Optimizing your EHR: How to get the most from your EHR investment after go-live. Bruce Kleaveland President Kleaveland Consulting, Inc.

Transcription

1 Optimizing your EHR: How to get the most from your EHR investment after go-live Bruce Kleaveland President Kleaveland Consulting, Inc.

2 Learning Objectives: Define additional job functions needed to support the EHR Anticipate predictable issues associated with first year Develop strategies to solve these issues Identify add-on projects to optimize your EHR investment 2

3 #1 Objective after go-live is adoption Adoption=integration into provider/practice work flow 3

4 Adoption is a dependent variable Adoption Support & Leadership Technical Stability 4

5 Technical Stability Definition: A reliable technical infrastructure that maximizes uptime The first 90 days of go-live requires the greatest level of support (as the system is load tested) Persistent hardware & software issues interfere with user adoption Technical stability is a function of the quality of initial setup, the EHR software, and staffing to support network 5

6 Support & Leadership Training & support to assist users with learning the system Ability to fine tune and adjust workflow Technical support to resolve technical issues Physician/practice leadership to keep the project moving forward despite the challenges 6

7 People required to support an EHR Physician Leader Advocacy & problem resolution Content & configuration (help build & enhance EHR) Time required:.20 FTE IT Analyst Support hardware & network Training, troubleshooting & upgrades Time required:.5 to 2.0+ FTE EHR/Training Lead Training, troubleshooting & upgrades Content development & special projects (i.e. order entry) Time required:.33 to 1.0 FTE 7

8 Maintain EHR workgroups EHR workgroups should carry over to post-implementation phase including relevant reps, i.e. Physicians/owners, nursing & MAs, administration, medical records. billing office and IT support Regular (i.e. weekly or bi-weekly) meetings with general staff to build support, educate, create enthusiasm and address issues Establish training infrastructure for new employees and to support existing staff 8

9 Incremental approach Based on functionality (easy to more difficult) e.g. Viewing of Data E-prescribing Encounter Documentation Advanced EHR features Based on locations/providers (for multi-site practices) Pilot site with technically enthusiastic & competent group to establish baseline for other offices An office should not have split implementations (some using and some not) 9

10 Big Bang Typically requires all providers to message, abstract charts, e-prescribe, and document encounter through EHR May require all providers to enter data utilizing templates (to standardize data and lower transcription costs) Multiple locations typically done one at a time Provides the most rapid return, but requires the most support 10

11 Physician adoption curve System has to serve the majority Innovators and early adopters are fairly self-sufficient There will always be laggards 11

12 ID & support of reluctant MDs Reluctant MDs typically have poor typing skills and limited computer familiarity Supporting reluctant MDs: Additional education and one on one support Allow dictation (to minimize workflow change) Scribes/nursing support (data entered by 3 rd party) Voice recognition Incremental approach (vs. big bang) 12

13 Optimizing technical support Understanding of the vendor s basic operating & escalation procedures Operating hours & specific contact numbers/ /web Methodology (leave a message or wait on hold) Event tracking (i.e. open ticket number) On-site support options & expense Contact info for tech support/customer relations managers Basic terms should be defined in contract or SLA (service level agreement) 13

14 Service level agreements (SLA) SLAs should define: Response time by severity of incident Down (system not usable) Critical (issue severely impairing use) Standard (non-critical issues) After hours support policy and prices Escalation policies Upgrade policy (included or separate fee?) Customer web site capabilities Customer requirements & responsibilities i.e. hardware support, backup, personnel training 14

15 Troubleshooting Utilize good troubleshooting techniques Isolate the problem Hardware, software, or operator issue A bug or feature deficiency? Replicate Can you easily repeat the problem? Document Allows effective tracking & communication of issue 15

16 The Blame Game Practice EHR Vendor Hardware Vendor 16

17 Breaking the blame game Practice s responsibility: good troubleshooting and documentation of issue through a primary contact EHR/Hardware vendor s responsibility: understanding of causal factors so that problem can be resolved Requires collaboration between all three parties Advice: use telephone conferencing and scheduled meetings to help resolve difficult issues 17

18 Measuring success Technology adoption by clinic & staff Technical stability of the system Other measures dependent on objectives of project: Coding levels (i.e. % of level 3 vs. level 4 visits) Physician productivity (patients/per day) Transcription expense Chart retirement Requires baseline measurement of pre-ehr status 18

19 What happens after Year 1 Build new content (i.e. progress note templates) Add new modules New EHR features Order entry Practice Management Patient portal/secure Add new accessories Enhanced document management Card scanners, signature capture Refine/update network/hardware infrastructure 19

20 Case Study: Summit View 8 providers, 38 additional staff Family Practice, 1 location 72 PCs, 40 printers, 3 servers Per FTE cost (hardware/software): ~$40K/provider 5 year ROI Modified Big Bang (EHR & PM) 24 exam rooms, 2 procedure rooms, 1 treadmill room Contract signing to go-live: ~12 months 20

21 Post-implementation staffing Physician leader during selection retained role during implementation and post-implementation Health IT Adoption Committee (formed during implementation) continued post-implementation Hardware support provided internally with assistance from third party New staff training infrastructure created No new hires--but existing positions modified to support EHR 21

22 Organizational support for EHR 22

23 Day to day staffing EHR Analyst Former FTE RN Part-time (~15 hrs/week) Focus on work flow, template development, new projects Staff Assistant to EHR Analyst Full time in medical records department Supports analyst on projects on part-time basis (~15hrs/wk) IT Help Desk Roughly half time on IT support/projects (also functions as referral coordinator) Supported by third party IT (utilize between 50 to 100 hours per year) 23

24 Transition of paper charts Dictation saved for pre-loading EHR Chart summarized as patients scheduled (starting before go-live) Dictated summary note by physician Nursing staff assisted for specific items (i.e. immunizations) After summary, chart is marked & retired to basement Total paper charts: 50,000+ No additional pulling of charts after 9 months Chart room re-claimed for medical records staff 24

25 Strategies for physician adoption Schedule lightened & gradually increased (50% 90%) during first 5 days; at full productivity by Week 2 Weekly education/motivation meetings for first 6-9 months of the project (food included) All physicians continued to dictate during Year 1 Gradual transition to EMR templates One provider at a time starting with most technically astute After 5 years 7 of 8 providers are utilizing templates All new providers exclusively on templates 25

26 The retired chart room 26

27 A rough chronology after go-live Year 1: Focus on user adoption Years 2-5: Focus on optimization including Utilization of additional EHR features Transition of providers from dictation to templates Transition to thin client hardware network Intranet resource library developed ( Knowledge Base ) Participation in QI organization based on EHR data Upgrade to Windows-based practice management Transition to electronic encounter form Addition of accessories to support paperless office (fax server, signature capture, card scanner, document management) Next major project: order entry 27

28 Document management system 28

29 Card scanner 29

30 Signature pad 30

31 Benefits Improved coding & reimbursement Templates help support more accurate coding Access to charts by billing staff supports auditing Lower costs ( $110K in annual transcription expense alone) Reduced labor overhead ( ~5 FTEs) Primarily in medical records area Improved charting documentation Improved customer service and staff morale Instantaneous access to charts improves customer service Technology makes staff more productive (and happier) 31

32 Questions? Bruce Kleaveland Kleaveland Consulting