1 EMR Incorporation: Evaluating the Benefits for Your Organization BHM Healthcare Solutions Measurable Results. Sustainable Solutions
2 Learning Objectives To evaluate the pros and cons of electronic medical records (EMRs), and determine whether or not EMRs make sense for their practice Summarize the importance of staff buy in and how to customize EMRs for their individual practice Identify key components for fluidly incorporating EMRs into practice
3 What is an EMR An electronic medical record, or EMR, is simply a patient s medical record in digital form The digital information is typically stored in a database and is accessible from anywhere via a secure network Prior to EMR, a patient s medical information was typically kept as a paper record available at each physician s office or the hospital a patient has visited EMR s contain mainstream data normally found on a patient s medical records. These include blood type, blood tests, inoculations, and X-rays--patient specific genomic information may also be included
4 EMR s and the Political Climate Starting with the Economic Stimulus Package in 2009, financial incentives were offered to hospitals and physicians who implemented EMR s according to meaningful use criteria A recent expansion of this bill is allowing for the same financial incentives to be applied to: Behavioral health and mental health professionals and clinics Substance abuse professionals and clinics Psychiatric hospitals Licensed psychologists Clinical social workers Federal mandate for the use of EMR s will be effective 2014/2015
5 Current EMR Implementation Office-Based Physicians, % CDC/NCHS. National Ambulatory Medical Care Survey: 2001-preliminary Available at:
6 EMR Components Problem List Diagnostic Departmental Reports Images Medications Laboratory Results Microbiology Progress Notes/Narrative Documents Allergies Demographics Administrative Transactions Quality Measures Privacy and Security
7 Pro: The Benefits of EMR s Minimize errors and aid in standardization of patient health records Ensure safe storage of patient records Make health care more cost efficient Encourage coordination between health professionals Improve the quality of care by increasing the efficiency and speed of diagnosis, improve the delivery of preventive health services, and improve adherence to clinical guidelines
8 Cons: The Drawbacks of EMR s Could constitute threat to patient privacy Can lead to standardized rather than customized care EMRs can be inefficient due to poor design, or lack of user knowledge EMRs are often not standardized, which prevents cross-compatibility between systems, and lessens the total benefit of data sharing
9 Cons: The Drawbacks of EMR s (cont) EMR s are not secure, many people are not convinced of the safety of their personal data when stored on large servers, and there have been multiple instances of large health record security breaches which have compromised thousands of patients There is a substantial cost related to the conversion from paper to electronic records, and those who invest may find it difficult to qualify for incentives due to the all or nothing meaningful use approach
10 Summing it All Up EMR systems offer substantial opportunities to organize and manage clinical data in ways that can potentially improve preventive health care, the management of chronic illness, and the financial health of clinical practices. The functionality of EMRs as implemented, however, can vary substantially from that envisaged by their designers, and even from those who purchase the programs. Safety, usability, and overall design continue to be barriers to successful EMR conversion and implementation
11 EMR OPERATIONAL AND TECHNICAL COMPONENTS
12 Operational Changes Organizations will need to review how the EMR system will change work flow Integrations with appointment and billing systems, as well as staff access will need to be analyzed Business processes on finalization of billable services will need to be reviewed Focus on current paper processes to determine what is staying, what is going and how are you going to implement into the new system.
13 EMR Technical Issues Operations Security Management of Role Specific security within the EMR software. Know who can see what information. Data Backup Must have a strong process tested on a regular basis. Disaster Recovery Understand and develop strong policy and procedures. Contract specifics for fully hosted system is critical. Testing of recovery process is imperative. Business Continuity Plan - Closely related to a disaster recovery plan but encompasses every aspect of the business.
14 EMR Technical Issues (cont) System security Web based applications Wireless workstations including work tablets Desktop EDI exchanges with other medical vendors Data Capture Not all EMRs are created equally, you need to evaluate based on type of practice, practitioner and patient volumes.
15 IMPORTANT EMR CONSIDERATIONS
16 Infrastructure Questions It is important to have full working knowledge of the systems and networks available to the practice including: How old is the server, and what are it s capabilities? How often is data backed up? Are there redundant systems in place if the server crashes? What encryption capacities are in place to ensure privacy? Do I have adequate bandwidth to perform daily activities? Are hardware upgrades necessary, and what are the associated costs? Who will be responsible for hardware and software maintenance?
17 Training and Support Training and support prior to and during implementation are key to the successfulness of the project. Some questions to consider may include: Is training covered by the vendor, or is it necessary to have an internal implementation specialist? What is your staff s current knowledge base, and how does it need to be expanded for successful implementation? What will be the time and financial costs of training and support to your practice? How will follow up training and support be handled after implementation and who will be responsible for associated costs?
18 Clinical Customization During the Customization Process the following should be considered: To what extent will we need customization in our practice? What are the goals that we are hoping to achieve with EMRs? Will the vendor assist with customization, or will this need to occur in house? To what extent will assistance from the vendor be provided, and what costs are covered relating to customization? Will the new program deliver what both clinical staff and management need, or will compromises need to be made? What specific processes will be automated, and which will not?
19 BARRIERS TO EMR IMPLEMENTATION
20 #1 Hurdle: Staff Buy-In According to a recent survey by Health Data Management, the No. 1 challenge associated with implementation of EMRs is staff buy-in (28%) followed by systems integration (27%) and funding (24%) According to a study by Korn/Ferry International one of the most common mistakes that executives make is failing to read the corporate culture In many instances staff buy-in may be contingent upon information systems working smoothly and seamlessly with clinical workflows Childress John R, Senn Larry E. In the Eye of the Storm: Reengineering Corporate Culture. 2nd Edition. New York: Executive Excellence Publishing, Health Data Management. Critical Success Factors for EMR Implementation. 18 June Feb 2010 < html>.
21 Facilitating Staff Buy In: Planning is Key For most practices, EMRs will constitute a significant change and proper planning is essential to successful implementation. Planning not only applies to new processes and procedures to be used, but also pertains to the network which will be utilized A detailed project plan should be outlined with room for minor tweaks that will need to be made along the way to best incorporate EMRs into the practice The Principles of Change Management (POCM) can be useful in EMR implementation
22 Principles of Change Management Address The Human Side Jobs will change, and so will daily protocol, come up with a plan to address these changes and concerns relating to EMR implementation Facilitate communication among the staff to discuss and hear their opinions and gather feedback about EMRs Start at the Top It is important for key staff, and even more importantly physicians be on board with EMR implementation. A physician lead is recommended who has a strong commitment to see the project through, and is realistic, but not overly optimistic
23 Principles of Change Management Involve Every Layer Everyone needs to feel that their contribution is important. Form a committee of employees to evaluate different systems and let them make proposals to the physicians. These should be people who will be using the system (administration, business office, ect.) Make the Formal Case Have a written vision statement outlining what this change will mean to the organization, as well as what, how, and why this change is taking place. Provide reasons why the EMR system is superior to the paper system, or it will not be used
24 Principles of Change Management Create Ownership Appoint leaders who will have ownership of the project. Train these core people and then use them to train the rest of the practice. Keep communication open, and encourage feedback. Lay out a plan and sequence of action, and keep staff informed and involved Assess the Landscape Identify core values in the current cultural landscape of the practice. Look for beliefs, perceptions, and areas of resistance. Identify people who may be lacking technical knowledge (the employee who doesn t know how to use a mouse, or the MD who doesn t use )
25 Principles of Change Management Address Culture Explicitly If necessary take small steps. Employees should learn to use a computer, a mouse, , more sophisticated programs, and then finally EMRs. Keep less enthusiastic members of management involved, or they will be resistant Prepare for Unexpected There will be problems so take this into consideration in your planning. Dates for going live with the project, or timelines may be missed, build in a cushion so that delays can be dealt with sans a ripple effect.
26 Principles of Change Management Speak to the Individual Set out clear guidelines and expectation for each individual within the organization. Be confident, and realistic about employees fears and concerns in relation to the change Be Flexible Be flexible and optimistic in dealing with the change. Take into consideration the feedback that you receive throughout the project and use it to make changes to best meet the needs of your organization
27 STAFF TRAINING FOR EMR IMPLEMENTATION
28 Staff Training: The Essential Steps We recommend the following 3 steps in effectively training and preparing staff for EMR implementation Identify the Current Skill Level Bring Staff up to the Needed Skill Level Design a Training Plan for the New Software
29 Identify the Current Skill Level Determining computer proficiency for all staff members is a vital step in preparing for EMR implementation. Staff competency may be determined by asking what programs the staff are familiar with, and what type of technology they use on a daily basis in the work environment In addition to this staff competency can be determined by the technical vocabulary that they are familiar with
30 Bring the Staff up to the Needed Skill Level In EMR implementation that uses a graphic interface, staff will need basic skills such as drag and drop functioning, how to transfer between systems, and how and where files are to be saved Most staff will need to know how to use the Electronic Practice Management system to make or look up appointment information
31 Bring the Staff up to the Needed Skill Level (cont) Some staff will require the ability to check patients in and out, while others will need to be able to post payments and generate claims The technical staff may not have to know the claims process, but will need to be proficient in the EMR process for successful implementation
32 Implement a Training Plan for New Software The EMR committee must design a training plan that takes skill level factors into consideration The EMR committee will need to determine what the common tasks for each employee will be, then add additional skills of increased complexity to the appropriate departments and jobs
33 Implement a Training Plan for New Software (cont) The entire staff should be taught system basics Following this training should be structured from a departmental perspective, each department receiving training on the necessary tasks for their particular jobs A training manual should be written for the EMR process, with room for improvements to the manual as the process progresses
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