!

A Web-based EHR provides LSU Healthcare Network with many benefits, including the ability for physicians to access medical records from home.

ExtendingAccessibility

Starting Over

Jason M. Doiron, MBA

LESS THAN TWO YEARS AFTER HURRICANE KATRINA STRUCK New Orleans with devastating force, LSU Healthcare Network (LSUHN) at Louisiana State University's School of Medicine has a new Web-based electronic health

record (EHR) system. The benefits of the EHR are tremendous: physicians can access patient records from anywhere in the world and patients can relax knowing that their records are maintained in a secure, remote digital warehouse. Although the road to success was relatively short, it was certainly not without its share of challenges.

www.advanceweb.com/HIE! October 2007 • ADVANCE for Health Information Executives!

In May 2006, six months after Katrina, I joined LSUHN as director of information technology. Our local health system was in a time of severe crisis; our data centers in downtown New Orleans had been underwater for weeks and more than 75 percent of our patient charts were flooded and destroyed. In short, I had to rebuild my organization's entire information technology infrastructure from scratch—and fast! My technology teams started the rebuilding process with the basics: ordering new servers, workstations and cables. Next we began unifying our network by provisioning voice and data lines and restoring Internet connectivity throughout the city. Once the network was back up and running, we restored our mission-critical practice management system (PMS), followed by other enterprise applications such as HR, payroll and Financials. Today, most of our clinics now reside in newly provisioned office space located well above the ground; however, other sites such as severely d a m a g e d C h a r i t y H o s p i t a l (Louisiana's well-known Tier 1 trauma facility) have yet to reopen their doors. In fact, a walk through of Charity Hospital today reveals a soundless, desolate institution with wall calendars at nurses' stations still displaying pages from August 2005. Ultimately, the post-Katrina recovery period was a time of extreme emotional stress and

!

devastation in New Orleans. Taking baby steps, we made slow but steady progress, and in 2006 our clinical supply chain began to stabilize. Taking advantage of posi t ive organizational change, our executive team began searching for a fully integrated EHR that would raise the healthcare IT bar of success for New Orleans and ultimately provide better continuity of care for our patients. Our mission was simple: Evaluate and select a fully integrated EHR solution vendor and related software product suite within 30 days. We appointed a 12-member EHR selection committee, which included my self, our chief officers and physicians. Our panel evaluated three software vendors and thoroughly performed clinical, financial and technical proper due diligence. The results? Each committee member independently graded the vendors and unanimously voted for the Allscripts product suite. This decision allowed us to go live with in 90 days of starling the selection process. We implemented the charge capture module first b e c a u s e i t w a s t h e q u i c k e s t implementation "win"; moreover, we were able to measure fast results.

The primary benefits of web-based, electronic c h a r g e c a p t u r e — t h e elimination of handwritten mistakes and mismatched c o d i n g e r r o r s , a n d monetary savings—began t o r a i s e c o m m u n i t y awareness, enabling us to gain necessary project momentum and further exciting our physicians and staff. Since the initial vendor selection victory in the first quarter of 2007, we

www.advanceweb.com/HIE!

LSU's data center shortly after Hurricane Katrina. The entire facility was destroyed and had to be rebuilt. Pictured below, Director of Information Technology Jason Doiron in LSU's restored data center.!

October 2007 • ADVANCE for Health Information Executives!

!!now have nearly every module successfully launched and running in the Allscripts suite, including Base, Charge, eRx, Order, Result, Scan, Document, Note and Analytics. Our EHR core implementation team provides clinical workflow redesign, interface support, on-call priority cellular-based help desk for physician technical support, end-user training

sessions, and clinical consulting for on-boarding of new providers into Allscripts. Our top priority during the rapid EHR implementation period was to better serve our patients using iHealth—a personal health record (PHR) and

patient web portal solution that subsequently integrates directly into Allscripts. This keeps patients in our direct line-of-sight and helps to bridge the gap between phone calls and routine office visits. The web portal empowers our patients to stay informed, allows them the added conven ience o f e l ec t ron ica l ly renewing prescriptions, and provides

better communication with our physicians and clinical call center. To further assist patients, we established patient kiosks (similar to airport check-in terminals) in many of our patient waiting rooms at our clinics, allowing patients to create and

maintain their own medical records while waiting to see their physicians. PHRs enable physicians to access patient-entered records, even when they are away from their primary care facility. This ensures that when the next natural disaster occurs, patient data will be both secure and globally accessible by any physician. Physicians can also interact with

patients through e-consultations using i H e a l t h . E - c o n s u l t s a r e a l s o automatically captured in the EHR, saving time and resources. While the health care industry provides CPT codes for e-consultations, this can expose serious legal implications for

www.advanceweb.com/HIE! October 2007 • ADVANCE for Health Information Executives!

health care professionals. For example, if a patient were to send a text message to his physician with a complaint of chest pain, how would the doctor know if the patient was suffering from simple indigestion or a serious heart attack? Due to the fact that e-consults are still an emerging technology with standards that have yet to be fully defined, our physicians will continue to see patients in person when responding to medical problems. For now, our patients and physicians use e-consults for simple, routine requests such as prescription refills. For providers, iHealth offers the ability to establish a personalized web presence. With a few short clicks, physicians can make basic information available to patients such as o f f i c e h o u r s , c o n t a c t information, patient education and even patient intake forms. Th i s enab le s pa t i en t s t o complete required office forms before the arrive at our clinics, thereby streamlining the intake process.

Redefining 'home office' A web-based EHR can support interesting applications for the traditional work/home divide. Most physicians receive clinical calls or text messages at home, but until recently they had to answer those calls to the best of their ability without access to p a t i e n t c h a r t s , l a b s a n d diagnostic images. Furthermore, they were required to go to the hospital—some times in the middle of the night—in order to provide urgent care or make important medical decisions. As of today, the rules have changed. Our providers can now access all of their patient files from home by simply connecting to the Internet. Now that physicians have heightened access to information, they also have greater medical-legal responsibility. Web-based patient records are creating gray areas with regard to legal and compliance issues. For example, now that patient records are virtually extended into the home of

the physician, how and to what degree must a provider respond?

List lessons When I extended EHR access to our remote home-office physicians, our IT department suddenly lost a sense of corporate standards and control; suddenly, they had to provide remote help desk assistance to hundreds of additional heterogeneous home PCs. Currently, at any given hour, hundreds of physicians in our network have access to our EHR from home. In order to create a win-win between remote users and IT staff alike, my support teams created a Top 10 EHR Issues blog for physicians who want to leverage technology at home, yet keep

things running smoothly. Our Top 10 list provides useful and easy-to-understand tips and tricks for quickly configuring a home computer for remote, web-based access. For example, recommendations include the requirement for remote users to have the latest spyware and anti-virus protection. Additionally, they must be running industry-standard Microsoft

Internet Explorer, as opposed to Firefox, Safari or other secondary web browsers. Further, users need to enable pop-ups and secure trusted sites in order to interact with the required Microsoft .NET software application c o n t r o l s — a l l o f w h i c h a r e prerequisites to successfully running an Allscripts EHR. Finally, users should be using a high-speed Internet connection such as cable or DSL. These helpful hints make technical support easier in remote environments and simultaneously help to decrease the flood of help desk calls. What are we doing to make EHR access better? We are currently in the process of implementing single sign-on (SSO) for all of our enterprise

applications. SSO allows our staff to utilize a single username and password for authentication to all of our enterprise software systems. The result is a seamless end-user experience between mixed applications, preserving patient context from work to home. To make remote EHR access even easier on our physicians, we are testing virtual desktops and thin client architecture from Wyse Corp . These ze ro -endpoint devices are basically stripped-down PCs without a hard drive or USB ports, allowing us to better secure patient data. Zero endpoint devices are typically less expensive, maintain corporate s e c u r i t y, c a n b e r a p i d l y deployed, offer a richer end-user experience, can be centrally managed and are much more energy efficient compared with

traditional desktop computers. We are piloting this advanced technology to a new breed of tech-savvy physicians who want

to maximize productivity and better compete in the marketplace. Forget the "plug-and-pray" scenario; instead, our providers are opting for out-of-the-box, worry-free simplicity. If we can arm our physicians with better tools and information, they can ultimately make more informed decisions and better serve our patients.

Jason Doiron was the Allscripts EHR Project Chairman at LSU Healthcare Network. He partnered with Dr. Brent Wallis, a key physician sponsor—to rollout electronic health records throughout the metro New Orleans area after Hurricane Katrina.

www.advanceweb.com/HIE! October 2007 • ADVANCE for Health Information Executives!