Health Plan Enterprise Management System

Overview

Family Choice of New York, an Independent Health subsidiary that serves as a special needs plan for the frail elderly in Western New York, needed an enterprise management system that provided electronic medical record functionality as well as helping in other operational aspects: secure messaging and file sharing, data analysis and business intelligence functionality, office-based workflow automation, and CRM functionality to power their client relations functions.

As a start-up organization in 2005, Family Choice of New York realized that its aggressive growth target could only be met with a highly efficient information management system that worked exactly how they needed it to. Two years later, the organization has revenues of over $16 million and is still growing fast. The enterprise system developed by Lance Technologies has grown flawlessly alongside. With an increasing amount of functionality developed quickly, the information system acts as a single point of operations – delivering efficiency that allows Family Choice to keep up its aggressive growth.

Situation

Family Choice of New York needed an information system that would allow them to deliver, document, and analyze care that it provided to the frail elderly in various nursing homes and assisted living facilities across the greater Buffalo area. Its over fifteen nurse practitioners and over twenty consulting medical doctors needed an electronic medical record system that would allow them to document care in a mobile environment where there was no ubiquitous internet access. Additionally, being a health plan, the organization required extensive complex data analysis to be performed on the data that was collected for myriad purposes ranging from tracking productivity to maximizing reimbursements to developing financial dashboards. Data entered in the EMR would also drive plan member relations efforts such as being able to perform satisfaction surveys.

In addition to these records management and analysis efforts, Family Choice also required the ability to communicate sensitive information and documents with internal staff and business partners. Finally, the system needed to be flexible and easy to extend with features as they became necessary.

Family Choice of New York also had the following key criteria that were critical:

1. Be accessible on-demand via any computer, anywhere, and at any time
2. Be highly secure when performing in such a decentralized way 
3. Require minimal client-side software and infrastructure
4. Have a highly usable user interface and minimal learning curve
5. Provide offline synchronization so that appropriate patient notes can be carried into a facility on a laptop and new notes can be synchronized with the EMR system when online
6. Provide a high-level of access granularity to allow people in different roles to access the EMR appropriately. For instance, a transcriptionist would be able to enter patient encounter information but never see other notes, lists of patients, or facilities.
7. Have consistent up-time and an effective technical disaster recovery plan 
8. Be built with an open architecture so that integration with any third-party system would not only be possible but easy  

These set of requirements presented two options to Family Choice of New York. The first option was to purchase a host of off-the-shelf solutions - an EMR system, a secure messaging system, a customer relationship management tool, and so forth – and spend expend extensive effort in integrating these solutions with the risk of not being able to do so fully. The alternative was to work with a software development and consulting agency that would be willing to take a vendor partner approach in developing and managing a system designed expressly to meet the needs of Family Choice.

Solution

After an audit of Family Choice of New York’s business processes, existing infrastructure, and project constraints, Lance Technologies proposed the development of a web-based system that would be built in an iterative fashion with intensive customer involvement.

A cross-functional team was selected from Family Choice to be on the development team due to their deep business process expertise. This client component provided valuable and immediate feedback during the development of the system through its various iterative stages.

With a one-month build time, the end-result of Lance Technologies’ development efforts was a web-based enterprise system that could be accessed with any computer using a standard browser. Based on HIPAA guidelines, the system included a robust user management system that provided fine-grained access permissions. As such, users were placed in groups and thus had access only to information they needed based on their roles. Lance Technologies, in its role as business process advisor, developed human resource protocols that strictly dictated how access to the system was granted and how access accounts were audited and terminated.

Within the EMR component of the system, patient notes were organized into individual files and the system acted as a document repository that tracked when files were uploaded and by whom. Version control mechanisms ensured not only the ability to see case history but also that a patient note could never be altered without the change being automatically recorded in a built-in access audit system.

The EMR system also allowed for patient notes to be downloaded, individually and in batch based on selected criteria, to a provider's laptop or tablet PC so that they had the latest patient records when they visited a facility. Any changes to the notes made by providers while offline could then be synchronized the next time they connected to the EMR system.

Encounter data captured easily in the EMR component was then able to be properly coded for reimbursement management. Furthermore, the business intelligence component of the system allowed extensive and complex reports to be run that provided insight into the operations of the business. Reports that would take hours to be generated manually were now one-click. As a bonus, business metrics that were never implemented due to the lack of resources were now implemented due to the processing power afforded by Lance Technologies’ business intelligence package.

The system was deployed on a dedicated server hosted by Lance Technologies. A mirror image of the system was also deployed at another geographically-distant data center. Based on that infrastructure, Lance Technologies developed appropriate auto-synchronization software to mirror data between these two servers to ensure that in the event one site should go down due to major service outage, the other site could pick up almost immediately. Such a backup system provided Family Choice of New York with reliability very close to global load balanced clustering without the capital investment of over $25,000. Additionally, since the system was hosted by Lance Technologies, Family Choice of New York did not need to allocate resources to purchase and maintain a complex technology infrastructure.