Best Practices for Implementing an EHR System

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Julian Hamilton
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1 Best Practices for Implementing an EHR System Robyn Leone Director, CO-REC The Case for EHRs Healthcare spending as a percent of our Gross Domestic Product (GDP) at unprecedented high According to HIMSS, more than $700 billon per year is spent on unnecessary medical tests and procedures that don t actually improve health outcomes 2 1

(GDP) at unprecedented high According to HIMSS, more than $700 billon per year is spent

2 2010 National Quality Forum: Six National Priorities 1. Enhance patient safety through prevention of medical errors 2. Improve care coordination across communities and within healthcare organizations 3. Improve patient and family engagement 4. Improve palliative care 5. Avoid overuse of inappropriate healthcare 6. Improve population health Common theme among all priorities.must have the data to measure impact of change 3 HIT as Centerpiece of Health Reform Movement Regional Extension Centers Workforce Training ADOPTION Medicare and Medicaid Incentives MEANINGFUL USE Improved Individual & Population Health Outcomes Increased Transparency & Efficiency Improved Ability to Study & Improve Care Delivery State Grants for Health Information Exchange Standards & Certification Framework Privacy & Security Framework EXCHANGE Health IT Practice Research 2

Improve population health Common theme among all priorities.

3 Benefits of EHRs Beyond Incentives Improved accessibility and legibility of the medical record Safety advantages with clinical decision support, e- prescribing, computerized order entry Creation of templates, care plans, and sets of care orders that are evidence or consensus-based Access to data to improve quality and outcomes Ability to exchange clinical information 5 Common Barriers to EHR Adoption Communication Standardization Funding Interoperability 6 3

sets of care orders that are evidence or consensus-based Access to data to improve quality and outcomes Ability to

4 Turning Barriers into Success Planning Go-Live Vendor Selection Implementation Workflows 7 EHR Success: Planning Is the Practice truly ready to adopt EHR technology? What does the Practice intend to get from adopting EHR technology? Are the staff s personal goals in alignment with Practice s goals? Prioritization of functionality and physician needs Physician Champion Identify staff at lower levels of readiness, address concerns Develop a timeline and project plan 8 4

Are the staff s personal goals in alignment with Practice s goals?

5 EHR Success: Planning Tools EHR Readiness Assessment EHR Project Charter EHR Project Plan EHR Planning Tools to be accessible on the CO-REC website in mid-may EHR Success: Vendor Selection Key considerations for EHR Products Meaningful Use Incentives are tied to use of Certified EHR Technology - More than 400 products on CHPL Modular Systems = 120+ Complete Systems = 280+ CORHIO & CO-REC Approved Integration Vendors Commitment to Colorado Providers includes: Transparency of Costs Connection to HIE Improved Accountability Vendor Selection 10 5

org 9 EHR Success: Vendor Selection Key considerations for EHR Products Meaningful Use Incentives are tied to use of Certified EHR Technology -

6 EHR Success: Prioritizing Functionality 1. Quick charting 2. Ease of coding 3. Patient Education 4. Meaningful Use Ready (Complete vs. Modular) 5. Interfaces & Interoperability (HIE, labs) 6. Easy to Use 7. Remote Use (Internet-based or Hosted/VPN) 8. Clinical Reporting & Disease Registry Tools 9. Ability to transfer contract/access to data 10. Customer support 11. Contract cancellation 12. Chart Organization 13. Patient tools 14. Integration with PM/Billing 15. Use of specific technology (ipad, tablet PC) Vendor Selection 11 Colorado EHR Selection Summit Educational event for any Colorado medical practice looking to gain insight into EHR technology Four opportunities to view clinical-based product demonstrations from 13 CORHIO/CO-REC Approved EHR Vendors/Products May at the Denver West Marriott Time is running out register today Vendor Selection 12 6

Contract cancellation 12. Chart Organization 13. Patient tools 14. Integration with PM/Billing 15.

7 EHR Success: Workflows Workflow = Refers to the interaction of processes and tasks through which healthcare is delivered Patient Calls for Rx Refill MD Review Message Taken RN Returns Call Areas Requiring Workflow Analysis Patient Registration Medication Refills Orders for imaging studies Referral to specialist Eligibility verification Pharmacy called Workflows 13 EHR Success: Workflows Build multidisciplinary team clinical processes don t usually start and finish in the same department Document the process and receive sign-off from the staff doing the work Do not rely on the EHR vendor to do workflow analysis for your individual processes Assign an owner to key processes to ensure they are mapped into the EHR configuration Workflows 14 7

Success: Workflows Build multidisciplinary team clinical processes don t usually start and finish in the same department Document the process and receive sign-off from the staff doing

8 Which Processes Should Be Analyzed? Start with a high-level view from the patient s perspective of an end-to-end interaction at an office visit Scheduling Check-in Receiving care Check-out Billing Collections Requisitions Who does each task Is it appropriate for their expertise Workflows 15 Workflow Analysis: Means to Drive EHR Adoption Documenting a process doesn t ensure it will be adopted in the EHR Use Process Mapping as a means to improve communication about all the steps involved with completing tasks Improve less than perfect process before EHR configuration takes place Implementing EHR is not about taking a paper process and turning it into an electronic process Workflows 16 8

Requisitions Who does each task Is it appropriate for their expertise Workflows 15 Workflow Analysis: Means to Drive EHR Adoption Documenting a process doesn t ensure it

9 EHR Success: Implementation Optimization Testing Conversion Templates User Roles Assigned Strategy for chart input Favorites Lists Labs Medications Orders Identification of Protocols Learning the system Training methods Test database Allows you to test specific templates and inputs Security Risk Analysis Volume testing Dry-run of average day Identification of each provider s top 10 patients Implementation 17 EHR Implementation: Won t Happen Overnight Planning & Readiness Vendor Due Diligence & Selection Workflow Documentation Implementation Scheduled Next Steps: Hardware installation Notification to Patients Updates to Policies & Procedures Go-live of EHR 18 9

Dry-run of average day Identification of each provider s top 10 patients Implementation 17 EHR Implementation: Won t Happen Overnight Planning & Readiness Vendor Due

10 Questions? Robyn Leone Director, CO-REC

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Bureau of Primary Health Care Office of Quality and Data Affordable Care Act - Health Center Controlled Networks