Title
Authorize the Deputy Purchasing Agent for Natividad Medical Center (NMC) to execute Amendment No. 4 to the Agreement (A-12461) with Navin, Haffty & Associates, LLC for Information Technology Project Management Consulting Services at NMC, adding $1,365,000 for a revised total Agreement amount not to exceed $6,241,000 and with no change to the term end date.
Report
RECOMMENDATION:
It is recommended the Board of Supervisors:
Authorize the Deputy Purchasing Agent for Natividad Medical Center (NMC) to execute Amendment No. 4 to the Agreement (A-12461) with Navin, Haffty & Associates, LLC for Information Technology Project Management Consulting Services at NMC, adding $1,365,000 for a revised total Agreement amount not to exceed $6,241,000 and with no change to the term end date.
SUMMARY/DISCUSSION:
NMC's Transition to a Fully Staffed IT Department
NMC is in the process of reducing its reliance on independent contractors. NMC's goal is to fully staff its Information Technology ("IT") department with County employees wherever possible and to rely on the skills and expertise of independent contractors on a limited, project-specific basis when it is in the best interest of the County to do so.
Since the Board's July 2014 approvals, NMC has taken more determined measures than in prior years to increase success in NMC's recruitment efforts.
· During the summer of 2014, NMC IT Department hosted a university intern from California State University - Monterey Bay ("CSUMB"). The internship experience was intended to encourage a local university student to consider the public healthcare field in seeking out IT employment, NMC anticipates hosting another CSUMB intern this coming summer.
· In July 2014, NMC requested and the Board approved 6 new FTE IT positions bringing the total number of budgeted open positons to 14. NMC opened recruitment for these previously budgeted and new positions the same month.
· In February 2015, NMC opened recruitment for the Chief Information Officer ("CIO") position.
· In February 2015, staff of NMC IT and Human Resources ("HR") attended a CSUMB hosted job fair for IT professionals to promote the presence of NMC and encourage job seekers attending the fair to consider the County of Monterey, especially NMC, as a potential employer.
· In April 2015, NMC HR staff attended the Monterey Community job fair at the Portola Hotel in the City of Monterey, to encourage local job seekers to consider their employment opportunities at the County of Monterey/NMC.
As a result of these and other efforts, NMC filled one FTE position in September 2014, another FTE position in January 2015 and two additional FTE positions in March 2015. There are still currently 10 positions to fill.
Navin's Assistance With NMC IT Transition
Amendment #4 to the Agreement with Navin, Haffty & Associates, LLC ("Navin") is intended to assist with NMC's transition of IT projects connected to its Meditech Electronic Health Record to a County IT staff that can fully support NMC's Meditech needs. NMC has selected Navin for this transition because of the company's depth of experience and expertise of its consultants. Navin is focused solely on Meditech and its customer base and, since 2001, has been providing consulting services to over 400 healthcare organizations that utilize Meditech as their EHR solution.
Over the last several years NMC has purchased, and continues to purchase necessary modules of Meditech, NMC's health records system, in order to systematically build a fully electronic EHR. The implementation of these modules provides for improved services and safety to NMC patients as well as meeting the ongoing mandated Medicaid and Medicare Meaningful Use requirements via the HITECH Act legislated by the federal government.
NMC has been successful in its implementation of its acute, hospital based EHR. NMC now needs to move forward with a clinic solution for its specialty and primary care clinics. NMC will need to modify the hospital based EHR to meet clinic needs. The same hospital based Meditech modules will be utilized which were described in previous board reports, including but not limited to PCS ( nursing documentation), CPOE (Computerized Physician Order Entry), PDOC (Physician Documentation module) and Dragon, (Natural Language speech recognition software). Although there are no planned additional software purchases at this time, there will need to be subject matter experts and project management expertise to make these needed clinic modifications.
NMC seeks the services of one of Navin's 220 subject matter experts ("SMEs") to build and implement the extension of Meditech to the hospital clinics ("the Ambulatory Project"). The build out and implementation of the Ambulatory Project is expected to be completed by the end of February 2016. The Ambulatory Project cannot be performed by an existing County employee because our current FTE pool does not have the clinical IT subject matter expertise. Once implementation is completed, continued support will be necessary until an appropriate hospital FTE is hired and available to take over these support needs. Until that time NMC seeks on going Ambulatory SME support from the Navin SME through 6/30/2016 via this Agreement.
In addition to the SME for the Ambulatory Project, NMC needs a second SME to provide ongoing consultation with regard to software interfaces of the hospital's Meditech EHR, both internal and external. A software interface is a shared boundary across which two separate software applications exchange information. All non-Meditech software that interface with the Meditech EHR needs to be maintained continuously and at times new modules need to be implemented. Examples include ESO, an ambulance software hospital interface which supplies critical ambulance data to the accepting Emergency Department team, Relay Health's Patient Portal and the Health Information Exchange, Philips and DynamapVital Sign equipment and software, and Monterey County Health department interface with Epic OCHIN, among others. The interface work will be transitioned to a new County employee as soon as he or she can be hired.
In addition to the SMEs for the Ambulatory Project and to provide ongoing interface support, NMC needs a third SME to provide ongoing report writing needs. Reports are needed across hospital service lines and are critical for daily operations. There are approximately 1600 active reports that need regular updating at NMC plus frequent requests for new reports. Currently NMC's report writing is primarily Meditech's Non Procedural Reporting (NPR) which is unique to Meditech. NMC is in the process of migrating to a more standard report writing format using SQL. Meditech itself has recommended this report writing transition which is ultimately more efficient and is the common standard report writing platform beyond health care electronic health records. Currently NMC has a SQL capable report writer and this position is filled by eCare consulting. The reporting work will be transitioned to a new County employee as soon as he or she can be hired.
This Amendment No. 4 will ensure that the interface, report writing and Ambulatory SME positions are available for NMC during the period 4/1/15 through 6/30/16, in the event that recruitment effort are unable to locate IT professionals who are qualified to perform these services
OTHER AGENCY INVOLVEMENT:
County Counsel has reviewed and approved this Amendment No. 4 as to legal form and risk provisions, and the Auditor-Controller has reviewed and approved Amendment No. 4 as to payment provisions. The Amendment No. 4 has also been reviewed and approved by NMC's Finance Committee on 3/5/15 and by its Board of Trustees on 3/6/15.
FINANCING:
The cost for this Amendment No. 4 is $1,365,000 of which $273,000 is included in the Fiscal Year 2014-15 Adopted Budget. The remaining amount will be included in the FY 2015-16 Recommended Budget as appropriate. There is no impact to the General Fund.
Prepared by: Dr. Charles Harris, Physician, 783-2785
Approved by: Gary R. Gray, DO, Interim Chief Executive Officer, 783-2504
Attachments:
Amendment No. 3
Amendment No. 2
Amendment No. 1
Navin Haffty & Associates, LLC Original Agreement
Spend Sheet
Attachments on file with the Clerk of the Board