i-net - IPHCA's SIMIS Network

Information regarding the implementation of i-net is organized into the following sections:

Implementation Process

Estimated Costs

Approximately seven weeks of planning, preparation, and end user training is required prior to “going live”. Following is an overview of the complete implementation process.

1. Executed Contract. Sign the “I-Net Network Agreement.” Once the contract is executed, i-net Support Staff will contact the agency to begin preparations for implementation.

2. Pre-Site Visit. A “Pre-Site” visit is conducted. Information gathered at the pre-site visit is used to tailor the system to fit the needs of the organization. A hardware assessment will be performed at this time, and the hardware survey must be completed and returned to IPHCA. Note that any custom reporting needs, programming, and/or data conversion are not included in the cost of implementation and are the responsibility of the site to work out with HealthPort. I-net support staff will assist in facilitating this process.

3. Telecommunications Installed. The fractional T1 circuit is installed at the main site. This establishes connectivity between the site and the Springfield host. IPHCA supplies an IP address to the Ethernet port on the router. It is the site’s responsibility to use this address within their own LAN/WAN connectivity to all their remote sites.

4. End User Training. The amount of End User Training needed is determined, and the training is scheduled. The length of the End User Training is based on the number of user licenses the participating site will receive. (The number of licenses issued, as well as any additional licenses purchased by the site, is included in calculating the length of training.) Typically, training lasts for three weeks, but could be for more or less time.
End User Training is performed on-site. Sites can use PCs or workstations to access their practice management software. The site can set up their own training lab environment and IPHCA staff will load the software on the designated PCs.

5. User IDs. User IDs are issued. The site submits a User ID Request Form to IPHCA as soon as possible. These forms must be received by IPHCA at minimum one week prior to the start of Table File Training. IPHCA will assign user IDs (only one user ID is created per user license).

6. Table File Training. Table File Training, which is the configuration of the HealthPort system for the individual site, occurs. During this training, the “super users” of the system (see below) under the guidance of the i-net Training and Support Analyst (or the HealthPort trainer, if needed) begin the process of entering information on the practice, physicians, patient demographics, financial class, and other modules. The training dates are scheduled with the i-net support staff, and by the time the training ends, the site has the tools needed to enter their data into the HealthPort Table Files. Sites are given one week after the training to complete entering data into the table files. The trainers will assist the health center staff with this process, and will also review the table files prior to the start of the End User Training

It is highly recommended that each site evaluate who needs to attend the Table File Training, as critical business decisions will be made during this time. This training is intended for “super users,” or experts on the health center’s current practice management system. Key staff performing billing, patient registration, and administration functions need to attend. While the training is performed on-site, it is also recommended that staff participate in the training independent of their daily responsibilities. Interruptions and distractions during the training can jeopardize a successful implementation.

7. End User Training. One week after the completion of the Table File Training, the End User Training begins. The end user training can continue anywhere from two to five weeks, based on the dates and times determined by the agency staff and i-net support staff.
Topics covered during the training include basic system navigation, patient registration, insurance billing groups, charge entry, payment entry, proof and post, account inquiry, and appointment scheduling. During the final week of End User Training, the health center will begin to enter appointments.

8. Data Conversion. The next step is data conversion. HealthPort and the health center’s current practice management vendor (or third party support entity) work together on the conversion process. There are several steps involved in this process:
a. A “pre-conversion” meeting takes place to review the conversion rules for the health center prior to the data conversion.
b. The health center determines a final cutoff date, and performs a tape back-up.
c. The tape back-up is sent to the practice management vendor or the third party support entity.
d. The data is placed in a flat ASCII file format.
e. The flat file is sent to IPHCA on a CD, or the file uploaded to an FTP site for IPHCA to download.
f. The files are loaded onto the host in Springfield.
g. The actual data conversion is processed by HealthPort staff, then loaded into the health center A/R.
h. The health center staff will review the live data to determine if the conversion is acceptable.

9. Go Live. The site “goes live,” or officially begins operating on the i-net network. The i-net support staff (and HealthPort staff if needed) participates in this process by being present at the health center when the site goes live. The i-net support staff is stationed at the main site to handle operational issues and assist the health center staff in this critical time of transition with patient registration, electronic claim submission, and various other key practice management issues.

10. Follow Up Training. Follow Up Training is conducted on-site, and is intended to correct any potential outstanding operational issues not resolved up to this point in the process.

The following are estimated costs for participation in the i-net network as of January 2007. These costs are for estimation purposes only, and are subject to change.

Overview. The model for IPHCA's SIMIS Network, is based on a centralized server located in Springfield. All i-net network participants access this server via a fractional T1 at the main site. Each site is responsible for the connectivity between the main site and their remotes. IP addressing is assigned by IPHCA, and the IP standards must be adhered to by the participating members. Each site has one A/R, which means that any reporting is done by location code versus A/R.

NSA Cost. The i-net Network Service Agreement (NSA) currently carries an annual fee that ranges between $25,000 and $100,000 – based on the number of user licenses assigned to the network member. Fee range information is provided below:

Number of Licenses	Annual Fee
1 to 19	$25,000
20 to 39	$35,000
40 to 59	$45,000
60 to 99	$50,000
100 to 149	$70,000
150 and above	$100,00

The Network Service fees are paid in quarterly installments. An annual increase, effective the first of October each year, is implemented based on the government’s reporting of the Consumer Price Index (CPI).

User Licenses. The issuance of user licenses will be based on the number of total patients served as indicated on the site’s most current UDS report. User licenses are issued at a 1:350 ratio. For example, if the site’s current UDS reports 33,932 total patients served, 97 user licenses would be issued. This is calculated simply by dividing the total number of patients served by 350.

Telecommunication Costs. While the cost of hardware and hardware maintenance is paid by IPHCA, the fees for phone line services are paid by the participant. Estimated line charges are as follows:

Fractional T1 (128 CIR 256 Burst). The fractional T1 is used for data transmission from the site to the central server. Estimated costs are $420 monthly ($5,040 annually).

Printer Devices. For the HealthPort software, system printers are connected via an Ethernet interface. The preferred equipment is an HP JetDirect device. These can be purchased either as a stand-alone external device for an Okidata printer or Genicom printer, or can be an internal card for HP LaserJet printers.
The estimated cost for these devices is from $200 to $500 per printer, depending on the model that will be used on the system. HealthPort does not recommend directly connecting a printer to either a PC or a terminal. While HealthPort will attempt to make this configuration work, they can not make any guarantees.

Data Conversion. As data conversion is the site’s responsibility, each site must work with HealthPort to receive an estimate and for the details on data conversion. However, the estimated cost for data conversion is a one-time charge between $5,000 and $10,000.
There are three data conversion options available:
1. Demographics only.
2. Demographics with balance forward.
3. Full data conversion.
Generally, option #1 is the least expensive, and option #3 is the most expensive. Most sites chose the “demographics only” option, and keep their legacy system to pay down accounts. Unfortunately, there is no way for the balances to be broken out based on Revenue Code, which makes it difficult to determine where the money is to be allocated to the costs of the center.

Potential Additional Costs. Based on the existing configuration of a site, additional costs may be incurred. Those identified after Phase I include:

Serial Communication Port Server. If sites are using terminals, a serial communication port server will be required. DigiPort is the preferred equipment. While HealthPort will attempt to make any existing equipment work, please keep in mind that if the preferred equipment is not used, HealthPort may not be able to assist your site with communication issues. The estimated cost of a 16 port DigiPort server is $2300; a 32 port DigiPort server is estimated at $4600.
Additional wiring. Your site must be wired with Category 5 wiring or better. All PCs that access the SIMIS server must be able to have an IP address assigned. The MegaView terminal emulation software is used to access the system via a thin client Telnet session.

In addition to the Category 5 wiring, any additional wiring that is needed to extend D-marcs for the fractional T1 line is the responsibility of the site. We have no way of estimating these costs; please contact a cabling vendor for an estimate.

Additional potential costs to be included in your cost analysis:

1. Additional wiring (Category 5 and extending telephone lines).
2. Print servers (a list of system printers multiplied by the cost of the Print server device to make it IP addressable).
3. DigiPort servers (the number of terminals planning to be used will determine the size of the DigiPort server needed).

Savings to i-net network participants. When analyzing the costs of the i-net network, be sure to consider the savings of participating. IPHCA pays for the following services on behalf of i-net network participants:

Server hardware
Server hardware maintenance
Frame relay hardware
Frame relay 24/7/4 network monitoring and support
Frame relay hardware maintenance
HealthPort software support
Software table file and end user training
Daily, weekly, monthly, and yearly archive of data
CPT and ICD9 annual table code updates

In addition, IPHCA also has two full-time staff dedicated to the i-net Network and to providing support to the i-net member health center sites. Both staff are certified by HealthPort, and are very capable of providing training and support to i-net members.