Successfully Implementing Anesthesia into your Perioperative EMR Leah Baron, MD Teresa Gocsik, MS,CRNA,CPHIMS

Transcription

1 Successfully Implementing Anesthesia into your Perioperative EMR Leah Baron, MD Teresa Gocsik, MS,CRNA,CPHIMS DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Leah Baron, MD has no real or apparent conflicts of interest to report. Teresa Gocsik, MS, CRNA, CPHIMS has no real or apparent conflicts of interest to report HIMSS

3 Introduction Our New Jersey connection Our qualifications Our AIMS adventure

4 Learning Objectives Apply lessons learned to foster active engagement of front line physician clinicians in the EMR selection and implementation process Identify tips to assist your project team in creating a highly reliable system utilizing such tools as biomedical device integration Outline the process steps for creating a foundation (training staff, IT support, user groups) to support the initial implementation and future upgrades and system optimization

5

6

7 The Challenges

8 The Business Challenge 60% 40% 20% 0% 2012 AIMS1 EMR2 Anesthesia Information Management Systems (AIMS) implementations are increasing. Yet considering the rate of inpatient EMR implementations, the difference is apparent. (1,2) Sources: 1 Stonemetz, J. (2012, May 26). AIMS Market Penetration [Web log comment]. Retrieved from: 2 HIMSS Analytics. (Q3, 2012). EMR Adoption Model. Retrieved from:

9 The Business Challenge HITECH acceleration of EMR, CPOE, and Bar Code Medication Administration (BCMA) implementations Consideration for various anesthesia team work models: contracted, employed, hybrid Complexity of integrating critical devices into electronic workflow Difficulty in calculating a return on investment (ROI) with no forcing function for either party

10 The Providers Challenge My anesthesia is an art form, so is my Anesthesia Record.

11 The Providers Challenge The electronic record will make my practice more vulnerable to lawsuits. I cannot trust the information the machine will send to my record. This implementation will have a negative impact on our profitability.

12

13 The Tipping Point Meaningful Use Stages 2 and 3 Interoperability of data between systems to improve patient outcomes Data Capture and Sharing Advanced Clinical Processes Improved Outcomes

14 The Tipping Point Data silos create workflow challenges, workarounds and safety concerns Pay-for-performance Negative impact on never events Reductions in reimbursement and overhead costs for manually coding, billing and upkeep with quality and credentialing requirements

15 The Tipping Point An interest by the providers to look for a better way New associates join practices out of residency expecting to document electronically Anesthesia staff leading or participating in quality teams need to be assured that they will have access to their data to protect their practice and demonstrate the quality of their work

16 Engaging the Clinicians Organizational Change Management (OCM) strategies must be planned for and utilized with a few special call-outs Make sure the vision is agreed upon, easy to describe, and conveyed clearly. Choose effective leaders and don t be afraid to coach them. Consider the financial burden of participation on both sides hospital and clinicians. Make the EMR the path of least resistance. Utilize decision support tools to improve compliance with payfor performance metrics.

17 Engaging the Clinicians (continued) Create a highly reliable system. The OR is a critical care area (24/7 in most cases). Support structures must mirror those needs. Consider all competing priorities when timing project activities to ensure participation. Set expectations early. Make training mandatory. Make the training a hard stop from peers vs. administration.

18

19 Case Study 4-hospital system in Southern New Jersey 3 anesthesia groups: 2 contracted, 1 employed 40 Anesthetizing locations (OR, labor and delivery, endoscopy, no hearts, no major trauma) 380 anesthesia providers (MD, DO, CRNA) New Jersey

20 Health system Leadership IT Anesthesia Group The Challenge

21 The Outcomes

22 Plan for Success

23 Steps to Success Align incentives (if offered) Address challenges common to all EMR users Documentation under a wrong provider Documentation under a wrong patient name Use the system to full capacity Plan for optimization Leverage user groups Ensure robust reporting capabilities Start design with the end in mind. What data do you need to get OUT of your system?

24 BMDI Biomedical Device Integration HL7 Gateway Interface Engine ORIS Database Terminal Server New HL7 ORIS Server Can this be pushed out to workstations? Device OR1 Backup folders Workstation

25 Lessons Learned Engage all stakeholders early in process Consider what you want out of the system before it is built (reports, workflow improvements) Big bang is great in theory but staging also works very well for practicing tricky workflows For non-enterprise implementations, plan for integration and data interoperability early in process

26 Here is What We are Working on Today Optimizing the pre-admission and pre-operative processes Improving the continuity of communication from provider to provider, admission to admission Working through technical issues for lack of inherent clinical decision support within the application Reports and data for clinical decision making

27

28

29 Speaker Contact Information Leah Baron, M.D. Terri Gocsik, M.S., CRNA, CPHIMS