Big Time, Big Deal. Strategies for Creating a Successful Organization-wide EMR. Charles B Wang Community Health Center Laminasti (Ina) Elbaar

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1 Big Time, Big Deal Strategies for Creating a Successful Organization-wide EMR Charles B Wang Community Health Center Laminasti (Ina) Elbaar 5 th Annual Asian & Pacific Islander Community Health Center Conference San Francisco, November 10, 2006

2 CBWCHC - Demographic Overview- Established in % of patients use language other than English Location: 3 sites in Manhattan 1 site in Queens Payor mix: 70 % Medicaid, Medicare, Managed Medicare Products 28% uninsured 2% commercial insurance plan Patients served in 2005: >35,000 Number of visits in 2005: 140,000

3 Mission Implement an EMR system that will electronically document, support, and transform the Center s patient data to improve clinical quality of care and healthcare delivery process. Vision EMR will serve to improve upon three domains: Quality of Care Empower patient Empower staff

4 EMR project - Goals Patient encounter documentation Access & review test results and clinical documents Integrate Clinical Pathway to practice Provide guidelines and health maintenance reminders on disease prevention E-Rx with interaction checking Enhanced pt education at the time of encounter Better utilization of data for outcome analysis and QA process Instant, appropriate, enterprise-wide access

5 Establishment of Clinical Informatics Department Clinical Informatics department separate from IT department CI reports to Chief Medical Officer CI responsible for all clinical data CI responsible for all functionality of EHR

6 EMR Leadership EMR Steering Committee EMR Core Team Design Team Reporting Workgroup Design Team Design Team Funding Work Group

7 EMR Ownership EMR project is not an IT/IS project Clinician driven and Clinician created Clinical team selected the system

8 Process Redesign Design eliminates irrelevant or duplicate documentation and redundant processes Design supports clinical data collected from other systems, which are captured by an interface whenever reasonable Patient data is standardize throughout the patient record Patient safety is a primary design requirement

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14 Guiding principles Encourage participation Challenge the current ways Design for best practice Clinicians time is highly valued If you oppose, you must propose

15 Common Objections System takes too much time Confidentiality/Security Patient-Physician relationship 100% accuracy?

16 How to Overcome Leadership Physician Executive Physician Champion Participation Domain expert Super users to take ownership of processes and support changes Training

17 Managing Change Pain Management Transition is the core issue Acknowledge expected losses Outline specific expected changes Involve affected individuals Identify potential problems Maintain open communication

18 Hardware Considerations Standardized hardware Space considerations Connectivity Remote access

19 Interfaces Demographic interface Duplicate patient charts Device integration Laboratory interface Billing interface Document management interface

20 Preload Process Focus on: Pts with chronic diseases Pts with future appointments Incentives for doctors to preload Familiarity with the system Load historical clinical information Increase efficiency during go-live

21 Instant EHR Benefit Reliable documented clinical communication: staff communication, documenting phone notes, referral, etc Mobility of patient records Patient level data is retained and validated from encounter to encounter Culture change of standardization Quality assurance

22 Current ROI Outcomes data generated for: Obesity in Pediatrics DM Review (A1C, LDL, Microalbumin, Eye exam) Women s Health and Men s Health Outcomes Review Geriatric Care Review Depression in Mental Health (PHQ3 and PHQ9) Public reporting to NYCDOH Child Immunization Registry Communicable diseases

23 Key Lesson Learned Organizational structure & direction MD acceptance & engagement Comparison with peers Choices: Incremental/staggered rollout vs big bang Historical data upload vs cold start Perfect vs good enough

24 Key Lesson Learned Watch for variation and scope creep Capture consensus Be prepared for surprises Make sure everyone is telling the same story Communicate, communicate, communicate Be painfully honest with your staff and leadership Tell them often; show them more often

25 Future ventures Ongoing upgrades Further optimization Ongoing educational and research opportunities Device integration New technology Changes never end.

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