(emr 101) - noac.com presentation.pdfthis presentation focuses on providing practical implementation...

©Copyright & Patent Pending

BY: Rod Walker, FACHE, FHFMANEGLEY, OTT & ASSOCIATES, INC.

STRATEGIES FOR A SUCCESSFUL EMR

IMPLEMENTATION(EMR 101)


• Formed in 1992 by IS professionals

• 40+ Clients– United States / Canada / United Kingdom– Community Hospitals– Academic teaching Facilities– Medical Practices– National Health Centers

• Scope of services:– Systems installation project support– Database development– System testing– System training– Go-live support– Post-live system maintenance– Operational process improvement– Privacy program development


PRESENTATION DISCLAIMERS

Contents of presentation are based on actual operational experience in a hospital setting and reflective of generally applicable best practice observations

This presentation focuses on providing practical implementation insight rather than product specific recommendations.

Recommendations are based on a model which has had proven success.

Successful implementation of an electronic medical record (EMR/CPR) system is contingent upon challenging the traditional silo based operational routines and paradigms for all departments within a hospital.


Understanding the differences between repositories and care delivery decision support systems:

FUNDAMENTAL QUESTIONS TO ASK… ..

• Is the EMR a repository only for storage and retrieval?• Is the EMR a decisions support tool for augmenting and

supporting best practice?

Hopefully, the EMR is both of the above!

WHERE DO YOU BEGIN ?


REPOSITORY– Ability to document

information (e.g.: free text or imported data)

– Provides for convenient access to patient records for documentation and viewing

– Can be customized for hospital priorities

• CARE DELIVERY / DECISION SUPPORT– Ability to utilize discrete

information (either documented or imported) to augment care based decisions

– Strong reporting capabilities due to codified data types

– Knowledge based applications

DIFFERENCES BETWEEN REPOSITORY AND DECISION SUPPORT


THERE ARE FUNDAMENTAL DIFFERENCES BETWEEN A PAPER BASED CHART AND AN ELECTRONIC MEDICAL RECORD WHICH NEED TO BE UNDERSTOOD BEFORE YOU START AN EMR / CPR PROJECT… …

WHAT ELSE DO YOU NEED TO UNDERSTAND?


PAPER CHARTS– Single physical

document– Not easy to update or

modify– Not easy to access– Easy to control access– Not easy to audit

access for active visits

• ELECTRONIC CHARTS– Non-physical record– Easily updated– Easy access to

information– Easy to audit access

depending on product– Can be difficult to

control access if not installed correctly

DIFFERENCES BETWEEN PAPER vs ELECTRONIC CHARTS


SAME ROLE ASPECTS– Still the gatekeeper– Still the facility expert

on laws and regulations regarding access

– Still responsible for accountability of the patient records

• NEW ROLE ASPECTS– More technically savvy– New technical tool set – Control over IT decision

involving charts– Control over security

decisions with charts– More complex due to

decentralized control– More stringent policies

HOW WILL YOUR ROLE CHANGE WITH AND EMR / CPR WORLD ?

AKA: BRAVE NEW WORLD


WHAT DOES YOUR ORGANIZATION HOPE TO ACCOMPLISH?TYPICAL GOALS

• Improve chart legibility• Improve chart completeness• Regulatory compliances• Reduce incident liability from sentinel events• Decrease operational costs via improved efficiency• Improve patient care and outcomes• Improve strategic decision support abilities by the hospital**THESE ADD UP TO RETURN ON INVESTMENT… … .

GOALS FOR THE EMR


DEPARTMENTAL SYSTEMCustomized only for a single operational dept or unitHighly specialized benefitsTends to promote silo based operations

PRACTICE MANAGEMENT SYSTEMFocuses on key volume based activities• Scheduling, registration, charge capture, billing and reports• May support certain clinical documentation & decision support• Tends to promote silo based operations

ENTERPRISE SYSTEMPromotes integration of information across deptsGreatest potential for ROI due to improved operational processes from emphasis on integrationCan incorporates both departmental and practice management functionality due to advanced configuration tool sets that come with the systemRequires greatest amount of design and planning effort to achieve benefits

DIFFERENCES BETWEEN DEPARTMENTAL vs. PRACTICE MANAGEMENT vs.

ENTERPRISE SYSTEMS?


NEEDS ASSESSMENT – JCAHO I.M. standards compliance– Certificate of need foundation– Other reasons

• POLITICS / BUY IN• STRATEGIC ROI

– PROCESS (SURVEY/INTERVIEWS / ETC.)• Can be biased and subjective if not designed with metrics• Need to start with global philosophical goals of the organization

and include key objective oriented areas of interest– AUDIENCE (MD’S, RN’S, ANCILLARY DEPTS, CFO and

HIM)

WHAT’S RIGHT FOR YOUR ORGANIZATION?


TYPICAL GOALS FOCUS ON– FINANCIAL

• Reduced paper cost• Reduced CPAD• Improved revenue via charge capture• Operational efficiency (similar to CPAD but less measurable)

• Reduced LOS• Reduced staffing via automation

– CLINICAL OUTCOMES• Improved patient outcomes via increased use of protocols• Decreased risk of sentinel events

ROIBUSINESS CASE JUSTIFICATION


RFP DEVELOPMENT PROCESS – PROs & CONs (do you really need an RFP?)

• Organizational focus• Legal basis for contracting

Certificate of need (CON)– Time constraints on project time line?– Accountable for project cost tracking?– Accountable for project scope change?– Should project costs be capitalized or expensed?

• Chart of accounts implications– Filing cost for CON application?

OTHER CONSIDERATIONS


Product evaluation team (interdisciplinary team)IT team (technical resources)Clinical analyst team (primary implementation team)Project oversight committee (administrative)Medical staff committee (leaders & early pilot group)

PROJECT TEAM SELECTION


• Executive & clinical champions• Market research to limit max of 6• HIMSS attendance to talk to vendors & see

products (kick the tires phase)• Site visits to validate medical service &

scope of use

VENDOR / PRODUCT SELECTION


VENDOR / PRODUCT SELECTION(continued)

•Limit to 3 products for RFP•RFP submission•RFP response evaluation

•Final site visits or conference calls to validateoutstanding information or concerns•Product evaluation team vote or ranking


IMPLEMENTATION PROCESS

•Contract negotiations & RFP•Executive champion for project•Clinical / IT team meetings•Work plan evaluation•Leadership briefings•Vendor relations•Third party support•Super users


STAYING FOCUSED ON GOALS

•Workflow based design•Clinical process improvement•Operational efficiencies•Improved access to information•Mantras

•Process enabling tool•Dedication of resources •Protecting your investment


SIGNIFICANT CHALLENGES INVOLVING AN EMR

(DURING & AFTER IIMPLEMENTATION)

PATIENT PRIVACY

(AKA: HIPAA)


PRIVACY EXAMPLES

THE FOLLWING SLIDES DEPICT ADDITIONAL INFORMATION AS

EXAMPLES OF PRIVACY RELATED OPERATIONAL ISSUES TO ANTICIPATE

WITH AN EMR


#1- EXAMPLE OFPRIVACY OFFICER ROLE

OBSERVING PUBLIC ACCESS AREAS

(ARE PCs LEFT ON WITH PATIENT RECORDS DISPLAYED??)

*HOSPITAL*


#2- EXAMPLE OFPRIVACY PRACTICES BY STAFF

OBSERVING STAFF PRACTICES

(DO THEY SHARE PASSWORDS??)

*CLINIC*


#3- EXAMPLE OFPRIVACY OFFICER ROLE

INFORMAL STAFF TRAINING

(DEPLOYMENT OF EMR SHOULD INCLUDE BEST PRACTICE TRAINING ON PRIVACY IN ADDITION TO FUNCTIONAL TRAINING OF SYSTEM)

*HOSPITAL*


PHILOSOPHICAL STATEMENTIn a paper based environment there can be less risk of privacy breach because access to information is restrictive by default due to having only a single physical record. In an EMR/CPR environment you have a potential for increased risk of privacy breach due to multiple unobserved concurrent access opportunities from any location or system user. This is true unless the EMR is augmented with a robust system auditing capability plus a strict “need to know” database security design

#4- I.T. INFRASTRUCTURE FOR AUGMENTING PRIVACY PRACTICES


BEST PRACTICE AUDIT & REPORTING CAPABILITIES:Will your EMR system be able to report on risk related profiles defined by your organization such as ?

- staff assignment - order entry- chart documentation - location of PC- patient unit location - employee assigned unit

Can you automate scheduling of reporting frequencies and timing such as an immediate notice of certain events ?Can your privacy officer generate reports on demand ?

#5- EMR INFRASTRUCTURE ABILITY FOR AUGMENTING PRIVACY

PRACTICES


• BEST PRACTICES THAT SHOULD BE INTRODUCED DURING DEPLOYMENT OF AN EMR:

- privacy screens - unique ID and password- changing passwords - not sharing passwords- signing off of system(s) - PHI display control practices- phone practices - PHI disposal practices- need-to-know access - verbal (person-to-person)

communication process

#6- CLINICAL & BUSINESS PRACTICE PATTERNS


#7- EXAMPLES OF CLINICAL & BUSINESS PRACTICE PATTERNS

OBSERVING PUBLICLY VIEWABLE INFORMATION

(VIEWING ACCESS TO PCs AND USE OF PRIVACY SCREENS)

*HOSPITAL*



OBSERVING PUBLICLY VIEWABLE INFORMATION

(ARE PCs ANGLED PROPERLY OR PRIVACY SCREENS USED??)

*CLINIC*



OBSERVING PHYSICAL SECURITY vs. TECHNOLOGY SECURITY PRACTICES

(ARE BOTH PHYSICAL AND TECHNOLOGICAL SECURITY / PRIVACY PRACTICES CONSISTENT??)

*HOSPITAL*



OBSERVING MANAGEMENT OF PATIENT INFORMATION

(IS PATIENT INFORMATION PROPERLY DESTROYED OR DISPOSED ?)

*CLINIC*


#11- ORGANIZATIONAL LEADERSHIP KNOWLEDGE OF HIPAA & PRIVACY

Need for leadership orientation on EMR based privacy matters in order to gain support of enforcement process:

• Regulations specific on privacy• Trends from privacy audits• High-risk related recurrent problem practices• Recommended policy changes


#12- STAFF AWARENESS OF PRIVACY (ASSESSMENT)

BEST PRACTICES FOR AN EMR SHOULDBE REINFORCED ACROSS ALL DEPTS RATHER THAN JUST PATIENT CAREAREAS:– Briefing campaigns on privacy practice

awareness– Privacy education scope in new employee /

staff orientation– informal assessments & in-services in work

areas by Privacy Officer based on operational audit findings.


#13- EXAMPLE OF STAFF AWARENESS ON PRIVACY

FORMAL TRAINING & ORIENTAITON FOR SPECIFIC DEPARTMENTS


IN SUMMARY

• UNDERSTAND WHAT A AN EMR CAN DO FOR YOUR ORGANIZATION

• SET GOALS FOR THE EMR• BUILD A BUSINESS CASE TO DEFINE METRICS

FOR MEASURING ROI• CONDUCT PRODUCT EVALUATIONS, SITE

VISITS AND SYSTEM SELECTION• FORM DEDICATED PROJECT TEAM• STAY FOCUSED ON ORIGINAL GOALS DURING

IMPLEMENTATION• ALWAYS USE THE EMR AS A “PROCESS

ENABLER”


QUESTIONS & ANSWERS

ROD WALKERNOA CORPORATE OFFICE (912) 598-2186

CELLULAR (912) [email protected]

WWW.NOAC.COM

(emr 101) - noac.com presentation.pdfthis presentation focuses on providing practical implementation...

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