a
series of “Must-Haves” for their EMR. From the inception of the Select/Build/Implement process,
they moved forward on the presumption that their system of choice would:
• Support a seamless flow of patient information across their organization
• Provide easy access to accurate, reliable data
• Ensure essential information is available between caregivers
• Position the organization for healthcare reform and regulatory changes, and
• Be efficient and cost-effective.
Based on their extensive research, JAA planned from the early stages to pursue an
enterprise-wide implementation approach. They realized that while a slower phased strategy
might lessen some of the pain points on the path to paperless operations, it would prolong the
overall transition period. For CCRCs, phased implementations also create information silos,
increasing the likelihood of fragmented workflows across varied care settings. Moreover, the
leadership team realized that bringing core systems online in close proximity would shorten the
organizations path to return on investment. They realized that one of the inherent benefits of a
comprehensive system was the ability to move more quickly through the change management
phase and onward towards optimization and direct operational benefit.

5-Step process
Across a four-month span, JAA initiated a coordinated vendor selection process that
included strategy definition, RFI evaluation, reference calls, cost modeling, technical review and
final selection of their vendor of choice. Decisions were made with a strict governance model
that included the oversight of an Executive Steering Committee that incorporated institutional
considerations such as strategic goals and financial impact. A multi-disciplinary System
Selection Committee – including medical staff, clinicians and JAA leadership – guided the
overall selection process, including establishment of selection criteria and final recommendation
of a preferred product & vendor. With the shrinking margins of long-term care, tight cost
considerations were very much a factor. As such, the JAA team considered everything down to
the cost of education, staffing and hardware upgrades that might be needed to accommodate
the adoption and launch of a comprehensive EMR. Much of the funding discussion focused on
5-year Total Cost of Ownership (TCO) for the final two vendors. Recognizing that purchase
price and implementation fees are merely a portion of the aggregate cost of any system, the
team carefully considered secondary costs, including incremental staffing & consulting, patient
data conversion, external/ internal system interfaces, and even detailed travel costs for training
and support. JAA dug deep and made an extra effort to achieve an “apples-to-apples”
comparison, big-picture view of each vendor’s total cost to accomplish JAA’s broader long-term
goals – not just achieve the bare-minimum functionality and expand to enterprise usage over
time. Early evaluations leveraged JAA’s self-identified needs against the LeadingAge CAST
EHR vendor matrix and online selection tool, while final selection was based on broad criteria
that included interoperability, reference visits and 5-year total cost of ownership. The
organization narrowed the vendor pool from six to three, then two finalists, before selecting
Missouri-based long-term software developer HealthMEDX as their system of choice.

Implementation Approach
While the adoption of an integrated enterprise EMR was part of a longer, broader To-Do
list, JAA encouraged a “What-if” mentality when it came to configuring and launching their
system.
The resulting mindset allowed fuller exploration of options and impacts, allowing JAA to
optimize the software developer’s HealthMEDX Vision® platform, as well as their own adjacent
processes and workflows. With their HealthMEDX implementation team, JAA developed a
two-track roadmap that detailed a preliminary design/build/test period for Long-term Care and
Billing operations, which went live in July of 2014. JAA is currently in the process of
implementing the EMR across their Home and Community-based services, including HomeCare
and Hospice operations, with an anticipated go-live date of late summer 2015.

COMMENTS AND SUGGESTIONS (bukod to, kay donna to)

Challenges/ Pitfalls to Avoid

Buy-in of front-line staff is critical to a successful implementation, and must be taken into
careful consideration and closely managed. Despite JAA’s significant preparation – which
included internal awareness campaigns and a go-live countdown/celebration – a bump in
turnover rates negatively impacted the adoption consistency of the new system, necessitating
unplanned retraining. Even considering their highly strategic approach, JAA leaders said it was
easy to lose focus on maximizing system functionality while managing the go-live details. They
also cited the importance of maintaining internal system user groups beyond the initial
implementation phase, in order to generate ongoing feedback on how the system is being used
and ensure the EMR platform delivers optimal operational value.

Advice to Share
 A clear understanding of workflows, forms and reports is critical to successful system
selection, build and implementation. JAA also recommends staffing of a full-time project
manager and technical analyst and utilization of tech-savvy board members for board-governed
non-profits. Key project proponents should also be allocated 10-15% of protected weekly time to
focus on project work.