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Sand or Cement? Sand or Cement? Building a Physician Foundation Building a Physician Foundation in EHR Implementations in EHR Implementations Stephen Beck MD, FACP, FHMISS, CPHIMS

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Page 1: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

Sand or Cement?Sand or Cement?Building a Physician Foundation Building a Physician Foundation

in EHR Implementationsin EHR Implementations

Stephen Beck MD, FACP, FHMISS, CPHIMS

Page 2: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 2 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

ObjectivesObjectives

Understand the general state of IT

Review the need for physicians on IT projects

Learn how to find physician resources

Review hospital implementation essentials and pitfalls

Page 3: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 3 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Page 4: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 4 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

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Page 5: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 5 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

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Page 6: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 6 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Patients are Seeking Health Care Patients are Seeking Health Care InformationInformation

2007 Study from the Center for Studying Health System Change

– 56% of American adults sought information about a health concern from a source other than their physician (up from 38% in 2001)

– 32% looked for information on the internet (up from 16% in 2001)

Page 7: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 7 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

And Hospitals Need ITAnd Hospitals Need IT

(Tell me something I don’t already know)

Page 8: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 8 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Page 9: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 9 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

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Page 10: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 10 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

ButBut……

Page 11: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 11 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Page 12: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 12 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

CPOE Causes Errors??CPOE Causes Errors??

This is not plug and play technology

Proper planning and implementation is essential

You need to leverage the systems to reap the benefits

Page 13: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 13 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Page 14: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 14 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Page 15: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 15 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Reasons to Use PhysiciansReasons to Use Physicians

Physician Attitudes

Peer status

Front Line Experience

“You just don’t understand…”

Page 16: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 16 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Physician ResourcesPhysician Resources

Interested physicians

Consultants

Vendor references

Page 17: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 17 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Finding a ChampionFinding a Champion

PC interest / knowledge

Experience is a plus

Respect of other physicians

Specialty or sub-specialty representation

Time commitment

Hospital vs. Outpatient

Stipend for work

Page 18: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 18 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Physician Uses in ImplementationsPhysician Uses in Implementations

Roles:

Core team / Implementation team

Reporting to CEO/CIO

Training / Testing /Support

Sales: “Road Show”

Page 19: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 19 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Physician Uses in ImplementationsPhysician Uses in Implementations

Testing / Support

Workflow development testing

Order Set and Charting development and testing

System Enhancement Recommendations

Customization for Individual Physicians

Page 20: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 20 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Assembling the TeamAssembling the Team

Involve a cross section of the organization

Project manager

Clinical staff

Nursing staff

Department Managers are not always the right choice!

Good communicators are essential

Page 21: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 21 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

A PhysicianA Physician’’s Priority Lists Priority List

Ease of use

Efficient system

No added time to the day

Remote Access

PACS in hospitals

Customization!

Decision Support

Page 22: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 22 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

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Page 23: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 23 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Evaluation of Physician /Hospital Evaluation of Physician /Hospital ReadinessReadiness

Survey of staff and physicians

Computer skills - offer education!

Local attitudes / culture

Use of hospitalists / residents

Physician’s need to use the hospital

Page 24: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 24 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Essentials of Hospital Essentials of Hospital ImplementationImplementation

Nursing Involvement

Order Sets

Training

Testing - Does it really work?

Incentives to early adopters

Resident considerations

Start with easy wins, end with CPOE

Page 25: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 25 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

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Page 26: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 26 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

PitfallsPitfalls

Believing everything your vendor tells you

Waiting for consensus

Waiting too long to get physicians involved

Not providing incentives / stipends

Not being open to enhancement suggestions

Not using decision support

Not using change management principles

Page 27: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 27 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

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Page 28: Physician Considerations in CPOE implementationscsohio.himsschapter.org/sites/himsschapter/files/Chapter...Building a Physician Foundation in EHR Implementations Physician Uses in

© CSOHIMSS 2008 | Slide 28 Sand or Cement? Building a Physician Foundation in EHR ImplementationsNovember, 2008

Questions ?Questions ?