implementing an ehr amda power point charlotte

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PAST DOQ-IT INTO PRACTICE

Mark A. Heard, MD CMD

Mary F. Heard, MT MBA



2500 N. EsplanadeSuite 102

Cuero, Tx 77954

[email protected]



We debated as a group for four years.

We knew that our charts were inadequate.

We inherited several thousand charts

from a forty year old practice.



� We had recently purchased the practice from our community hospital.

� We were well established in the practice butnot as owners.

� We needed to integrate 3 doctors, 4 nursepractitioners, and 25 employees into a

functional unit covering2

office locations and5

nursing homes.



Space



TIME



MONEY



efficiency



fear



regulation



� Our initial quotes varied from $50,000 to$250,000 for an Integrated PracticeManagement/ E.H.R.

� Quotes were difficult to compare and pressureto buy was high.

� Quotes could be very fluid depending on howclose you were to signing



� Efficiency - less people, paper, dictation

� Accessibility ²print, fax, escribe, email

� Less mistakes in notation, transcription,implementation

� Better communication between staff and otherproviders and institutions



� Specialty

� Volume

� Practice style



� Implementation downtime

� Decreased patient volume

� Steep Learning curve

� High upfront cost

� Would doctors buy in?



� Practicemanagement software only

� Template Records

� The sky didn·t fall but not there yet



� Less cost

� Eliminatedmost dictation

� Worked well for routine NH sick visits

� Eliminated doctors putting off dictation



� DOQ-IT

� TMF

� Survey and assist

� No grant money for implementation



What DOQ-IT taught me about choosing anE.H.R.

The Texas Medical Foundation, under contract

with Health Quality Institute of CMS providedat no cost to small/ medium primary carepractices

Doctors Office Quality of Care ² InformationTechnology ¶s goal was to improve quality ofcare, safety, and efficiency by promoting theadoption of information technology



� Determine the features most important to yourpractice

� Practice Questionnaires

� Staff surveys

� Patient surveys

� Personal observations



� Understanding Industry surveys

� Learn the language

� Vendor questionnaires

� Contract negotiations

� Request for proposals

� Sample scenario for evaluating systems



� Team approach

� Put requirements in writing

� Realistic budget

� User network



� Integrated

� Certified

� Reputation ( look for reviews), get referencesfrom like practices, go look at system inpractice

� Service ( local or portal to portal)



� Do not rush your purchase

� Motivate staff

� Plan for unexpected cost



� Management of clinical and PM information ina coordinated manner. (preventativeprotocols)

� Manage # of employees� Control cost per visit



� Great info when chart is finished

� Less paper every month

� Less paper scripts with inherent mistakes

� Easy H&Ps for NH and Hospital

� Better routine notes

� Better coding



� Still slower, especiallymonthly NH notes

� Paper not eliminated

� Support issues , time and cost

� Payment issues secondary to PM change

� Not all docs had easy conversion

� Not all staff survived

� Nursing home logistical issues remain



� FIRST DAY- LONGEST DAY OF THE YEAR

� FIRSTWEEK-TOTAL EXHAUSTION

� SECONDWEEK- STILL FRUSTRATED

� THIRDWEEK- BETTTER BUT LOTS OFKINKS

� FOURTHWEEK- SEEING SOME LIGHT

� THIRD MONTH-WORKINGOUT LITTLETHINGS



� START 4-6 MONTHS BEFORE GO LIVE

� MAKE ALL DOCTORS PARTICIPATE

� DECIDE EARLYWHAT TO SCAN

� INVOVE KEY STAFF FROM DAY ONE



� EXTEND HOURS

� CUT LOAD

� INCREASE PROVIDERS

� NO DAYS OFF DURING GO LIVE PROCESS



� VENDOR ASSIST

� BANK ( GOOD LUCK)

� HOSPITAL ASSIST (safe harbor)

� Grants



� Assume 25% OVER NEGOTIATED PRICE

� ASSUME DROP IN VOLUME FOR FIRST 3-6MONTHS OR LONGER

� CONSIDER RUNNINGOLD PM INPARALLEL FOR FIRST 1-2 MONTHS IFCHANGING

� W

HAT ARE COSTS FOR TRAINING

ANDMAKE SURE IT IS REALISTIC ( portal toportal)



� Comparing EHRS, Memag.com/ITBulletin2-09

� www.doqit.com

� DOQ-ITUniversity

� Your Connection to Electronic Health RecordSolutions in Texas, TMF Health Quality

Institute

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