Component 8: Installation and Maintenance of




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Component 8:

Installation and Maintenance of

Health IT Systems

Instructor Manual


Version 3.0/Spring 2012

Notes to Instructors


This Instructor Manual is a resource for instructors using this component. Each component is broken down into units, which include the following elements:


  • Learning objectives

  • Suggested student readings, texts, reference links to supplement the narrated PowerPoint slides

  • Lectures (voiceover PowerPoint in Flash format); PowerPoint slides (Microsoft PowerPoint format), lecture transcripts (Microsoft Word format); and audio files (MP3 format) for each lecture

  • Self-assessment questions reflecting Unit Objectives with answer keys and/or expected outcomes

  • Application Activities (e.g., discussion questions, assignments, projects) with instructor guidelines, answer keys and/or expected outcomes

  • Labs/Simulations for virtual machines



Contents


Notes to Instructors 2

Disclaimer 9

Component 8/Unit 1 10

Component 8/Unit 2 14

Component 8/Unit 3 17

Component 8/Unit 4 19

Component 8/Unit 5 21

Component 8/Unit 6 23

Component 8/Unit 7 26

Component 8/Unit 8 28

Component 8/Unit 9 31

Component 8/Unit 10 34

Component 8/Unit 11 37

Component Acronym Glossary 39

Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported 49

Appendix 1: Sunny Happy Care Family Practice Scenario 50



Component Overview

This component covers fundamentals of selection, installation and maintenance of typical Electronic Health Records (EHR) systems. Students will be introduced to the principles underlying system configuration including basic hardware and software components, principles of system selection, planning, testing, troubleshooting, and final deployment. System security and procedures will also be introduced in this component.


Each Learning Unit requires 2-5 contact/instructional hours and an additional 6-15 hours of independent or team work on the part of the student in order to be completed successfully. Each unit contains more material than would likely be used in any one teaching/learning experience so that the instructor can pick and choose material most applicable to local workforce needs.
Unit 1, Elements of a Typical EHR System

Unit 2, System Selection – Software and Certification

Unit 3, System Selection – Functional and Technical Requirements

Unit 4, Structured Systems Analysis and Design

Unit 5, Software Development Life Cycle

Unit 6, System Security Procedures and Standards

Unit 7, System Interfaces and Integration

Unit 8, Troubleshooting; Maintenance and Upgrades; Interaction with Vendors, Developers, and Users

Unit 9, Creating Fault Tolerant Systems, Backups, and Decommissioning

Unit 10, Developing a Test Strategy and Test Plan

Unit 11, Pilot Testing and Full Scale Deployment
This entire Component is estimated to require 18-45 total contact/instructional hours plus 54-135 additional hours of independent or team work, depending on the learning activities and assessments used within each unit.
Component Objectives

At the completion of this component, the student will be able to:




  • Describe the use of client and server hardware for access to and storage of EHRs

  • Describe network needs for access to and storage of EHRs

  • Identify the application software and back-end data storage software needed for a comprehensive, effective Health IT System

  • Compare and contrast COTS (Commercial Off-The-Shelf) and In-House /homegrown systems and describe their relative advantages and disadvantages

  • Verify system compliance with ONC-ATCB certification

  • Identify purpose and categories of ARRA “Meaningful Use” criteria

  • Identify 12 possible steps to choosing an EHR system

  • Gather functional requirements from institution and users

  • Document use-cases and relate them to functional requirements

  • Identify the 8 basic components to a project plan

  • Define the role of a project manager

  • Equate the basic project plan components to a typical EHR implementation plan

  • Create a project plan for system design and implementation

  • Define the steps of the Software Development Life Cycle (SDLC) and the purpose and importance of each.

  • Describe different models of the SDLC and their key differences.

  • Describe how and why an HIT software application would go through the SDLC

  • Identify regulatory requirements for EHRS and integrate into the project plan

  • Identify best practices for OS and network system security installation and patches (such as those provided by vendors, SANs, and ISC2) and integrate into project plan

  • Identify and assess protection measures including access control, firewalls, intrusion detection and encryption

  • Provide training for system users regarding the methods and importance of security compliance

  • Determine and document system interfaces and integration requirements

  • Describe the pitfalls associated with installing a new application in an environment of pre-existing applications

  • Give examples of interfacing modalities

  • Identify and implement an effective troubleshooting procedure for reporting, evaluating, fixing, deploying, and follow-up of errors, problems, or limitations for the system

  • Integrate downtime schedule for OS, network, database, and client application maintenance and updates

  • Develop a process for communicating requirements and supplying updates between vendors/developer and users

  • Create a baseline for system performance measurement and comparison for troubleshooting

  • Create redundancy and fault-tolerance in systems for access and data storage, providing high performance and reliability

  • Backup and restore databases, applications, and operating systems

  • Develop a plan for decommissioning systems and data

  • Gather user feedback and performance baseline for system validation and testing

  • Document problems with their resolution status

  • Create, execute, and document a test plan

  • Identify pilot group and plan scope of pilot

  • Install pilot system, train pilot users, and make pilot available

  • Gather and prioritize feedback from pilot test, revising project plan if necessary

  • Develop and implement strategy for:

    • Communicating deployment plan to end users and management

    • Technical support of deployment (e.g. live on-site support versus phone/Internet support)

    • Getting feedback from end users following deployment

    • Evaluating usage and capacity of system resources under conditions of full deployment

  • Deploy revised system



Component Authors
Assigned Institution

Duke University, Durham, NC


Team Leads

Scott Neal

Durham Technical Community College
R. Clayton Musser, MD, MS

Duke University


Primary Contributing Authors

Scott Neal

Durham Technical Community College
R. Clayton Musser, MD, MS

Duke University


Harry Bulbrook

Durham Technical Community College


Lecture Narration/ Sound Engineer

 

Sound Engineer

Raland Technologies LLC

1387 Fairport Road

Suite 1050 Fairport, NY 14450

http://www.raland.com/
David Flass - Project Manager

Team Members
Scott Neal

Durham Technical Community College

Information Systems Security/Networking Technologies
R. Clayton Musser, MD, MS

Duke University

Assistant Professor, Internal Medicine & Medical Informatics
Harry Bulbrook

Durham Technical Community College

Coodinator/Instructor, Information Systems Security/Networking Technologies

Disclaimer
These materials were prepared under the sponsorship of an agency of the United States Government. Neither the United States Government nor any agency thereof, nor any of their employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, apparatus, product, or process disclosed, or represents that its use would not infringe privately owned rights. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply its endorsement, recommendation, or favoring by the United States Government or any agency thereof. The views and opinions of authors expressed herein do not necessarily state or reflect those of the United States Government or any agency thereof.

 

Likewise, the above also applies to the Curriculum Development Centers (including Columbia University, Duke University, Johns Hopkins University, Oregon Health & Science University, University of Alabama at Birmingham, and their affiliated entities).


The information contained in the Health IT Workforce Curriculum materials is intended to be accessible to all.  To help make this possible, the materials are provided in a variety of file formats.  Some people may not find the Flash video and .SWF files accessible and should instead utilize the PowerPoint slides together with the .mp3 audio file and/or Word transcript to access the lectures. For more information, please visit the website of the National Training and Dissemination Center at http://www.onc-ntdc.org or http://www.onc-ntdc.info to set up a profile and view the full accessibility statement.

Component 8/Unit 1


Unit Title

Elements of a Typical EHR System
Unit Description

This unit provides an overview of what a typical electronic health record system is and focuses on the elements that make up such a system -- hardware, networks, software, and storage requirements.


Unit Objectives

By the end of this unit the student will be able to:




  1. Describe the use of client and server hardware for access to and storage of EHRs

  2. Describe network needs for access to and storage of EHRs

  3. Identify the application software and back-end data storage software needed for a comprehensive, effective Health IT System


Unit Topics / Lecture Titles

1a Elements of a Typical Electronic Health Record System

1b Elements of a Typical Electronic Health Record System
Unit References

(All links accessible as of 3/12/2012)
Lecture 1a

DesRoches, C.M. et al. (2008). Electronic Health Records in Ambulatory Care — A National Survey of Physicians. N Engl J Med. 359:50-6. http://www.nejm.org/doi/full/10.1056/NEJMsa0802005

Dickinson, G., Fischetti, L., & Heard, S. (2003). HL7 EHR System Functional Model and Standard. Retrieved July, 2010, from HIMSS.org: http://www.himss.org/Content/Files/EHR_Functional_Model_Ballot.pdf

Garrett, P., & Seidman, J. (2011, January 4). EMR vs EHR – What is the Difference? Heath IT Buzz. Retrieved December, 2011, from http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/

Greenhalgh, T. et al (2009). “Tensions and Paradoxes in Electronic Patient Record Research: A Systematic Literature Review Using the Meta-Narrative Method”.[PDF on the Internet]. The Milbank Quarterly. [Cited June 2011]. http://www.milbank.org/quarterly/8704feat.html

Gurley, L. (2004). Advantages and disadvantages of electronic medical records. Retrieved from http://www.aameda.org/MemberServices/Exec/Articles/spg04/Gurley%20article.pdf

Institute of Medicine. (2001, March 1). Crossing the quality chasm: a new health system for the 21st Century. Retrieved June 30, 2010, from http://www.nap.edu/catalog/10027.html

Pawola, L. (2011, February 22). The history of the electronic health record. Health Informatics and Health Information Management. Retrieved December, 2011, from http://healthinformatics.uic.edu/the-history-of-the-electronic-health-record/

Maons, D. (2011, November 11). EHRs are inevitable, experts say. Heathcare IT News. Retrieved from http://www.healthcareitnews.com/news/ehrs-are-inevitable-experts-say

Medical Associates. Electronic Medical Record. Retrieved September 2011 from http://www.medical-software.org/electronic-medical-record.html

Steele, E. (2009, December 16). Research explains why EHRs won’t achieve “Meaningful Use.” Retrieved Nov, 2011, from http://blog.srssoft.com/2009/12/research-explains-why-ehrs-won%e2%80%99t-achieve-%e2%80%9cmeaningful-use%e2%80%9d/

Torrey, T. What is an EMR (Electronic Medical Record) or EHR (Electronic Health Record)?” (2011, April 11). Retrieved June, 2011, from Patients.About.Com: http://patients.about.com/od/electronicpatientrecords/a/emr.htm

Torrieri, M. (2011, August 23). EHR adoption grows slowly, steadily at small practices. Retrieved from http://www.searchmedica.com/resource.html?rurl=http%3A%2F%2Fwww.physicianspractice.com%2Fblog%2Fcontent%2Farticle%2F1462168%2F1933985%3FCID%3Drss&q=Kleaveland&c=pm&ss=physiciansPractice&p=Convera&fr=true&ds=0&srid=3

Wikipedia. (2011, August). Client Server Model. Retrieved June, 2011, from Wikipedia.com. http://en.wikipedia.org/wiki/Client%E2%80%93server


Lecture 1a Charts, Tables, Figures

1.1 Figure: MITRE, 2006 Electronic Health Data—Pre EHR Figure 1 Electronic Health Records Overview , http://www.ncrr.nih.gov/publications/informatics/EHR.pdf Used with Permission.

1.2 Figure: MITRE, 2006 EHR Concept Overview Figure 2 Electronic Health Records Overview , http://www.ncrr.nih.gov/publications/informatics/EHR.pdf Used with permission

1.3 Figure: Neal, Scott. 2011. Client Server Model. Used with Permission


Lecture 1a Images

None used in this lecture.


Lecture 1b

  1. Kleaveland, B. EHR Implementation: What you need to know to have a successful project: Part 2. Physicians Practice. Retrieved from http://www.physicianspractice.com/files/audioconference/pdfs/id_7.pdf?CFID=1675309&CFTOKEN=75588070

  2. Torrey, T. (2011, April 11). What is an EMR (Electronic Medical Record) or EHR (Electronic Health Record)? Retrieved June, 2011, from patients.about.com: http://patients.about.com/od/electronicpatientrecords/a/emr.htm.

  3. Torrieri, Marisa (2011, August 23). EHR Adoption Grows Slowly, Steadily at Small Practices. Retrieved from http://www.searchmedica.com/resource.html?rurl=http%3A%2F%2Fwww.physicianspractice.com%2Fblog%2Fcontent%2Farticle%2F1462168%2F1933985%3FCID%3Drss&q=Kleaveland&c=pm&ss=physiciansPractice&p=Convera&fr=true&ds=0&srid=3

  4. Wikipedia. (2008, July). Thin Client. Retrieved from Wikipedia.com: http://en.wikipedia.org/wiki/Thin_client .

  5. Wikipedia. Computer network. Retrieved from Wikipedia.com: http://en.wikipedia.org/wiki/Computer_network .


Lecture 1b Charts, Tables, Figures

1.1 Table: Neal, Scott. EHR Hardware – Servers. Used with permission.


Lecture 1b Images

Slide 15: Laptop. Courtesy Scott Neal. Used with permission.

Slide 19: Local Area Network (LAN). Courtesy Scott Neal. Used with permission.

Slide 20: Wide Area Network (WAN). Courtesy Scott Neal. Used with permission.


Unit Required Readings.

None for this unit.


Unit Suggested Readings

  1. “What’s Inside My Computer?” by Jonathan Strickland, November 2006, http://www.howstuffworks.com/inside-computer.htm This “How Stuff Works” article and video explains the seven major components inside a typical computer system.

  2. “Understanding Application Servers” by Ajay Srivastava & Anant Bhargava 2003 http://hosteddocs.ittoolbox.com/AS030504.pdf This article explains in depth how application servers work, particularly in a three tiered system similar to a typical EHR system structure.

  3. “What is a Server?” by Webopedia, http://www.webopedia.com/DidYouKnow/Hardware_Software/2005/servers.asp A short but thorough article about the function of a server, types of servers, and how the term applies to hardware and software.


Student Application Activities

comp8_unit1_activity.doc

comp8_unit1_activity_key.doc

comp8_unit1_self_assess.doc

comp8_unit1_self_assess_key.doc
Component 8/Unit 2
Unit Title

System Selection – Software and Certification
Unit Description

This unit will discuss the differences in COTS (Commercial Off-The-Shelf) and in-house/homegrown systems and how to select the system to meet the needs of the end users. We will also look at the advantages of purchasing a CCHIT-certified system and discuss ARRA and “meaningful use” in the context of EHR systems. Lastly we will look at estimating the typical costs associated with EHR system startup.


Unit Objectives

By the end of this unit the student will be able to:




  1. Compare and contrast COTS (Commercial Off-The-Shelf) and in-house/homegrown systems and describe their relative advantages and disadvantages.

  2. Verify system compliance with ONC-ATCB certification.

  3. Identify purpose and categories of ARRA “Meaningful Use” criteria.



Unit Topics / Lecture Titles

2 System Selection – Software and Certification


Unit References

(All links accessible as of 3/12/2012)


Lecture 2

  1. About ARRA. Retrieved from HITECH Answers website: http://www.hitechanswers.net/about/about-arra/

  2. ARRA Meaningful Use Snapshot. (n.d.). Retrieved from Medical Information Technology, Inc. website: http://www.meditech.com/interoperability/pages/ARRA_snapshot_final_0311.pdf

  3. Certified Health IT Product List. Retrieved from Office of the National Coordinator for Health Information Technology, US Department of Health & Human Services website: http://onc-chpl.force.com/ehrcert

  4. Electronic Medical Record. Retrieved June 20, 2010, from: http://en.wikipedia.org/wiki/Meaningful_Use#Meaningful_Use

  5. EHR Incentive Programs Overview. (n.d.). Retrieved from Centers for Medicare & Medicaid Services website: https://www.cms.gov/EHRIncentivePrograms/

  6. Medicare and Medicaid Programs; Electronic Health Record Incentive Program (2010, July). Federal Register. [Internet]. Retrieved from http://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-program .

  7. Fornes, D. (2008, February 6). Should CCHIT Influence Your EHR Selection? [Web log post]. Retrieved from Software Advice - The Medical Blog: http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection

  8. Gates, M. (2009, Winter). All Systems Go? How to Select an EHR That Meets Your Needs. Correct Care, Retrieved from http://www.ncchc.org/pubs/CC/selecting_ehr.html

  9. Goals for EHR System. Retrieved June 20, 2010, from Health Technology Review website: http://www.healthtechnologyreview.com/viewarticle.php?aid=113

  10. HITECH Act Enforcement Interim Final Rule. (n.d.). Retrieved from U.S. Department of Health & Human Services website: http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/hitechenforcementifr.html

  11. McKinney, D. (2001, August). Impact of Commercial Off-The-Shelf (COTS) Software and Technology on Systems Engineering. Retrieved from Presentation to INCOSE Chapters website: http://www.incose.org/northstar/2001Slides/McKinney%20Charts.pdf

  12. Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule, 75 Fed. Reg. 44314 (2010) 42 CFR Parts 412, 413, 422, and 495 http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf

  13. ONC-Authorized Testing and Certification Bodies. Retrieved from Office of the National Coordinator for Health Information Technology, US Department of Health & Human Services website: http://healthIT.hhs.gov/ATCBs

  14. Pizzi, R. (2007, October 30). EHR adoption an "ugly process," but CCHIT can improve appeal. Retrieved from Healthcare IT News website: : http://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appeal

  15. Rice, R. (2009). Testing COTS-Based Applications. Retrieved June 21, 2010, from http://www.riceconsulting.com/articles/testing-COTS-based-applications.htm

  16. Standards & Certification. Retrieved from Office of the National Coordinator for Health Information Technology, US Department of Health & Human Services website: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__standards_and_certification/1153

  17. Standards & Certification Criteria Final Rule. Retrieved from Office of the National Coordinator for Health Information Technology, US Department of Health & Human Services website: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__standards_ifr/1195


Lecture 2 Charts, Tables and Figures

None used in this lecture.


Lecture 2 Images

Slide 13: ARRA recovery.gov logo http://www.recovery.gov/News/mediakit/Picture%20Library/circle_recovery_logo.jpg

Slide 13: Center for Medicare and Medicaid Services EHR Incentive Programs logo http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRIncentiveLogoweb.JPG
Unit Required Readings

None for this unit.


Unit Suggested Readings

  1. Should CCHIT Influence Your EHR Selection? By Don Fornes http://www.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/. An excellent overview of CCHIT’s role in EHR selection and the criteria certified by the organization.

  2. Healthcare Industry show demonstrates wealth of opportunities, By Steve Hicks http://mindset.mercurypay.com/?p=475. An overview of Interoperability, Meaningful Use, and Revenue Cycle Management


Student Application Activities

comp8_unit2_actvities.doc

comp8_unit2_activity_key.doc

comp8_unit2_self_assess.doc

comp8_unit2_self_assess_key.doc
Component 8/Unit 3
Unit Title

System Selection – Functional and Technical Requirements
Unit Description

This unit will discuss the 12 different steps associated with system selection focusing on defining user functional requirements of systems and technical requirements (by the system), including how to the determine, document, prioritize, and act on those requirements through the use of case studies and other means.

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