RadiologyRadiology

Judy Iskandar, RTRJudy Iskandar, RTR

Objectives for this SessionObjectives for this Session

• Finishing the Radiology order in RPMS

• Process Changes

• Pros and Cons

• Finishing the Radiology order in RPMS

• Process Changes

• Pros and Cons

Registering the Patient in the Radiology Package

Registering the Patient in the Radiology Package

Registering the Patient in the Radiology Package

Registering the Patient in the Radiology Package

Entering the ExamEntering the Exam

Radiology Reports in EHRRadiology Reports in EHR

Process ChangesProcess Changes

• Using RPMS Radiology Package

• Providers order the exam electronically

• Radiology orders print out automatically

• Using RPMS Radiology Package

• Providers order the exam electronically

• Radiology orders print out automatically

Pros and ConsPros and Cons

• LMP?

• Modifiers?

• LMP?

• Modifiers?

Questions?Questions?

Practical Transition and Practice: The Pharmacy and EHR

Practical Transition and Practice: The Pharmacy and EHR

CAPT Steven C. Doane

Chief Pharmacy Services

CAPT Steven C. Doane

Chief Pharmacy Services

Elements of TransitionElements of Transition• Clinical Transformation

• The redesign of clinical process involving the adoption of information technology

• Fundamental Changes• New business model for health care• Pharmacy/clinic workflow• Mental process changes – paper to electronic

• Planning/Preparation• Standardization• Staff Preparation

• Clinical Transformation • The redesign of clinical process involving the

adoption of information technology

• Fundamental Changes• New business model for health care• Pharmacy/clinic workflow• Mental process changes – paper to electronic

• Planning/Preparation• Standardization• Staff Preparation

EHR/Pharmacy GoalsEHR/Pharmacy Goals

• To make patient data available across the spectrum of care

• Improve the care provided

• Improve the efficiency of care

• Improve patient safety

• Maintain and/or expand pharmaceutical care practice

• To make patient data available across the spectrum of care

• Improve the care provided

• Improve the efficiency of care

• Improve patient safety

• Maintain and/or expand pharmaceutical care practice

Preparing the PharmacyPreparing the Pharmacy

PersonnelPersonnel

• Assess ability to accept and handle change• Problem solve

– Address concerns and issues

– Adapting as the process evolves

– Creation of new procedures – some transitional

• Involve staff • Make assignments to accomplish tasks• Training and communication• Staffing levels and placement

• Assess ability to accept and handle change• Problem solve

– Address concerns and issues

– Adapting as the process evolves

– Creation of new procedures – some transitional

• Involve staff • Make assignments to accomplish tasks• Training and communication• Staffing levels and placement

Equipment - 1Equipment - 1

• Review current department status– Availability of computers/workstations– Staffing ratio and availability to equipment– Type of terminals– Number of workstations– Placement of workstations– Age of equipment and terminals– Availability and placement of printers and

automated counting equipment

• Review current department status– Availability of computers/workstations– Staffing ratio and availability to equipment– Type of terminals– Number of workstations– Placement of workstations– Age of equipment and terminals– Availability and placement of printers and

automated counting equipment

Equipment - 2Equipment - 2

• Needs Assessment for EHR/Ver. 5/7– Computers/workstations and work areas– Placement of equipment for effective operation– Need for multiple points of entry?– Expense to upgrade systems– Ability to maintain systems– Placement of personnel– Electronic signature capability?

• Needs Assessment for EHR/Ver. 5/7– Computers/workstations and work areas– Placement of equipment for effective operation– Need for multiple points of entry?– Expense to upgrade systems– Ability to maintain systems– Placement of personnel– Electronic signature capability?

Workflow - 1Workflow - 1• Transition phase

– Maintaining continuity and safe practice– Managing two systems simultaneously– Map workflow: present and anticipated

• Future processes– Managing patients and prescriptions without a

physical chart– Processing prescriptions: Assurance of accuracy,

safety, verification, etc– Process for documenting interventions and notes– Pharmacists finish – Technicians fill?– Patient signature capture – changes?

• Transition phase– Maintaining continuity and safe practice– Managing two systems simultaneously– Map workflow: present and anticipated

• Future processes– Managing patients and prescriptions without a

physical chart– Processing prescriptions: Assurance of accuracy,

safety, verification, etc– Process for documenting interventions and notes– Pharmacists finish – Technicians fill?– Patient signature capture – changes?

Workflow - 2Workflow - 2• Policies and Procedure Review

– Standardization– Uniformity – electronic systems highlight

weaknesses in operation– Managing CII prescriptions– Managing “outside” prescriptions– Providing the insurance audit trail

• Patience– Allow time to adjust, adapt, and evolve to new

practice and business model– Allow time for pharmacy preparation prior to EHR

– Familiarity with Pharmacy RPMS Version 5/7

• Policies and Procedure Review– Standardization– Uniformity – electronic systems highlight

weaknesses in operation– Managing CII prescriptions– Managing “outside” prescriptions– Providing the insurance audit trail

• Patience– Allow time to adjust, adapt, and evolve to new

practice and business model– Allow time for pharmacy preparation prior to EHR

– Familiarity with Pharmacy RPMS Version 5/7

Practice Considerations and

Best Practices

Practice Considerations and

Best Practices

Finishing the PrescriptionFinishing the Prescription

• Prescription order transfers from EHR to pending file on pharmacy prescription screen

• Pharmacist involvement and intervention• Opportunity for pharmaceutical care• Review process

– Cover sheet for ADR and other key data– Provider notes– Review prescription and make changes– Send for filling

• Prescription order transfers from EHR to pending file on pharmacy prescription screen

• Pharmacist involvement and intervention• Opportunity for pharmaceutical care• Review process

– Cover sheet for ADR and other key data– Provider notes– Review prescription and make changes– Send for filling

EHR Prescription Orders -1EHR Prescription Orders -1• New orders

– Use of quick order lists• Individualize for facility

• Make quick orders for key drugs and dosages

– Consider multiple refills

• Renewal– Pros

• quick

• No changes in previously written prescription

– Cons • Inability to modify Rx

• Previous errors will remain

• Do not used until on 5/7 for period of time

• New orders– Use of quick order lists

• Individualize for facility

• Make quick orders for key drugs and dosages

– Consider multiple refills

• Renewal– Pros

• quick

• No changes in previously written prescription

– Cons • Inability to modify Rx

• Previous errors will remain

• Do not used until on 5/7 for period of time

EHR Prescription Orders -2EHR Prescription Orders -2

• Refill requests

– Benefits• Can be prompted to pharmacy from EHR• Shows up as “refill request” in pending file• Processes similar to other refills

– Problems• What if refill is too early?

– Process, hold, pending file, or discontinue?– Cannot undo request

• Refill requests

– Benefits• Can be prompted to pharmacy from EHR• Shows up as “refill request” in pending file• Processes similar to other refills

– Problems• What if refill is too early?

– Process, hold, pending file, or discontinue?– Cannot undo request

Partial Fill FunctionPartial Fill Function• Advantages

– Can fill limited amount based on previous prescription order

– Does not affect order with refills currently in system

• Disadvantage– Does not show on patient profile

• Consideration of policy change– Provide for multiple refills (up to 1 year)– Decreases workload for pharmacy– Decreases partial fills– Decreases changes to current prescriptions which

affect provider’s efficiency with EHR

• Advantages– Can fill limited amount based on previous

prescription order– Does not affect order with refills currently in system

• Disadvantage– Does not show on patient profile

• Consideration of policy change– Provide for multiple refills (up to 1 year)– Decreases workload for pharmacy– Decreases partial fills– Decreases changes to current prescriptions which

affect provider’s efficiency with EHR

Hold – Unhold FunctionHold – Unhold Function• Used to place a prescription in a hold category for

further/future follow-up• Common use – placement of an order on the system

until next or additional refills needed by patient• Can edit prescription when released from hold• Problematic

– Individual sites need to set standards for use– Overwrites current prescription items– Providers cannot affect held prescriptions– Can write comments, but only visible through EHR

• Used to place a prescription in a hold category for further/future follow-up

• Common use – placement of an order on the system until next or additional refills needed by patient

• Can edit prescription when released from hold• Problematic

– Individual sites need to set standards for use– Overwrites current prescription items– Providers cannot affect held prescriptions– Can write comments, but only visible through EHR

Return to Stock and ReissueReturn to Stock and Reissue• Previous Prescription(s)

– Adds additional refill to the prescription– Process reissues by refilling

• Original Prescription(s)– “R” Designation given– To Reissue

• RP – Reprint prescription(s)• Edit Fill Date (optional)• RL – Release prescription(s)

• Problem– Retains original fill date on the reissued

prescription and profile unless changed

• Previous Prescription(s)– Adds additional refill to the prescription– Process reissues by refilling

• Original Prescription(s)– “R” Designation given– To Reissue

• RP – Reprint prescription(s)• Edit Fill Date (optional)• RL – Release prescription(s)

• Problem– Retains original fill date on the reissued

prescription and profile unless changed

Paperless RefillPaperless Refill• Simple process to turn on and use

• Consider workflow changes– No progress notes, PCC(s), etc.– Direct patient interaction

• Procedure– Select drug(s) to be refilled– System asks for POV on each drug– POV chosen from sequence of 3 lists – Problem list, POV

list, then free text narrative entry– Prescriptions print as previously

• Refill line prescriptions are handled similarly

• Simple process to turn on and use

• Consider workflow changes– No progress notes, PCC(s), etc.– Direct patient interaction

• Procedure– Select drug(s) to be refilled– System asks for POV on each drug– POV chosen from sequence of 3 lists – Problem list, POV

list, then free text narrative entry– Prescriptions print as previously

• Refill line prescriptions are handled similarly

DocumentationDocumentation

• Pharmacy Note– When? Each refill, significant interventions, other?– How? Free text, template, other?

• Education Coding– Where? Wellness Tab– When? Complete patient education prior to a note– How? Select education topic, level, plan, time– Create visit if different day than original provider visit

• Add name as a provider• No POV usually needed except for counseling V68.1• Can create POV pick list to aid in process

• Pharmacy Note– When? Each refill, significant interventions, other?– How? Free text, template, other?

• Education Coding– Where? Wellness Tab– When? Complete patient education prior to a note– How? Select education topic, level, plan, time– Create visit if different day than original provider visit

• Add name as a provider• No POV usually needed except for counseling V68.1• Can create POV pick list to aid in process

ImplementationImplementation

Christopher Lamer

Grant Rogers

Christopher Lamer

Grant Rogers

New TerminologyNew Terminology

POE – Provider Order Entry

CAC – Clinical Application Coordinator

GUI – Graphical User Interface

OE/RR – Order Entry/Results Reporting

PIMS – Patient Information Management System

TIU – Text Integration Utilities

POE – Provider Order Entry

CAC – Clinical Application Coordinator

GUI – Graphical User Interface

OE/RR – Order Entry/Results Reporting

PIMS – Patient Information Management System

TIU – Text Integration Utilities

Server side applications – roll and scroll; back end applications

CPRS – Computerized Patient Record System

VueCentric Framework

Vista – Veterans Health Information System & Technology Architecture

Server side applications – roll and scroll; back end applications

CPRS – Computerized Patient Record System

VueCentric Framework

Vista – Veterans Health Information System & Technology Architecture

Leadership, Commitment, Buy-in

Leadership, Commitment, Buy-in

• Confirmed Leadership support• Tribal Endorsement• Area Office Support• Patient Awareness• Clinician driven

• Confirmed Leadership support• Tribal Endorsement• Area Office Support• Patient Awareness• Clinician driven

Force AnalysisForce Analysis

What factors will encourage EHR implementation?

What EHR implementation barriers exist?

Hire a CACHire a CAC• The incumbent is responsible for the implementation and support of multi-service

software packages that automate the capture of clinical encounter information and its subsequent retrieval. The application coordinator manages the customization of the site parameters and addresses integration issues with other software packages. The incumbent assists in the implementation of new software products obtained by the facility that cover these functions.

• Analyzes and evaluates processes related to information flow and serves as liaison between service lines concerning these processes…Assists staff in the efficient use of the current software.

• Provides training to clinical staff … emphasizes timeliness, accuracy, security and the importance of these functions on every other clinical application. Coordinates classes with IRM training section and serves as backup for basic training classes.

• Incumbent promotes an awareness of the importance of data validity and data security and coordinates efforts to correct deficiencies and errors that occur in the electronic record..,provide secondary support on related software modules…

• The incumbent is responsible for the implementation and support of multi-service software packages that automate the capture of clinical encounter information and its subsequent retrieval. The application coordinator manages the customization of the site parameters and addresses integration issues with other software packages. The incumbent assists in the implementation of new software products obtained by the facility that cover these functions.

• Analyzes and evaluates processes related to information flow and serves as liaison between service lines concerning these processes…Assists staff in the efficient use of the current software.

• Provides training to clinical staff … emphasizes timeliness, accuracy, security and the importance of these functions on every other clinical application. Coordinates classes with IRM training section and serves as backup for basic training classes.

• Incumbent promotes an awareness of the importance of data validity and data security and coordinates efforts to correct deficiencies and errors that occur in the electronic record..,provide secondary support on related software modules…

Develop training plan for CAC

Develop training plan for CAC

• �Training for CAC & Implementation Team, • Basic Site Manager, • Fileman, • PCC Outputs,• Lab Package, • Radiology Package, • Preparing Pharmacy for EHR• Advanced EHR trainings, • Site Visit to EHR site

• �Training for CAC & Implementation Team, • Basic Site Manager, • Fileman, • PCC Outputs,• Lab Package, • Radiology Package, • Preparing Pharmacy for EHR• Advanced EHR trainings, • Site Visit to EHR site

Training Site Webpage

Implementation TeamImplementation Team

• Clinical Champions from each discipline (Lab,RN, RPh,MD,etc)

• Administration/Executive Leadership

• Information Technology

• Include Area IRM representation

• Clinical Application Coordinator

• Clinical Champions from each discipline (Lab,RN, RPh,MD,etc)

• Administration/Executive Leadership

• Information Technology

• Include Area IRM representation

• Clinical Application Coordinator

Implementation Team RolesImplementation Team Roles

• Identify and define Policies and Procedures • Address staffing and scheduling during

transition• Peer Training & Marketing• Monitor and Execute Implementation Plan• Design and Approve templates, menus, and

ordering lists for E.H.R.

• Identify and define Policies and Procedures • Address staffing and scheduling during

transition• Peer Training & Marketing• Monitor and Execute Implementation Plan• Design and Approve templates, menus, and

ordering lists for E.H.R.

HardwareHardware

• Evaluate current hardware needs• Evaluate network needs• Begin procurement process for

hardware• Hire additional IT staff if

necessary• Install new equipment and test it

before using

• Evaluate current hardware needs• Evaluate network needs• Begin procurement process for

hardware• Hire additional IT staff if

necessary• Install new equipment and test it

before using

Upgrade Hardware/Infrastructure

Upgrade Hardware/Infrastructure

• RPMS server

• Training server

• Network

• Lab Interface Upgrade

• Workstation Access - Everywhere• Backup Power

• RPMS server

• Training server

• Network

• Lab Interface Upgrade

• Workstation Access - Everywhere• Backup Power

Assess utilization of RPMS "Point-of-Service" packagesAssess utilization of RPMS

"Point-of-Service" packages• Assure packages are being used correctly

before going to EHR– Immunization 8.0,– Women's Health,– Diabetes Management, – Behavioral Health System v3.0, – Behavioral Health GUI, – Dental, and – Case Management

• Implement or assure correct usage to appropriately capture required data.

• Assure packages are being used correctly before going to EHR– Immunization 8.0,– Women's Health,– Diabetes Management, – Behavioral Health System v3.0, – Behavioral Health GUI, – Dental, and – Case Management

• Implement or assure correct usage to appropriately capture required data.

• Identify go-live clinic or location• Address staff concerns

– Identify all affected staff: lab, pharmacy, nursing, radiology, medical records…

• Schedule an overview of EHR training• Publicly promote the EHR implementation

– Discuss with all parties: hospital, tribal, labor union, etc.

• Identify go-live clinic or location• Address staff concerns

– Identify all affected staff: lab, pharmacy, nursing, radiology, medical records…

• Schedule an overview of EHR training• Publicly promote the EHR implementation

– Discuss with all parties: hospital, tribal, labor union, etc.

Setup Implementation Plan/Timeline

Setup Implementation Plan/Timeline

Implementation StrategyImplementation Strategy

• Implementation-Who and When

• Everyone at once - one at a time?

• Lab ordering , then radiology ordering, then pharmacy ordering, then notes

• Bring up one team/dept at a time

• Implementation-Who and When

• Everyone at once - one at a time?

• Lab ordering , then radiology ordering, then pharmacy ordering, then notes

• Bring up one team/dept at a time

Implementation Sample ScheduleImplementation Sample Schedule

2005

Jan Feb Mar Apr Ma y Jun Jul Aug Sep

DR. FARRELL DR. BRANNON FRANCES PLAC IDE TRAC Y W OLFE

DR. HARVE Y KATE MCK ITTR ICK DR. TOEDT N ILOFER

DR. BR O W N DR. H Y DE INPAT IENT TR AI N ING INPAT IENT SETUP IMPLEMENT ELECTR O NI C MAR JOAN PARKS MON ICA P RI EST DR. W ILDCATT DR. G RI MES DR. MAULT DR. STE W ART

Document PlansDocument Plans

• Assess risk and effects of initial changes in productivity

• Develop contingency plan

• Provide area office with a copy of implementation plan

• Assess risk and effects of initial changes in productivity

• Develop contingency plan

• Provide area office with a copy of implementation plan

0

0.5

1

1.5

2

2.5

APR MAY JUN JUL AUG

PATS PER HOUR

Prepare for InstallsPrepare for Installs

• Review CAC and User Guides

• Coordinate with consultants

• Prepare a plan for providing staff with training on new RPMS packages

• Review CAC and User Guides

• Coordinate with consultants

• Prepare a plan for providing staff with training on new RPMS packages

Kernel 8 (1010), Mailman 7.1 p1004 patched to support CPRS v20

Kernel 8 (1010), Mailman 7.1 p1004 patched to support CPRS v20

Site RPMS SystemBaseline applications: Cache 5.0.12 (FM22, F200 conversion, K8), Laboratory v5.2 p17, Radiology v4.0/4.5 p10, Outpatient Pharmacy v6 p5, Pharmacy Inpatient Suite v4.5, Immunization v8.0 p1, Women’s Health v2 p9, Patient Chart v1.4 p1, Patient Registration v7.0 p4, MAS v5, p8Current patches of the following: AUT, AUPN, ACPT, AVA, XB; (ER package)

Site RPMS SystemBaseline applications: Cache 5.0.12 (FM22, F200 conversion, K8), Laboratory v5.2 p17, Radiology v4.0/4.5 p10, Outpatient Pharmacy v6 p5, Pharmacy Inpatient Suite v4.5, Immunization v8.0 p1, Women’s Health v2 p9, Patient Chart v1.4 p1, Patient Registration v7.0 p4, MAS v5, p8Current patches of the following: AUT, AUPN, ACPT, AVA, XB; (ER package)

PCC Data Entry v2.0 P7PCC Data Entry v2.0 P7

Fileman 22 (1002), HL7 v1.6 p1005, Kernel Toolkit v7.3 p1002, Kernel v8 p1009

Fileman 22 (1002), HL7 v1.6 p1005, Kernel Toolkit v7.3 p1002, Kernel v8 p1009

- Integrated Billing 2.0- Auto Info Collection Systems 3.0- Generic Text Generator 3.0

- Integrated Billing 2.0- Auto Info Collection Systems 3.0- Generic Text Generator 3.0

- VA Lexicon v2.0- VA Health Summary v2.7- Visit Tracking/PCE/ Clinical Reminders (requires PIMS 5.3)

- VA Lexicon v2.0- VA Health Summary v2.7- Visit Tracking/PCE/ Clinical Reminders (requires PIMS 5.3)

Update Your SoftwareUpdate Your Software

PIMS 5.3patched to support CPRS v20

Radiology v5.0(requires PIMS 5.3)

Lab v5.2 p18

TIU v1.0(requires PIMS 5.3)

Ancillary Packages

Pharmacy Data Management-PSS v1 p1

Part of EHR suite:

Dietetics 5.0Nursing 4.0Surgery 3.0Medicine 2.3

Problem List 2.0I/O Package 4.0Vitals 5.0

Scheduling GUI (9/30/04)Vista Imaging v3.0

(Optional)(Requires Radiology

5.0)

IHS-EHR

Graphical User Interface (GUI) Electronic Health Record

Pharmacy Package (OE/RR 3.0 Inpatient Pharmacy 5.0, Outpatient Pharmacy 7.0, Consults 3.0) with PSG mods

Controlled Substances 3.0, Drug Accountability 3.0, Auto Replenishment 2.3, Pharmacy Benefit Management 3.0, BCMA 2.0

Electronic Health Record Functionality

Clinical Queue, Services tab, Provider POV, Health Maintenance (Wellness), Nursing triage, CPT codes, Problem List, Immun.

PIMSPIMS

• Patient Information and Management System– Scheduling– ADT – security

• Patient Information and Management System– Scheduling– ADT – security

Begin Work flow Analysis and Business ProcessesBegin Work flow Analysis and Business Processes

• Follow the paper chart from patient registration to the billing office– What processes will change with EHR?– What processes will not work with EHR?– Make sure everyone is on the same page!

• Follow the paper chart from patient registration to the billing office– What processes will change with EHR?– What processes will not work with EHR?– Make sure everyone is on the same page!

PCCPatient

Database

PCCPatient

Database

Patient RegistrationPatient Registration

Data EntryData Entry

CodingCoding

Patient VisitPatient VisitPharmacyPharmacy

LabLab

BillingBilling

RadiologyRadiology

Case MgtCase Mgt

Key

Paper Flow EHR Flow Common Flow

Key

Paper Flow EHR Flow Common Flow

Ballpark TimelineBallpark Timeline

• PIMS install• Radiology 5.0 install – after PIMS• EHR-Pharmacy 5/7

– Needs to be scheduled– Requires several months of preparation– Pharmacy needs to be used 3-6 months before

implementing medication order entry.

• Installation of GUI client - After Pharmacy• EHR Set-up• Go-live – 3-6 months after Pharmacy

• PIMS install• Radiology 5.0 install – after PIMS• EHR-Pharmacy 5/7

– Needs to be scheduled– Requires several months of preparation– Pharmacy needs to be used 3-6 months before

implementing medication order entry.

• Installation of GUI client - After Pharmacy• EHR Set-up• Go-live – 3-6 months after Pharmacy

Lab PreparationsLab Preparations

• All Labs need to be entered in RPMS– On-site Labs– Reference Labs– State Labs

• Computer Access Points

• Changing from Esig to EHR

• All Labs need to be entered in RPMS– On-site Labs– Reference Labs– State Labs

• Computer Access Points

• Changing from Esig to EHR

Pharmacy PreparationPharmacy Preparation

• Pharmacy preparation can take up to 2 months!– Adverse drug reactions - 1 month

• Provide GMRA key to data entry to document allergies and adverse reactions

– RPMS/Scriptpro Format -1-2 days– Dosages in Pharmacy 7 -1 week– Quick orders -1 week

• Pharmacy preparation can take up to 2 months!– Adverse drug reactions - 1 month

• Provide GMRA key to data entry to document allergies and adverse reactions

– RPMS/Scriptpro Format -1-2 days– Dosages in Pharmacy 7 -1 week– Quick orders -1 week

EHR ConfigurationEHR Configuration

• Quick Orders• Design templates • Design Menus and Quick Orders

– Meds, Labs, Radiology, Nursing• Define consults• Pick lists for ICD9CM & CPT Codes• Note Titles• User Setup (keys)• Parameters• Printing Chart Copy and Orders• Print Formats

• Quick Orders• Design templates • Design Menus and Quick Orders

– Meds, Labs, Radiology, Nursing• Define consults• Pick lists for ICD9CM & CPT Codes• Note Titles• User Setup (keys)• Parameters• Printing Chart Copy and Orders• Print Formats

EHR Before ConfigurationEHR Before Configuration

EHR After ConfigurationEHR After Configuration

Medication Quick OrdersMedication Quick Orders

Lab Quick OrdersLab Quick Orders

TemplatesTemplates

Go Live Week Go Live Week

• 4-6 hours training outside of clinic

• Departmental Trainings

• Use Knowledgeable Trainers (IHS/VA)

• One-On-One Training Also

• Competency Checklists

• 4-6 hours training outside of clinic

• Departmental Trainings

• Use Knowledgeable Trainers (IHS/VA)

• One-On-One Training Also

• Competency Checklists

Going Live WeekGoing Live Week

There is no-where safe to hide!

0

20

40

60

80

100

120

Mon Tues Wed Thurs Fri

Stress Level

How the Week First GoesHow the Week First GoesGrowling at CAC’sGrowling at CAC’s

Crying, gnashing of teethCrying, gnashing of teeth

Excited Excited

TGIFTGIF

Cat in the microwaveCat in the microwave

Going LiveGoing Live

• Intense CAC and IT Support• Make Appropriate Scheduling Adjustments• Daily Debriefings….

– Procedural Questions– Technical Issues– How did it work before EHR?– More Training

• Intense CAC and IT Support• Make Appropriate Scheduling Adjustments• Daily Debriefings….

– Procedural Questions– Technical Issues– How did it work before EHR?– More Training

Miscellaneous Policies/Procedures

Miscellaneous Policies/Procedures

• Use of personal templates

• Template approval process

• Use of chat and broadcast

• Use of personal templates

• Template approval process

• Use of chat and broadcast

Things to Think AboutThings to Think About

• Referral / Consults• Patient Registration: Centralized /

Decentralized• People who aren’t using E.H.R. yet-

how are they handled?• Handle the missing PCC elements?

SHX, colonscopy, refusal,mammogram (offsite)

• Referral / Consults• Patient Registration: Centralized /

Decentralized• People who aren’t using E.H.R. yet-

how are they handled?• Handle the missing PCC elements?

SHX, colonscopy, refusal,mammogram (offsite)

Medical Records ProcessMedical Records Process

• When to stop pulling the chart

• Filing notes in chart?

• Print And File Chart Copies? Batch Print?

• Release Of Information?

• Outside Consults? Scanning?

• Incorrect Entries?

• When to stop pulling the chart

• Filing notes in chart?

• Print And File Chart Copies? Batch Print?

• Release Of Information?

• Outside Consults? Scanning?

• Incorrect Entries?

Impact on StaffingImpact on Staffing

• Provider support during implementation

• Future plans to shift staff from Medical Records to other locations (clinic)

• Provider support during implementation

• Future plans to shift staff from Medical Records to other locations (clinic)

What does EHR cost?What does EHR cost?

Or… How much do you have?

What goes into costs?What goes into costs?

• Hardware– Servers, computers, peripherals

• Network– Wireless, LAN, Servers– Vista Imaging, Meuse

• Additional staff• Additional time• Emotional distress• Loss of friends

• Hardware– Servers, computers, peripherals

• Network– Wireless, LAN, Servers– Vista Imaging, Meuse

• Additional staff• Additional time• Emotional distress• Loss of friends

Cost Reporting

Has your facility hired a Clinical Application Coordinator (CAC)?

If YES, please indicate month

and year of hire:

Did your facility add IRM staff to support EHR?If YES, please indicate month

and year of hire:

Did your facility hire or contract for any other staff in support of EHR implementation?

If YES, please indicate month

and year of hire:

Has your facility purchased hardware of any kind SPECIFICALLY for EHR?

Type (i.e. server, computer, LAN, etc. -- no detail required) Date Acquired Approximate Cost

If YES, please indicate below the dates of acquisition and costs of any EHR-related hardware and associated costs

(consultation, installation, etc. Please report by date acquired, not by type of equipment.)

Please report ONLY those costs directly associated with your facility's implementation of EHR

Please estimate the costs for the CAC position (salary, benefits, indirect costs)

during the first year:

Please estimate the costs for any new IRM positions (salary, benefits, indirect costs)

during the first year:

Please estimate the total cost (up to the first year only) for these additional staff:

YES NO

YES NO

YES NO

YES NO

Questions?Questions?