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2004-140-Resolution No. 2004-014 Recorded 2/26/2004REV 1E LEGAL COUNSEL �COUNTY OFFICIAL r f +� d NANCYDESCHUTES COUNTY CLERKOS U 204-140 COMMISSIONERS' JOURNAL 0212612004 02:23:20 PM 1111111111111111111111111111111 2004-140 For BEFORE THE BOARD OF COUNTY COMMISSIONERS OF DESCHUTES COUNTY, OREGON A Resolution Transferring Appropriations Within Various Funds of the 2003-2004 * RESOLUTION NO. 2004-014 Deschutes County Budget and Directing Entries WHEREAS, it is necessary to transfer appropriations within the Deschutes County Budget; BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF DESCHUTES COUNTY, OREGON, as follows: Section 1. That the following transfers of appropriations be made: FROM: 001-4500-501.97-01 General Fund, Non -Departmental, Contingency $100,000 TO: 259-2000-441.94-45 Health Department Fund, Technology Improvements $100,000 FROM: 001-4500-501.97-01 General Fund, Non -Departmental, Contingency $100,000 TO: 001-4500-491.96-11 General Fund, Non -Departmental, Transfers Out -Health Department $100,000 Section 2. That the Finance Director make the appropriate entries in the Deschutes County Budget document to show the above appropriations. DATED this 25th day of February, 2004. BOARD OF COUNTY COMMISSIONERS OF DESCHUTES COUNTY, OREGON ATTEST: ' TOM Recording Secretary MW PAGE I OF I -RESOLUTION NO. 2004-014 (2/25/04) M. DAL S R. LUKE, Commissioner DESCHUTES COUNTY INCREASE OR TRANSFER OF APPROPRIATIONS FORM B.O.C.C. Meeting Date: Resolution No. Line -item Description Resources Total Resources Form No. February 25, 2004 2004-014 Budget Prior to this Line -item Account Resolution Inc/(Dec) Revised Requirements: Deschutes County General Fund, Non -Departmental, Contingency 001-4500-501.97-01 Deschutes County General Fund, Non -Departmental, Transfers Out-Healt 001-4500-491.96-11 Deschutes County Health Department, Technology Improvements 259-2000-441.94-45 Total Requirements 3,908,894 - 3,908,894 2,034,834 1,843,812 30,248 (200,000) 100,000 100,000 1,834,834 1,943,812 130,248 3,908,894 - 3,908,894 ,TEs r, 2bbo / q Board of County Commissioners (541) 388-6565 Fax (541) 388-4752 E-mail: mikem@co.deschutes.or.us To: Ai4-_�j From: Michael A. Maier, County Administrator Subject: Date: 4 J f -5 D1>v , v u eowrowl ex -et , i1 v �.?1/P�tivC.✓� 'Ar Ive XYA-,.) - Vj al^ r � yv.Cj h9i/tet 7101 r1- I/2v1 VPAf,i(nvA AA., 1.0 o L Mr.. ✓L.— In Wea,&k -4'0 " 100, 000 CcS dire (-kd- Lq AKe Ma)er, Lemorandum To: Board of County Commissioners CC: Mike Maier From: Daniel Peddycord, Tamara Weaver Date: 1/28/2004 Re: OPERATIONS SOFTWARE FOR HEALTH DEPARTMENT OCHIN SYSTEM The Health Department suffers from extensive business inefficiencies and barriers to effective operations from outdated operational software. Implementing new software is critical for improved scheduling, client registration, billing, aged accounts receivable and management reports. In addition, the ability to add electronic medical records in the future would be a desirable option. After extensive research, the Health Department has concluded that implementing the EPIC software system, by joining a consortium called OCHIN, is the preferred option. This system is needed to enable the Health Department to become a cost effective, efficient and mission -driven organization. The attached report gives detailed reasons why the OCHIN system is unique system and the only reasonable choice for the County. The Health Department will have access to a multi-million dollar software Health system (EPIC) for less than $80,000 preliminary costs and annual operating costs of less than $30,000. Most Counties experience a significant increase in revenue and reduction i expense that offsets the costs of the system. The EPIC medical practice and electronic medical records system�is used by such organizations as Harvard, Kaiser, Group Health of Puget Sound, Children's Hospitals and Cleveland Clinic (to mention a few). The Counties in the OCHIN consortium (which allows access to EPIC and enhances it for County use) are Multnomah, Clackamas, Tillamook, Benton and Lane. Washington and Deschutes are in the decision process. The Health Department is requesting the one-time only costs of implementing this system to be funded at the County level. The Health Department needs to make this change, but is currently operating at a reduced work level with no new revenue expected for the coming fiscal year. Often when operational inefficiencies are huge, it is difficult to "get to the other side". The Health Department has the will and commitment to change, but needs one-time fiscal assistance to enact the shed. needed change, which will revolutionize the way the mission and business are accompli In order to maximize the impact and changes needed for a full fiscal year, the Health Department needs to sign a contract by early March 2004. This will allow the needed four-month implementation process to occur. ■ Deschutes County Health Department Operational Software Analysis and Proposed Action January 28, 2004 BACKGROUND AND STATEMENT OF NEED The Health Department software is out -dated and does not provide such options as aged accounts receivables, monthly statements and comprehensive management reports. A comprehensive package is needed that will provide scheduling, client registration, statistical tracking, aged accounts receivable with client billing, electronic billing to third parties, and management reports such as productivity reports. All of this must operate within the requirements for County Public Health, which includes federal Title X requirements and numerous State regulations. There is an opportunity to meet these needs at reasonable cost while also obtaining high-level support and networking opportunities with Oregon Counties and FQHC's in Oregon and Washington. Deschutes County can obtain access to software and support by buying into a successful and established consortium called OCHIN. This expanded opportunity makes OCHIN the obvious best and only choice for Deschutes County. A three month process of research has been conducted that included staff at the Health Department and County IT department staff. RESULTS OF RESEARCH AND SUGGESTED SOLUTION Primary reasons to purchase OCHIN ■ SIN is a cooperative organizations a consortium), operating in Oregon and Washington, providing access to state of the art operational software, normally available only to large health systems (the EPIC system). Deschutes County IT staff assessed the OCHIN purchase cost as nominal compared to the normal cost of purchasing this type of software. Purchasing the rights to access this software also includes technical support to stay abreast of changing regulations and ongoing updates to medical coding and required updates from changing regulations. OCHIN staff and board work closely with the State of Oregon to resolve issues surrounding the operations of Public Health and FQHC clinics. ■ The medical practice software used and modified by OCHIN is called EPIC. It can only be purchased by very large organizations. OCHIN had obtained a total of $5,000,000 to allow the consortium to form. The EPIC software was voted the best Health System software in the United States by a 20,000 member user group called Health Information Medical Services Systems (HIIVICSS). ■ OCHIN staff includes people with a great depth of experience in information systems, as well as operations of Public Health and FQHC clinics. Other Counties in the OCHIN system use such words as "exceptional and timely support" to describe their experiences with the OCHIN organization. ■ Each consortium member is allowed a s on the OCHIN board and is�partf the de_, cisions made to upgrade an c ange the system. Thus, Deschutes Cotaff D IZC will be given equal voice with larger members, such as Multnomah County. j t / s 4-k4 4,V Page 1 of 3 1/28/2004, tdw, local/general statement of need.doc Our IT department has met with the IT staff from OCHIN. Our current hardware and IT software is compatible with OCHIN and will require very little upgrading (some older computer monitors and hardware need to be upgraded). A number of Oregon Counties are members of OCHIN. These Counties are Multnomah, Clackamas, Tillamook, Benton and Lane. Washington County and Deschutes County are in the decision process to purchase membership. In addition, by being a member, Deschutes County Health will have easy access to staff in other counties working to resolve the same issues. There are user groups, by topic, that telephone conference to share experiences and ideas for improvements of operations. OCHIN does a telephone conference every two weeks to discuss operations and determine if there are outstanding issues or suggestions for improvement. OCHIN staff work closely with the Counties and are able to work with top State officials. By joining forces with other Counties, Deschutes County will revolutionize the business operations portion of the Health Department, gaining much greater influence at the State level while improving administration through training opportunities gained by staff working closely with peers using the same software systems in other Counties. The Health Department is required to bill the Family Planning program grant (based on Medicaid funding) through a special system (Ahlers). Currently this causes duplication of staff time to enter both into the Abler's system and into the Health Department system. OCHIN has incorporated the Ahler's system into its system and duplication of effort is eliminated. Currently the State has implemented a system for WIC, called TWIST, which is outdated and causing the Oregon Counties operational difficulties. OCHIN staff is currently working to integrate Twist into OCHIN. They are in contact with top State officials over the TWIST project. Alone, Deschutes County would not have the ability to enact this change. As a group, with OCHIN, it appears it will happen soon. OCHIN has funds to provide this integration, free of charge, and the inclusion of WIC will not increase the annual fee. OCHIN based software allows all medical and grant based billing done by the Health Department to be done electronically. OCHIN downloads all current CPT, HCPC, and ICD-9 information into the system. OCHIN has a central clearing house for the electronic billing and payment turn -around is rapid. OCHIN processes monthly statements. Aged accounts receivable and other reports are comprehensive. Any additional reports needed can be generated using a large library of developed reports, or by designing specialty reports using software called Crystal reports (the Health Department will use Ray Wingert, IT staff, to generate new reports). The Health Department support staff is currently unable to handle the workloads efficiently. This new software will eliminate double work and hand work, done both in the Ahler's work mentioned above, in billing (staff have to re-enter receipts taken at the front desk and hand enter all codes that could be entered at time of check-out) and will eliminate the hand -statements that are now done. Staff can be shifted to unmet work needs and new staff will not need to be hired to meet the current unmet needs. The Health Department's future growth will be able to be met without increasing administrative staff working in these areas. Page 2 of 3 1/28/2004, tdw, local/general statement of need.doc ■ There will be one statistical data base (at this time we access at least five different sources of data: Acuterm system, Ahler's system, Twist, TCM, and Iris). This will significantly ease reporting requirements and provide meaningful management reports. ■ The OCHIN system is capable of adding electronic medical records (it exists as part of the underlying EPIC system). Planned implementation is in about a year, which would allow the Health Department to fully implement the scheduling, client registration, billing and reporting modules before implementing electronic medical records. This may be grant funded. CONCLUSION Many software systems allow medical billing and scheduling. No other software system available offers the advantage of addressing the unique needs in Oregon (working with the State to incorporate special programming such as Ahlers, Twist, TCM and IRIS) while meeting all Title X and Oregon State regulations. In addition, there is no other opportunity to combine the expertise and strength of the majority of Health Department clients serviced in Oregon, with a strong expert staff at a central location. Making a purchase decision on OCHIN and signing a contract by March 2004 will allow implementation by the beginning of this next fiscal year, July 1, 2004. This will give the advantage of a full year of data needed for most reports and operational decisions. County Counsel (Mark Pilliod), at this time (January 26, 2004) advised updating the Commissioners on the procurement process as Mark believes it is entirely feasible to meet the critical time -line to ensure this software can be live by July 1, 2004. He will have his final recommendation as to process finished very soon. Benton County staff took three months to implement software. They strongly recommended allowing more time. Four months should allow adequate time, though it will be a challenging process which will require the hiring of a temporary staff person over that four month period to assist with accounting tasks to allow the Business/Operations manager and billing staff the time for implementation tasks and training. PROPOSED TIME LINE March 1 to 10th, 2004 — Contract signed with OCHIN March 1 to April 30 — "Super -user" staff (3 to 4 staff) attends week training in Wisconsin on EPIC system, then Portland training on OCHIN and form internal planning group for set-up decisions and processes. OCHIN staff will do a walk through on entire system and guide the process. May All internal decisions on set-up are finalized June Implementation of system is commenced (schedule modules, coding, transfers of data) training of line -staff. OCHIN staff will be on site again at this point to assist transition July 1, 2004 SYSTEM IS LIVE Page 3 of 3 1/28/2004, tdw, local/general statement of need.doc a DESCHUTES COUNTY HEALTH OCHIN COST ESTIMATE January 26,2004 Total Cost Estimated Implementation cost (estimating on the high side) One-time payment to OCHIN Based on annual est visits in clinics $ 4.75 15,000 est. client visits $ 71,250 Other costs (high estimate) Purchase of new computer monitors $ 475.00 11 units 5,225 Telecommunications facilities charges 3,500 New equipment Printer Replacement terminals for old equipment $ 350 Cost of temporary accountant to assist Business/ Operations Mgr Total Estimate Cost of temporary staff to free Business/ Operation Mgr to be project leader Hours per week Weeks of implementation Cost per hour Annual costs Client visit estimates Additional cost for hand bills Eligible 25% discount on connectivig Electronic billing 13 cents each 2000 statements at 30 cents 10 units 1,000 3,500 $ 1.0,240 $ 94,715 32 16 $ 20.00 $ 10,240 $ 10,240 Low —Expected High $ 18,000 $ 22,750 $ 26,250 12,000 13,000 14,000 $ 1.75 $ 1.75 $ 1.75 $ 1,440 $ 1,560 $ 1,680 /Lraoovvc � / GofT �7+�C �.✓I�N�r1'Ct'`�1� 4 , A! CiV4J'/C � �i / v dlyt.(�/%3� a"�✓/�. �1L. I1taT !•t�� � � f s/S /1lrj�'! G! <'1 P vN S�✓1 a d /%� /� ri ^d 3� t /Jew,., /?'1 � ti ado�i� o��,u� �� Gam,, S /Lraoovvc � / GofT �7+�C �.✓I�N�r1'Ct'`�1� 4 , A! CiV4J'/C � �i / v dlyt.(�/%3� a"�✓/�. �1L. I1taT !•t�� � � f s/S /1lrj�'! G! <'1 P vN S�✓1 a d /%� /� ri ^d 3� t /Jew,., /?'1 � ti Exhibit A Software Modules and Hardware Capacity Unless otherwise defined, capitalized terms in this exhibit have the meanings given on the cover page of this agreement (the "Cover Page') or Exhibits B through D. Member will have access to the following software modules described on Exhibit 1(a) to the Epic Standard License and Support Agreement ("Epic License Agreement'): Resolute Professional Billing System Electronic Remittance Cadence Scheduling System Health Information Management -Chart Tracking - — — — -identity Embedded- Master-Personandex- --. -- ---- -- -- -- - — - — Clarity and Analyst Reporting Package SmartForms and Advantage Development Kit Bridges EDI Developer's License InterSystems Cache " KB Systems SQL Seagate Crystal Info for Windows (Version 7.x) Diagnostic Data Distinct Corporation - Object code version of TELNET. DLL CPT Code License *Member will pay an additional $1,100 license fee for each InterSystems Cache license in excess of those included in the Initial Payment. Member will have access to the following software modules described on Exhibit 1(c) to the Epic License Agreement only if OCHIN exercises its option to purchase a license for the module and. Member agrees to pay an additional charge for the module as allocated by the OCHIN Board: Identity Enterprise Master Person Index MyChart for Patients MyEpic Executive Information System Customer Relationship Management / Call Management Tapestry Managed Care Administration - Enrollment and Benefits Management for Payors Tapestry Managed Care Administration - Utilization Review and Case Management for Payors Tapestry Managed Care Administration - AP Claims / Capitalization for Health Plan and Insurers Tapestry Managed Care Administration - Premium Billing for Payors Tapestry Managed Care Administration - Claims Repricing for Payors Nurse Triage Chronicles Plus EpicCare Ambulatory EMR EpicWeb Light EpicWeb Medium Member will not have access to the following software modules described on Exhibits 1(a) or 1(c) to the Epic License Agreement: Advanced Rules -Based Scheduling Dental Billing PDXDOCS:I 372463.4 Cao/ - Y om- SD I. 9 7 of 70 1,000 141�s N AD To,w4L FROM 5-01 . 9 7 a � -o., 4-k 1� i 9(, i 0"4e� ;/ - Vo 2 -Sq - lJ0C0 3-11 - 0 0 grow ci5"oc-o