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1 EHR Challenged?

2 Background In the fall of 1996, the Carson Health Network was created to serve as an umbrella organization under which all the region s individual health providers could better surrounding communities. The Network s affiliated 14 clinical sites are located in 7 mid-michigan communities including: Ashley, Carson City, Greenville, Fowler, Ithaca, Lyons, and Stanton

3 Map of Network Sites

4 Location of CCH-owned Sites 1. Carson City Hospital 2. Carson Outpatient Behavioral Health Center 3. Carson Family Care Center 4. Internal Medicine Specialists 5. Pediatric and Adolescent Specialists 6. Ashley Family Care Center 7. Fowler Family Care Center 8. Greenville Family Care Center 9. Ithaca Family Care Center 10. Lyons Family Care Center 11. Stanton Family Care Center

5 Location of Independent Sites Independent Sites in Network 12. Carson City Hospital Orthopedics 13. Carson Surgical Associates 14. Carson Area Orthopedics New Independent Sites Planned for 2010 Carson City Dr. Ferguson, DO Maple Rapids Dr. Steigerwald, DO Stanton Dr. Gaffney, MD

6 Network Hardware Systems / Connectivity Two redundant, IBM AS/400 processors, located in separate locations, ensure safe backup and zero downtime. Remote computer access for physicians, and a wireless infrastructure for employees and patients. Clinical sites are wired to the hospital and to each other so medical and other information can be shared between physicians and with the hospital when it s essential to a patient s health. Network security safeguards include biometrics and digital signatures, off-site back-up systems, firewalls and encryption.

7 Diagram of EHR System Interfaces

8 Network Electronic Medical Record Software Inpatient EHR HMS Clinical View & Trace View Emergency department T-System EV and N Chart Clinical Sites Allscripts Professional EHR Network Physicians BlueWare Wellness Connection

9 Preparing for Meaningful Use Current Electronic Medical Record systems provide: Computerized physician order entry (CPOE); Electronic prescribing; Drug-drug / drug-allergy / drug formulary checks; and Reporting of quality measures.

10 The Physician Office Clinical Needs Business Needs Administrative Needs The search for the best system

11 Needs Analysis What problems should the EHR solve? Which processes need to be improved? Focus on process identification and analysis rather than product selection

12 Carson City Hospital Practices Patient records readily available and legible Real time charting and accessibility from multiple locations Quality Indicators Drug Recalls Electronic Prescribing Clinical Needs

13 Carson City Hospital Practices Business Needs Transcription Reduce / eliminate expense Documentation Expedite and make legible Coding Enhance coding accuracy Billing Clean claims first time Supplies Eliminate cost of chart supplies and materials Space No more space to store medical records Cost to store off site FTE reduction through attrition

14 Carson City Hospital Practices Administrative Needs Streamline internal communications Streamline external communications Eliminate the lost chart syndrome Electronic verification of insurance coverage and benefits vs time consuming phone calls HIPPA Compliance

15 Carson City Hospital Practices Administrative Needs cont d MCIR Transfer File Audit trail Quality incentive programs track, audit and report quality indicators (save time and resources) Back-up system of information

16 Evaluation Process Consider Your practice / system size Existing operating systems Interfaces necessary Security IS infrastructure Suggestions Talk with others using a EHR Obtain references from vendors Obtain bids Include all or key physician champion(s) throughout the entire process Site visits to other clients using the product Third party review of contract

17 Vendor and Product Selection Company profiles Product information Resources Healthcare Informatics Health Data Management KLAS Training and support (escalation process if/when necessary) Site visits On-site demonstrations of software and hardware options

18 Contract Third party review Require vendor to conduct a review of your technical environment to ensure their recommended configuration will operate properly Payment terms Software, hardware and support A percent upon contract execution A percent upon installation (or provision of support) A percent upon final Require an escalation process by which vendor will respond to your requests for resolution of issues and problems. Include option for the withhold of a portion of the annual maintenance fee (prorated per month) for the period of time problem(s) was/were unresolved. Project Management make sure you have the ability to change the assignment of a particular individual assigned to your project should you find him/her incompetent

19 Internal Considerations Project Management Point person(s) contact with vendor Contact with third party software vendors Interface development Application Expertise Super User(s) internal trainers Customization Information Systems Must complete training with the vendor Must be competent with all aspects of configuration Be available when needed Software Hardware Connectivity (interface, T-1 s, DLS, fiber, etc.)

20 Questions & Answers Panel Members: Duane C. Miller, MBA Vice President Finance Richard Terry Chief Information Officer Shelley Whitacre, RN, CEN Clinical Systems and Revenue Cycle Consultant Carson City Hospital Carson City, Michigan

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