EMR IMPLEMENTATIONS: AN ADMINISTRATOR S POINT OF VIEW

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1 EMR IMPLEMENTATIONS: AN ADMINISTRATOR S POINT OF VIEW Prepared by Gerald Cayer Executive Vice President Presented by Ralph Johnson, FHIMSS, CHCIO Franklin Community Health Network

2 Who We Are Franklin Memorial Hospital Licensed for 70 beds, staffed for 45 beds Independent, sole community hospital in Franklin County in rural Maine Franklin Health 11 Physician Practices 45 employed Multi-Specialty and Primary Care Provider Based Practices

3 System Selection Team was assembled Multi-disciplinary team Primary Care, pediatrics, surgical services, administration, information systems 5 Physicians CEO 2 Practice managers CIO Others, as needed

4 System Selection Started in the Spring of 2008 Primary guiding principle The right system for the doctors is the one they will use Adoption the driving force not technology Comprehensive RFP developed by the team Sent to every vendor that had a presence in Maine (11 vendors) Single Most Important Factor: No vendor would be invited for a demonstration unless proven experience interfacing to our existing hospital system

5 System Selection System selection was for a comprehensive clinical electronic medical record, billing was not a primary selection factor Selection was physician driven Vendors were invited to demonstrate their system on-site, all physicians were invited to review and score the demonstrations Debriefings occurred with providers after the demonstrations and unanswered questions were brought back to the vendors. Repeat demonstrations occurred as a result

6 System Selection Vendor was chosen unanimously by the team CIO and Medical Director of Franklin Health led the contract negotiations All providers were given ample opportunity to participate in the selection process and almost everyone did When the system was chosen they knew they had a stake in the EMR

7 Implementation Strategy Implementation strategy was developed by the EVP, CIO, Practice Administrator and Medical Director Implementation needed to be strategically rapid Understood provider productivity would be impacted during implementation Replacement RVU s were approved for training and implementation that interfered with patient workload

8 Implementation Strategy Complete records could not be converted before activation if we were going to be strategically fast Agreed that a minimum data set needed to be in a patient record before activation in the practice Medication list Problem list Allergies

9 Implementation Strategy Two weeks before a practice went live staff abstracted and loaded the minimum data set for all scheduled patients (1:2) Each practice went live with at least four weeks of the schedule pre-loaded with the minimum data set Light-duty clinical staff and low census nurses were offered the opportunity to abstract the data needed (system thinking)

10 Implementation Strategy Original plan was to activate primary care practices first, then specialties Opportunity arose to hire a dermatologist, decision made to open that practice all electronic first (best laid plans of.) Began implementation in April 2009 First practice went live in September 2009

11 Implementation Strategy Staggered activations every couple of weeks Consulting staff used for implementation Hospital EMR staff to support practices that were live Budget planning took activation into consideration 2 weeks with 50% patient load 4 weeks with 75% patient load Then return to previous load Substitute RVU s offered to providers for the 6 week period of lighter patient load

12 Activation The last practice went live in December 2009 Returned to full revenue by the end of January 2010 Remember planning began Spring 2008

13 Lessons Learned Designing workflow needs to consider pushing work down to the least paid qualified person Don t make your doctors become secretaries Engage Finance in the selection process Looking at the impact of documentation on coding and billing needs to be considered early Appreciating the Cash vs. Accrual based accounting reporting needs Staff Information Systems properly postactivation. It took Franklin a full year before we fully appreciated the need for two additional staff members

14 Lessons Learned Do not go-live in the pediatrics practice the same week a flu outbreak occurs (H1N1 hit hard) System was activated on a Monday. The next Wednesday saw over 60 patients with flu-like symptoms in a single day in pediatrics.

15 Process Validation (Actively) involving providers in the selection process paid big dividends in adoption Using a key physician champion who has stature in the medical staff Budgeting for the temporary productivity loss Creating substitute RVU equivalents Creating an aggressive but reasonable timeline (strategically fast)

16 Proof is in the Pudding Five of the practices were housed on the hospital campus in the new Franklin Health Medical Arts Center The Center opened in the summer of 2008 One year before the electronic medical record system went live.

17

18

19 One month after the last practice went live received a call from the administrator on call at 5:30AM on Saturday January 30 th that a fire was burning in the new Medical Arts Center All paper medical records in the building were either destroyed, damaged or inaccessible

20 The first time a doctor was heard to say Thank goodness we have an electronic medical record! All patient schedules were electronic A command center was established and patient appointments began to be rescheduled the next day (Sunday) Practices were relocated and seeing patients in three days (Tuesday) with full access to the EMR

21 Thank You Any questions?

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