Presenter Disclosures

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1 Presenter Disclosures Kathryn Swartwout The following personal financial relationships with ihcommercial ilinterests relevant to this presentation existed during the past 12 months: No relationships to disclose Presenter Disclosures Renee Birn The following personal financial relationships with ihcommercial ilinterests relevant to this presentation existed during the past 12 months: No relationships to disclose We Went Live (on EPIC)!: EHR Implementation in a SBHC Agenda I. Why an EHR in a SBHC? Kathy Swartwout Presented by: Kathy Swartwout, PhD, APN Nurse Practitioner, Site Manager ETHS School Based Health Center and Renee Birn, RN, BSN Project Manager, Medical Informatics II. Implementation Logistics i in a SBHC Renee Birn III. From Daily Challenges to a Successful Conversion Kathy Swartwout 1

2 Why an EHR in a SBHC? Potential to. Improve Health Improve Patient Care Improve Efficiency of Healthcare Delivery Contain Costs Enhance Image Definitions CPR = Computerized Patient Record (1960s) EMR = Electronic Medical Record (1990s) EHR = Electronic Health Record (current) Meaningful Use = Use of technology in ways that can be measured significantly in quality and in quantity (CMS) Meaningful Use Medicare and Medicaid Incentive Programs Result: Enhanced CMS Reimbursement American Recovery and Reinvestment Act of 2009 Use in a meaningful manner Use for electronic exchange of health information to improve quality Use to submit clinical quality and other measures Implementation Logistics in a SBHC Evanston Township High School Evanston, IL 2

3 NorthShore University HealthSystem NorthShore Hospitals and Clinics Evanston Hospital Glenbrook Hospital Highland Park Hospital Skokie Hospital NorthShore Medical Group NorthShore Home Services NorthShore Research Institute NorthShore University HealthSystem Characteristics Teaching hospitals Organized research function Integrated delivery network physician offices hospital inpatient care hospital outpatient care home care More than 75 sites of care Gurnee Waukegan NorthShore s Portfolio of Epic Products Round Lake Waukegan Grayslake North Chicago Libertyville Lake Bluff Mundelein Long Grove Lake Co. Cook Co. Vernon Hills Lincolnshire Buffalo Grove Deerfield Lake Forest Fort Sheridan Highwood Highland Park Wheeling Northbrook Glencoe Techny Arlington Heights Winnetka Prospect NAS Kenilworth Heights Wilmette Glenview Mount Prospect Morton Grove Des Plaines Evanston Niles Skokie Lake Michigan Patient Data C h i c a g o Edgewater Norwood Lincolnwood Park Edgebrook North Town Rogers Park Uptown Ravenswood Irving Park Currently on version Spring 09 Red indicates initial install 3

4 Epic Implementation Timeline ETHS Weekly Clinical Workflow Timeline: Date: week of 3/18 from 1 4 Office Visits Rooming the Patient Physician Documentation Physician Transcription Encounter Based General Order Entry Flow Changing Provider on Schedule Addendum to Closed Encounter Additional Workflows Incorporating paper records produced from ETHS (Lab/Radiology results) Office performed procedures ETHS Weekly Clinical Workflow Timeline: Date: week of 3/25 from 1 4 Other Visit Types Nurse Only Visits Immunization/Injection Visits Lab Only Visits Office Performed Labs and Procedures with Physician Appointment Consents Resident Office Visits Workers Compensation Visits ETHS Weekly Clinical Workflow Timeline: Date: week of 4/8 from 1 4 Ordering Radiology Orders Pre Epic Procedure for Standing Lab Orders Pre Epic Procedure for Standing Lab Orders Durable Medical Equipment Downtime Process for Epic Labs Hemoccults Quest workflow 4

5 ETHS Weekly Clinical Workflow Timeline: Date: week of 4/22 from 1 4 Telephone Encounters Patient Calls Refill Requests InBasket Reviewing Messages Closing Charts Cosign Orders Cosigning Charts Out of Office Notification Overdue Results Messages Results Follow Up ETHS Weekly Clinical Workflow Timeline: Date: Week of TBD Scanning Incoming Paper Medical Information Incoming requests for Medical Records Reprinting Orders Od Miscellaneous Documenting No Shows in EpicCare Do Not Resuscitate Flag Do Not See Flag Downtime Procedure End of Day Activities End User Requests for Urgent and Non Urgent Epic Communication Tools ETHS Form Inventory List All relevant information about meetings, workflows, issues in one location: 5

6 Abstracting Historical Patient Information ETHS Epic Connectivity Project Timeline Hardware Deployed Epic Training Epic Ambulatory Clinical Training Classes EpicCare Ambulatory for the Office Instructor Led Ambulatory Charting Tools Instructor Led Ambulatory Abstracting Online Training Make appointment for Physician and Nurses Online Training 6

7 Epic Training Epic Ambulatory Non Clinical Training Classes Epic Training Epic Ambulatory Non Clinical Training Classes Online Training Medical Group Front Office Basics approximately 2 hours. Make Appointment approximately 1 hour. Classroom Training: MG Front Office (2 day class) Registration, Making An Appointment, Check in/out. Charge Management for Physician Practices (1 day class) If they will be entering charges, working workqueues, collecting balances and/or reviewing transaction inquiry. Physician Practice Follow Up Workshop (1/2 day class) This should be done approximately 4 6 weeks after they attend the Front Office class. It addresses more advanced topics and gives them a chance to ask any questions about what they have been doing so far in Epic. Epic Training Epic Ambulatory Non Clinical Training Classes Classroom Training: Cadence Template: Build & Manage (1/2 day class) If they will be managing provider/resource templates. Working with Referrals (3 hour class) If they will be managing referrals. HIM Media Manager Scanning (2 hour class) If they will be scanning documents into the chart. Dress Rehearsal Mock go live of Epic in the clinic Mock patients created to review: the check in and arriving process the rooming process by the nurse or MA physician documenting and ordering any procedure s that needed to be carried out and the checking out process and follow up 7

8 EPIC: Getting Ready From Daily Challenges to a Successful Conversion! The SBHC Perspective Work Flows Mental Preparation! Staff Training Time consuming Alters patient care temporarily Epic: Confidentiality Epic: Confidentiality Staff concerns about system employees Problem list After Visit Summary (AVS) Birth control meds SW notes 8

9 Epic: Starting Out (Entering the Unknown) EPIC: Starting Out The Dress Rehearsal Go Live Day Importance of Supports Training team Knowing where to turn Epic: The Next Phase (Time Management) Epic: Time Management First 3 weeks: 2 hours for PE Next month: 1.5 hours for PE Start of school year: Usual schedule 9

10 EPIC: SBHCs are Unique! Epic: Following the Rules Walk ins Billing Medications Reminders Reports EPIC: Following the Rules Epic: Present JC: Pain, safety, med reconciliation State requirements Ease of chart review 10

11 Questions? 11

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