Table Of Content

© GrantThornton @ Us Depart VA EHR Strategic Options Assessment Briefing May, 2017 Table of Contents + Executive Suramary + Tradeoffs + Cost + New Stops + Appendis + Summary ot Qualranve Findings = Srmtegie & Cute) Be Fupeuonaty 8 Technology = Benes Risks = Assumptions Guiding Principles + Analysis Peamewun & Appa ~ VIIA de OFT Stakeholder Analysis (Clini & Teena Pres = Essima:ed Implementation Timeline Assessment Highlights “Ths Depart of Velen Alfa (VA) engaged Geant Thornton to acess fut strategie options for mnsdetaing. i Flectnaic Health Record (HR) prion LEOTS © + Adopticg » Commercial ofthe shelf (CCVTS}prosut where VA hosts the sfution ina VA purchase, feral ected seule doud cvisonmnet Option COTS + Adprings COTS prod wih Elauonic Heals Magnan Pons CHAP) adi Joint Tapes Viewes LV: VA eHMP /JLY hoses the sohisan ina VA punched fen certifi, sect lost Option 3 + Providig gold stands Viet vesson to a vendor to modernize and provide back to VA a a Saftwace ssa Seviee (Geshe | Su), whee the venorlaols he sululou nu Seda etic ecu cad, wad proves deouned ecg, Option 4 COTS + Adopting a COTS product forthe EFI where che veados host the solucon in a fedeay csi, seeue cloud, and VA Sus espe fone ‘Highligh (com the Assesement: The market does akltess Vitis EHR nerds with ited vara in erat ast the Grae pine + Key ditt bersea the option ince exercise in BTTR developmen: end cea access enc of software ownership, and degzce of influence and autonomy VA can + The sts sg chice wil noel to halance VA's appetite fo risk agains dhe enefits, costs and seategie alignment = Opsian 4 (Commercialized Vist) i the less expensive option ot caries dhe greatest rik appropriate and wing seslabie vereor fog, maturity of vendor, ecncmic resen} ~ Option 2 (COIS ~ eflMP/JLV} is the most expensive option and i less aligned with Olas ct-ategic pdr ( reduce TY footpant, ye: can enable toring boy test, (papa t {COTS and Opson + (COTS SaaS} cost the same and pamadly vary n a} che contol and Hes VA will have vo fntgrate new solaons as they ernesge in the market, tne responsibilty for hosting, which requizes IV investmet and skill Trade-off Analysis — Clinical Summary TOTS weston provide mane aici Ta ee Ope HReEOpERT Randa VA Tatas more Renibity For wre apalicntone wher fren asl administers she elouc: and, has the hignestdegzee oF talabiiy when ic design allo part ot dhe sltwane. The relative unpostance af these ester inform the strategie desi Dee Option & coms Option: cOrs+ etme OnHOAComsmersalized — Gouon 4. COTS Saas Inveroperab + Suc n Option 1: COTS Capable bake op ie vers iy ith Ako JLV proileinie ip the comme oli tenga cotherhealth HIM) wcrc logins ew of eal cos, Vcd oon tends fog. 1 TUR) 9 syatemt exon + eLtt co provi login) ene gin cond Modemity Leading software that upgrades © Same ns Option I: COTS Vengors cami!» Same a Option i: COTS sith nd bet ence | GMP fanstan woud <a apsade cova nctaleundein rs etiercg contingent om shy 0c fam bad connect ee gio eet ‘hon iamgzaed wah he Ors pret Fleiiny © VA aiinteel od + Sume at Opton HCOIS + Vendor admired cond + Vendor deinisered elo anceates VA Hexbiiyt0 Lith fornew empelidiin _ tereen VA Sexy” desenaes VA Dey acces Se paryvendors eg," neopedonecuee auch seem Sudpary vedas acces Sa party wad Uatinclie popu hel eet stat etet (ef beatin lane fee, hestin chs sadda pada pps ah) = populist ax endoesmay ave pe- Wend av ve pe- 4 Sofvaie wbdguation i met» Same a Option LCOTS. «Hight evel orally « Same at Opn Is COS nese practi pierene® gH TMP ascapaiis tv ay eine adona ont tw ve cage psp noe tls)” Sor beense isa VA to ptehae ening {Gesamte may na be + Cate evel change dered and manage Trainee onc clea pose dw sated (Gotan) cars poet ceorktows om id pcg soface wih oer cents Aidoeal ost oie fe, Dod 4 Trade-offs Analysis — Technology, Time, Risk & Cost ‘COTS solutions carry less dik az they are routinely implemented and ron in the marker, both an and all prciinex. More extensive Ialloring increaces costo time for implementssion. While Options 3 aed 4, moot a TL priosties, they tac off some Nesbit foe Wn choosing dosnatreat application, a ea PeSetege fe figesinatiteage eben eretgesen ee Agee pec 2 agente eee Migmet |" potineep amie’ |” loeigeenepep sci Shinar oer Gree Te auc PVA = Tine Iida + Owotshe bon +s Omotsbebon epee pan Opesing tacteatsrfanteg |" Racirmeaes ung >00m |" aegwtomctotvaea —_” fucsabietamag Cooly SebworVat nets! | ofa peeps Satavat aes oc) + Faia 1824 moms uy # Adisinal dive tw redesign iMplementing, Which lg gmat 1-28 outs 20 TGC ~ Paot Ste post tedeae HNP COTE SIE iran Toc = filet Ste pose ten oa soliton seivonal 12 months acquisition timate 24-36 months to TOC Puoc Sie pout Hsinate 18:24 tnt 1OC™ Pile Sit post seuiviion scavinton [Relative Rk ¢ Mediu ssksince vendors « Fighrssk due» continued + Tigh reset ited * Medinm dssnce vendors lemplemeat their solicons | slaace on anecal patie vail or appetie ave St mal in pce snikie inner mutinele develope sore 18-¥ear Cost are suse sig709799,568, stisoasa7 674 5, 065,009258 “15-Year Cast timate comtsins the 10 yeas implementation timefeame, pls five yess of postimplementation "eT IMP re-design an sealing effort may incteae ie © 1OC Z Next Steps We recommend the fullowing next steps + Vacilitared discussion with VA leaders to validate and prioritize decision criteria and evaluate against success at year Land year 10, Giinical / Operational: + Normally document and prioritize desired EHR capabilities clinicians would like to see in the next 3-5 yeass in a modernized IHR (eg, video conferencing capabilitics with Veteran on her PDA, receiving Veteran's vitals remotely before he arrives to the clinic) + Establish a communications strategy that includes the design of communications infrastructure that proactively anticipates and addresses internal and external concerns to maximize cooperation and understanding: ‘Technology: + Conducta technical readiness assessment that includes testing Vi\'s network infrastructuse, bandwidths and other technical capabilities co support the cechaology requirements of a modernized EHR system either in a cloud or SaaS cevironment * Conduct a system (application) and hardware inventory including end-user devices such as computers, tablets, cts, across each and every clinical location to ensure all software and hardwace is catalogued to evaluate future plans (apetade, maintain or decommission} and understand interface requirements with the new KHR Summary of Qualitative Findings “The four ssatege aptions have ditferentisted benefits, sks and alignment with IT steatepicpuioides, WA mut ances: th relative vali it places in these stacey and benefits and the teatve importa: tars in ientying the optioal solution. TT Stategie Drcvion Rink Rating ssunes ser pprrite legge int the contact n garare scot oan contol a date a8 wel a byt concer thic-paty solace st wll Ths ay meeise cost a VA. Strategic & Cultural Fit Review of mmtiple BITR vendor product deme sgqested that COTS vendoes have euttenteapabilies within their oct of de bo Fasetionaities io meet majority if not allot VHA's elisical pcs. Clinica Pics Opsion t:COS Option 2:cO1S + pron cAMP Commeraized Visth® Option & COTS Saas Addecses fares unique 10 VA Ani and eset Mental heh Interoperabiiy ih DuD and sing prods eeeeee e0e008 ecececee “f eeee0ee “Assumes the modecnized, Commercialize Vist fs based on single, "best of bred” instance nf Vit’. Functionality & Technology Options 1, 3, nd ¢ alow ally age with VAT strategie direction. Option 1 {COLS) has soune tli ug TT resources co suppor the hosing setup, Opdon 2 (COTS + IME) on the her hand ho ted alignment pari because sles ews om WA 1h osng erap and also or the iotecnal development so sport ad advance the ef TMP. | Teclloy Pieten Option COs Opting 2 COTS + Option 5 Option $: COTS Saas ae us firs approneh ‘Reduced 17 Satprint Coubased © Aina! Balaton Crises ‘Nemo re Aapttiiy Sealab Redundancy 0006 e00060