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DOQ-IT:EHR Roadmap to
Success
TEPR 2006
DOQ-IT DelmarvaDelmarva Foundation
May 21, 2006
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DOQ-IT Delmarva TeamMichael C. Tooke, MD, FACP Chief Medical OfficerBeth B. Franklin, RN, MS, CPEHR/CPHIT EHR Implementation AdvisorDonette Emory Branch, CPEHR/CPHIT Quality Improvement ConsultantTobi PrattEHR Implementation Advisor
Meskerem Abebe, RN, MSClinical Informatics Advisor
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Delmarva Foundation• National, not-for-profit organization• Mission: Improve Health• 30+ year history, 250 employees (associates), $30+ Million Revenue• Associates: Physicians, Nurses, Scientists, Analysts, Reviewers, Improvers• Quality Improvement Organization (QIO) for Maryland and DC• Customers: Centers for Medicare & Medicaid Services (CMS), State Medicaid Departments, Agency for Healthcare Research and Quality(AHRQ), Private Foundations, Private Firms• We Provide:
• Resources• Education• Training• Data Analysis
• Clinical Review• Best Practice Sharing• Collaborative Improvement• Leadership
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DF Team National ExperienceMedicaid External Quality ReviewMedicaid Quality AssuranceMedicare Quality Improvement OrganizationMaryland Patient Safety Center
Medicare Quality Improvement OrganizationMedicaid External Quality Review (Washington, DC)
Developmentally Disabled Statewide Quality Assurance Program
Medicaid External Quality Review
Program Safeguard ContractWestern Integrity States
Medicare+Choice Quality Assurance/Performance Improvement Project
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Delmarva FoundationMaryland PerformanceExcellence Award
Winner of the 2005 U.S. Senate Productivity Awardfor Maryland
Eligible for Baldrige Award pilot for non-profit organizations
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Quality Improvement Organizations (QIOs)National network of organizations in each U.S. state and territory under the direction of CMS.Enacted by federal statute “to improve the efficiency, effectiveness, economy, and quality of services delivered to Medicare beneficiaries.”Work with consumers, physicians, hospitals, and other caregivers to refine care delivery systemsEnsure patients get the right care at the right timeShare information about best practices with providers, to identify opportunities and provide assistance for improvement.
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CMS Quality Improvement Organizations
Non-governmentalAll 50 states & territoriesExisting commitment to work with
PhysiciansHospitalsLong term care facilitiesHome health agencies
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National Local Level
“The government’s 10-year strategy to have most Americans using electronic health records will fail unless small physician offices adopt technology…
…I can’t get to that goal without getting to the small physician practices.”
Dr. David Brailer, former National Coordinator, ONCHIT
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“DOQ-IT”
Doctor’s Office Quality-Information Technology:
A three-year project to accelerate the adoption of health information technology, in adult primary care physician offices.
A program of free technical assistance from Delmarva for adult primary care physicians committed to harnessing the power of electronic clinical information to improve patient care.
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Target physician groups
Adult primary care practicesFamily PracticeGeneral PracticeInternal MedicineIM/CardiologyIM/Endocrinology
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At Any Stage of HIT Adoption!
Without existing HITWith some modality
e-prescribinge-laboratoryMedical Registry
EMR in place, but would like assistanceTried, failed, would like to try again…
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Agenda for Workshop
3:15 pm – 3:25 pm Introduction3:25 pm - 5:00 pm EHR Roadmap Part I
* Adoption* Implementation
5:00 pm – 5:15 pm Break 5:15 pm – 6:00 pm EHR Roadmap Part II
* Implementation (continued)* Care Management
6:00 pm – 6:15 pm Questions
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PHR (Personal Health Record) - “contains medical information and it is owned by the patient.”1
EMR (Electronic Medical Record) - the electronic version of the health information about the patient owned by the healthcare organization. 2
EHR (Electronic Health Record) – ”is a longitudinal electronic record of patient health information produced by encounters in one or more care settings.”2
1 Hartley, CP, Jones III, ED EHR Implementation American Medical Association Press 20052 http://www.himss.org/ASP/topics_ehr.asp
EMR vs. EHR
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EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & office2. Planning Develop goals & barriers
Identify opportunitiesWorkflow redesign
3. Selection Understand and review available HIT/EHR options
4. Implementation Prepare staff and office for EHR. Go Live!
5. Evaluation Production of ECIImplement workflows
6. Improvements Practice evidence-based medicine. Patient safety.
CAREMANAGEMENT
IMPLEMENTATION
ADOPTION
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Assessment
What you want, what you need, what you can afford…
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EHR Implementation Roadmap
Adoption
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EHR Implementation Roadmap1. Assessment
ADOPTION
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When you think about implementing an EHR, what does “assessment”mean to you?
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Assessment
Assess the practice to:Identify opportunities to design and improve processes for patient careImprove workforce moraleIntegrate Health Information Technology (HIT)
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“Start where you areUse what you have
Do what you can…”
Arthur Ashe, Tennis Player, Wimbledon Winner
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Identify and Analyze Practice Needs
Know the practiceUnderstand the processesUnderstand the workflowIdentify the “pain points”Prioritize and focusPlan for changeManage change
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ASSESSING YOUR PRACTICE“The Green Book”
www.clinicalmicrosystem.org
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What is “The Green Book”?
A diagnostic tool that provides guided discovery of your patients, people, processes, and patterns. It helps you to start thinking about improvement…from the “inside-out.”
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Plan for
CHANGE!
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AssessmentIdentify a Physician ChampionDevelop an EHR Implementation Team to identify practice issues, (the team should be selected from key staff in each area of the practice.)How often does everyone get together?
HuddlesStaff meetings
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Assessment
Workflow assessment“Walk through”Identify pain points and bottlenecks
Begin mapping: Current processesIdealistic processesWhere do the two intersect
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Assessment
Assign an individual or team leader to lead practice changes (this may be the physician)For a successful implementation:
Plan regular communication with staff Staff must be committed to adoption of EHRChoose workflow changes to maximize results
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EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & officeADOPTION
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PlanningFailing to plan is planning to fail!
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EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & office2. PlanningADOPTION
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How does a practice plan for an
EHR implementation?
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Planning
Identify goals, priorities and barriers Identify high priority needs, features and functions of EHR from staff perspectiveDefine a project scopeCommunicate to staff the anticipated change
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Planning
Identify project goalsWhat are you doingWhen do you want to do itWhat is your budget
Long term objectives of the practiceWhat do you need nowWhat do you need in 5 years based on your projected growth
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Identify Project Scope
Putting a fence around what you want to accomplish
Identify goals and objectivesProduct functionalityResources availableTime defined
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Establishing ScopeWithin the scope:
Identify and prioritize components that are critical to project success
• Budget• Physical environment• Hardware requirements• Software requirements• Human resources• Budget
Set realistic timeline for attaining goals
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Establishing ScopeInvolve practice leader(s) with:
Requirements identification Project scope managementFeature functionality
Involvement ensures:QualityTimelinessSuccess
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Planning
Understand the implications of different rollout approaches:
Big BangIncremental
Do I need an “RFP” (Request for Proposal)?
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Planning
Scanning Patient ChartsProcess of making an electronic image of a documentScanned documents may or may not be searchableIs scanning the right option for your practice?
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Planning
To scan or not to scan?What scanning capabilities do vendors provide?Identify key information and documents that will need to be in the systemHow much of the chart do you want to scan?
The whole chart?The last three visits?Only pertinent data?
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PlanningDiscuss a plan for entering existing chart documents into the system
When will data be entered How will existing documents be enteredHow will new information be entered
How much will you scan going forward?ReportsOther documents
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Planning
Other planning needs:Change management with staffNotifying patients and other parties about your move to EHR
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Financial Planning
Do I need to complete:A cost/benefit analysis
Return on Investment (ROI) for an EHR system
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Classifying the Benefits“Hard” benefits
Predictable, reliable decrease in costs or increase in revenue
“Stretch” benefitsFinancial in character, but variable in quantityVaries based on effectiveness in using IT tools
“Soft” benefitsNon-financial
• Improved quality of care• Patient safety• Higher staff satisfaction
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Hard Dollar BenefitsCapture lost charges IF charges are now
being lost1% - 5% revenue gain
Reduce ‘defensive downcoding’
IF downcoding is prevalent
5% - 11% revenue gain
Reduce claims denials & delays
IF denials or delays are common
15 – 30 day A/R speedup
Increase preventive and management
services
IF new services are profitable AND capacity
exists
5% revenue gain
Reduce transcription IF dictating AND willing to change
$5K - $15K/yr costs cut
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Stretch BenefitsIncrease physician
productivityIF physicians have extra capacity AND get ‘faster’
with EMR
0% - 15% revenue gain
Staff efficiency IF overtime being paid, or IF staff ratio can be
reduced
0% - 15% cost reduction
Reduced chart pulls IF practice charged for pulls
$5/pull or $6K/yr/MD
Reduce cost of paper chart materials
IF office goes “paperless”
$1-5/patient or$1k/yr/MD
Reduce costs of chart storage and archiving
IF office goes paperless and chart room
eliminated
$1k/yr per physician
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Approximate costs per physician in a 2 physician family practice office
Assumes preexisting PMIS, but no preexisting computers at point-of-care
Year 1:<$20k> cash deficit
Cumulative ROI <$20k>
Relative CashFlows
Project Mgmt $5k
Training $5k
Software $7.5k
Hardware $7.5k
Revenue gain fromright coding $5k (50% of expected)
H/W, S/W Support$3k
Revenue gain from right coding $10k
Year 2:$12k cash benefit
Cumulative ROI <$8k>
H/W, S/W Support$3k
Revenue gain from right coding $10k
Year 3:$17k cash benefit
Cumulative ROI $6k
Cost saving from transcription reduction $10kCost saving from transcription
reduction $5k (50% of expected)
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EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & office2. Planning Develop goals & barriers
Identify opportunitiesWorkflow redesign
ADOPTION
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Selecting an EHR
Wading through the possibilities…
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EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & office2. Planning Develop goals & barriers
Identify opportunitiesWorkflow redesign
IMPLEMENTATION
ADOPTION
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EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & office2. Planning Develop goals & barriers
Identify opportunitiesWorkflow redesign
3. SelectionIMPLEMENTATION
ADOPTION
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How do you know if an EHR system is right for you?
How do you go about selecting a new car?
Research, Evaluate, Test Drive!
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Requirements
Do you need a new billing system (PMS)?Does your PMS support an interface to an EHR?Do you want a single vendor solution or an interface?Do you want a server on site or a vendor to host it remotely?
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Integrated Solution - ‘Best of Fit’
Single databaseInformation real-timeSimilar “look and feel’Reports less complicated to writeSingle support sourceNo “finger-pointing”
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Interfaced Solution - ‘Best of Breed’
Multiple databasesAdditional hardware and softwareInformation delivery delayAdditional maintenanceGreater complexity and costsComplicated support structure
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EHR Hosting ModelsApplication Service Provider (ASP)
Data & servers located off-site by third-partyCommunication across InternetSystem administration and maintenance managed remotelyLower initial costsOwnership and maintenance is spread over timeWho controls data?
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EHR Hosting Models
Locally Hosted ApplicationData and servers located in practiceCommunication across local networkSystem administration & maintenance managed locallyHigher initial cost of ownershipControl of data
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EHR Hosting Models
Web-basedUtilizes web browser to access patient dataNo installation of software on PC requiredNo ongoing management of PC requiredSystem updates easy to manageWho controls data?
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EHR Hosting Models
Client-ServerUtilizes specific softwareRequires installation/configuration of software on PCRequires ongoing management of PCSystem updates difficult to manage Potential conflict with existing software
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InteroperabilityWhat do you want to connect to?
LaboratoriesLocal hospitalPhysician Offices/ClinicsPharmaciesMedical devices
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Documentation Options
Understand the implications of your options:TemplatesFree TextVoice RecognitionDictation
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What will provide value?
Value does not necessarily equal ROIFocus on things physicians do 95% of timeWhat are staff needs?
EmailInstant messagingPatient education toolsForms
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Don’t Forget About…
HIPAAAuthentication & authorizationRole-based securityAudit trailsElectronic signature
Documented policies and procedures
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Full Featured vs Good Enough SystemsFull Featured
More customizable and flexibleMore moving partsBetter modeling of practice’s workflowsImplementation more complex and longerMore training required
Good Enough Less ability to accommodate workflowsImplementation less complex and shorterEasier to get going and maintain
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End User HardwarePhysician work habits
How and when do physicians do their work?Patient-physician interactionMobility needs (home, house calls, etc)Comfort level with technology
Practice infrastructureDesktop space in exam roomsSpace in staff workstationsNeed to re-wire practice
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End User Hardware OptionsDesktop PCs
Powerful & inexpensiveFull use of EHR
LaptopsPowerful & relative inexpensiveFull use of EHRFairly mobile, but short battery lifeErgonomics of physician-patient interaction
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End User Hardware OptionsTablet PC
Slate vs. convertibleLarge screen displayRequires different work styleExpensiveExtremely mobile but short battery life
PDAsExtremely mobile but short battery lifeLimited screen = limited use
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End User Hardware Options
Document ScannersHigh vs. low throughput (PPM)ResolutionType depends upon needs• What are you scanning• Who is scanning
‘Paperless’ vs. ‘chartless’
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Database Server
Buy Best Server You Can AffordExpandability – 5 year plan• Processor• Memory• Disk space
Back-up – what can go wrong• Redundancy• Failover server• Routine system back-up
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EHR Selection ToolsWeb-based Tools
EMR Update – www.emrupdate.com (free)EMR Institute – www.emrinstitute.com (free)HIMSS Ambulatory EMR Selector –www.ehrselector.com ($49/$149)EMR Consultant – www.emrconsultant.com (free)ELMR.com – www.elmr-electroninc-medical-records-emr.com (free)
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EMR Selector (EMR Consultant)
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EMR Selector (EMR Consultant)
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EHR Vendor Reports
AC Group Annual Reportwww.acgroup.org
KLAS Reportwww.healthcomputing.com
Family Practice Management Vendor Surveywww.aafp.org/fpm/20010100/45elec.html
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Other Sources of InformationDiscussion Forums
EMR Update, AAFP
Vendor Fairs and ExhibitsTEPR EMR Road ShowAAFP Intelligent Medical PracticeDOQ-IT Vendor Fairs
ReportsAC Group, KLAS
Peers
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Request for Proposal (RFP)General Format
Proposed solutions to problemsImplementation processTrainingSupportCosts
• Hardware and software• Implementation and training• Interfaces• Support
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Request for Proposal
RecommendationsFocus on practice’s needs and requirements Ask vendor to tell “HOW” system will address practice’s problems, not “IF”Ask specific, focused questions – not broad, open-ended questions
• Vendors will usually say they can do it – you need to probe and see it for yourself.
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Remember yourDUE DILIGENCE
of the vendor you select
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Evaluating EHR System OptionsProduct Demonstrations
Use patient visit-based scenarios the practice defines
• Multiple chronic conditions• Different diagnostic/treatment needs• Utilize actual patient cases
Develop work flow scenarios based on your practice• Referrals• Prescription refills
Ask data questions• Patients taking certain meds• Diabetic population• Elderly population
Make it your demo not the vendors demo!
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Options for Evaluating EHR System
Product DemonstrationsEvaluate functionality vs. ease of useDrive product – don’t be drivenMake vendor show youValidate vendor’s RFP responseInvolve practice staff
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Vendor Evaluation Matrix
Functionality/Usability Priority Vendor A Vendor B
Charting
Can the system accommodate (and potentially improve) my workflow?
Can I easily build and/or customize “off-the-shelf” templates?
Does the system offer a variety of data entry options, e.g., dictation, voice recognition, structured notes, etc.?
Can I make subsequent edits and addendums to clinical documentation?
Does the system alert me about unfinished portions of the clinical documentation and can I bypass it if necessary?
Can I access other such clinical information as previous labs, progress notes, etc. from a patient’s “electronic chart” while charting?
Does the system allow me to multi-task, e.g., create task, order lab, etc. while charting?
Does the system allow me to forward patient information to staff, other physicians, etc. via e-mail, electronic faxing, messaging, etc.?
Does the system ensure that only authorized clinicians can sign clinical documentation?
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Evaluating EHR System OptionsSite Visits
Vendor recommends site Visit practice with similar profile
• Size and specialty• Problems and goals• Geographic area
Conduct structured visit• Overall goals• Questions to ask• Things to observe
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Evaluating EHR System Options
Site VisitsInvolve practice staffSpend as much time as possible watching system in use Understand references’ incentives
• Discounts• Freebies
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Contract Considerations
What If:Need to get out of contract
• Bi-lateral termination clauseVendor goes out of business
• Data ownership• Source code escrow
Vendor merges or is acquired
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Contract Considerations
What If:Things don’t work …
• Performance warrantiesThings go wrong
• Resolution process• Breach of contract• Exit points and strategies
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Contract ConsiderationsScope of License
Total vs. concurrent usersTerm vs. perpetualTransfer of licensesAdditional licenses
Bold-typed ClausesWarrantyDisclaimerIndemnificationLimitation of liability
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What to Include in the Contract
Milestone-based Payment ScheduleIncentive for successful completionLeverage for practice
Example15% - Signing of contract10% - Installation of software and hardware20% - Completion of training25% - Completion of system testing30%- Final system acceptance
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Key Points to EnsurePreliminary Project Plan
Timing and scopeResource allocation
Acceptance TestingUnit (individual modules)Integration (inter-functionality of modules)Interface (functionality between systems)Stress testingLiveFinal (30 – 60 days post go-live)
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Key Points to EnsureCompliance with HIPAA
Transaction standardsSecurityConfidentiality (Business Assoc. Agreement)
Compliance with CHI StandardsOwnership of Data
Non-proprietary, readable format, e.g., XMLData can be converted to another system
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Key Points to UnderstandMinimum Hardware Specs
Practice’s Responsibilities
Ways vendor can terminate agreement and make contingency plans
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What’s included in your contract?Implementation & Training
What are costs?What resources are provided?How many hours included?What else is included?
• Project plan• Training and user documentation• Implementation guides
Who covers expenses, e.g., travel?What if more assistance is needed?Cost for customizations?
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What’s included in your contract?Interfaces
What interfaces will be provided?What are costs for each?What is included, e.g., specifications, development hours, etc.?What if additional hours needed?Who pays for modifications?Who will troubleshoot when it goes down or there are errors?Who is responsible for upgrades?
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What’s included in your contract?Support Agreement
Level of support provided• Normal hours• Response time• Services includedCost for additional or increased support• After hours, weekends, and holidays• Increased response time• Local or onsite assistanceWho is responsible for upgrades, patches, etc.?
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What’s included your contract?
Third Party Software/ContentAdditional costsAdditional licenses requiredResponsibilities for support and upgradesRestrictions on use
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http://ehr.medigent.com/assets/collaborate/2005/11/04/EHI-EHR-Master-Quote-Guide.doc
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Final thoughts on contracts
Does what you are purchasing meet your requirements?Have you done your due diligence on the vendor?Have your contract reviewed by your legal council
If they are not familiar with EHR vendor contracts find someone who is
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EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & office2. Planning Develop goals & barriers
Identify opportunitiesWorkflow redesign
3. Selection Understand and review available HIT/EHR optionsIMPLEMENTATION
ADOPTION
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Questions?
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Break time…back in 10 minutes!
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ImplementationYou have signed a contract, now
what do you do?
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EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & office
2. Planning Develop goals & barriers Identify opportunitiesWorkflow redesign
3. Selection Understand and review available HIT/EHR options
4. Implementation
IMPLEMENTATION
ADOPTION
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What needs to be done to get the system up and running…
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Incremental ApproachReduces “shock” to staff and physiciansSpreads out costs of software and implementation over longer periodProject less likely to ‘blow up’Total training, implementation costs may be higherROI is not achieved as quicklyMore of a risk getting ‘stuck’ at midpoint
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“Big Bang” ApproachShortens painful “parallel paper/EMR” operation periodAchieves ROI more quicklyLess likely to get “stuck” part way to the goalHigher risk of ‘blow up’Significant productivity hit at go-live and some time afterwardStaff or physicians unable to cope with change may rebel
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Critical Success FactorsExecutive Support/SponsorshipPhysician and End-user InvolvementProject Scope and Project PlanCommunicationStaff TrainingTesting
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Implementation
PreparationWorkflow changesPaper to electronicPolicies and proceduresScenario testingDevice testing
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Project Management Components & Tools
Project Scope and PlanRoles and Responsibilities MatrixAction Items and Risk TrackingCommunications ProcessMeasure Satisfaction/Quality
Sign-Off Milestones
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Project Kick-off
CommunicationsTeam BuildingStrategy for successSet expectationsValidate practice readiness
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Fitting the System to the Practice
Workflow reviewTemplate buildingAlertsInterface specificationsReportsChange management
Current vs. new workflow transition
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Fitting the System to the PracticeHardware InstallationSystem Configuration• Data Dictionaries• Templates• Workflow• Reports
Interfaces Developed
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Fitting the System to the PracticePolicies and Procedures
Backup and DowntimeSupport and MaintenanceSecurity
Test Infrastructure ConnectivityNetworkDatabase
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Fitting the System to the PracticeTest Interface(s)
PMSResultsOrderse-Prescribe
Test Workflow Changes
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Training the Practice on the SystemMake Training Mandatory for all Staff Members
Administrative UsersPhysician End UsersSystem Support Users
Devote sufficient time to trainingDevelop super-users Do not overload staff during training
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Training the Practice on the System
Training Agenda ItemsDay-to-Day Workflow ChangesAdministration and Clinical SetupGo Live Planning
Create training documentation
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Go-LiveRollout the system to site(s)Shadow staff operationsDebrief, trouble-shoot, and fine tuneMaintain an ongoing issues list
System/software issuesInternal issuesWorkflow issuesGo-live and Post go-live
Celebrate success and make it fun!Have snacks to celebrate the go-live
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Post Go-Live Transition to support Implementation evaluation
Lessons learnedAdd new features/functions
If incremental approach taken
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EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & office
2. Planning Develop goals & barriers Identify opportunitiesWorkflow redesign
3. Selection Understand and review available HIT/EHR options
4. Implementation Prepare staff and office for EHR. Go Live!
IMPLEMENTATION
ADOPTION
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EvaluationOr, now that you are live…
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EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & office
2. Planning Develop goals & barriers Identify opportunitiesWorkflow redesign
3. Selection Understand and review available HIT/EHR options
4. Implementation Prepare staff and office for EHR. Go Live!
CARE MANAGEMENT
IMPLEMENTATION
ADOPTION
122
EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & office
2. Planning Develop goals & barriers Identify opportunitiesWorkflow redesign
3. Selection Understand and review available HIT/EHR options
4. Implementation Prepare staff and office for EHR. Go Live!
5. EvaluationCare Management
IMPLEMENTATION
ADOPTION
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Now that the EHR is live:Is it meeting the goals you set
during your assessment and planning phases?
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Evaluation
Conduct post-live review of:Practice goals being metTraining needsWorkflowData captureReports
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Evaluation
An ongoing process Conduct post-live evaluation at determined intervals
DailyWeeklyMonthlyQuarterly
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EvaluationDid the practice meet their goals with installing EHR?
Not all goals will be met at liveWho needs additional training?
Assess staff daily/weekly during initial live period to determine need for additional trainingAre providers charting correctly?
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Evaluation
Are your new processes working?TweakTrashTry again!
Is you staff adopting to the changes?
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EvaluationHow do you notify the staff that the patient is ready to be seen? Are the ALERTS appropriate?What about:
Referrals?Prescriptions?Reports from outside sources
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Are you collecting the data you want?Does the system allow you to capture and report on the clinical data you want?
Assessment data• Vital signs• Tests performed• Pertinent history
Preventive data• Immunizations• Mammograms
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Workflow ChangesAre your charges being captured correctly?
Daily review of charges to ensure they are being captured for 30-60 days post live
Are the reports telling you what you need to know?Now what happens to the paper chart?
How long do you keep it before sending to storage? What do I do with all the paper reports that come in to the office?
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Scanning Patient Charts
Did what you scanned meet your needs:The whole chart?The last three visits?Only pertinent data?
How much will you scan going forward? ReportsOther documents
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EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & office
2. Planning Develop goals & barriers Identify opportunitiesWorkflow redesign
3. Selection Understand and review available HIT/EHR options
4. Implementation Prepare staff and office for EHR. Go Live!
5. Evaluation Production of ECIImplement workflowsCare Management
IMPLEMENTATION
ADOPTION
133
IMPROVEMENT
The use of electronic clinical information…
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EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & office
2. Planning Develop goals & barriers Identify opportunitiesWorkflow redesign
3. Selection Understand and review available HIT/EHR options
4. Implementation Prepare staff and office for EHR. Go Live!
5. Evaluation Production of ECIImplement workflows
6. Improvement
Care Management
IMPLEMENTATION
ADOPTION
135
Now that you are live…what to do with the data?
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Video
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Care ManagementA process which:
AssessesPlansImplementsCoordinatesMonitors, and Evaluates the options and services to meet
the health needs of an individual or a population of patients.
138
Your Practice can now…
Track patient follow-up activities, patient compliance and patient progressTrack patient health maintenanceSupport patient self managementIncrease patient education with online disease management toolImprove continuity of care and timeliness of diagnoses and treatment
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Using Electronic Clinical Information (ECI)
A successful DOQ-IT practice must be able to do all of the following:
Generate medication listsGenerate problem listsEnter laboratory tests and retrieve resultsSelect medications, print them out or transmit them to a pharmacy, and conduct safety checks
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Using Electronic Clinical Information (ECI)A successful DOQ-IT practice must be able to do
all of the following:Identify specific patients by disease Produce reminders or promptsDevelop patient-specific care plans
In at least two of the following clinical areas:DiabetesHypertensionCoronary Artery DiseaseCongestive Heart FailurePreventive Services
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Individual Patient Care Management
Improve the availability, timeliness, and accuracy of communication among health care providers Point-of-care decision support Rapid and remote access to patient information Easier chronic disease management Integration of evidence-based clinical guidelines
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Population Management
Target specific patients with special care needs (immunization, treatments, tests)Aggregate data on all patients to look of overdue interventionsStratified patients by risk or conditionsObtain population reports and profilesProvide feedback to healthcare providers
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Population ManagementSegment the patient population to administer tailored educational interventionsUse simple statistics to characterize the practice needs and patients demands
(Note: make sure that the EHR system that you are buying has population management functionality. Not all EHR systems have these features)
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EHR Implementation Roadmap1. Assessment Practice readiness:
Physician(s), staff & office2. Planning Develop goals & barriers
Identify opportunitiesWorkflow redesign
3. Selection Understand and review available HIT/EHR options
4. Implementation Prepare staff and office for EHR. Go Live!
5. Evaluation Production of ECIImplement workflows
6. Improvement Practice evidence-based medicine. Patient safety.
CAREMANAGEMENT
IMPLEMENTATION
ADOPTION
155
Acknowledgements
Centers for Medicare and Medicaid ServicesLumetra, QIO for CaliforniaNew Mexico Medical Review AssociationeHealth InitiativeVistA Office
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Suggested Readings/ReferencesHartley Carolyn P., Jones, Edward D.,III EHR Implementation: A Step-by-Step Guide for the Medical Practice. AMA Press, 2005Houck, Suzanne What Works: Effective Tools & Case Studies to Improve Clinical Office Practice. HealthPress Publishing, 2004Kilo, Charles M, MD, MPH, Leavitt, Mark, MD, PhD, FHIMSS Medical Practice Transformation with Information Technology. HIMSS, 2005Wasson, John, MD, Benjamin, Regina, MD, MBA How’s Your Health? FXN Corporation, 2005.
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Questions?
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