Technology has changed the way we connect with others, creating wonderful new opportunities.

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1 The American Recovery and Reinvestment Act of 2009 Electronic Health Records (EHR) is one of the requirements of the American Recovery and Reinvestment Act of The act requires hospitals to implement meaningful use of certified EHR technology by Hospitals that demonstrate meaningful use of EHR will receive financial incentives for Medicare and Medicaid. Hospitals that do not demonstrate meaningful use of EHR will have penalties imposed. A qualified EHR is defined as an electronic record of health-related information for individuals, with: Patient demographic and clinical health information, such as medical history and problem lists; The capacity to provide clinical decision support; Support for physician order entry; Ability to capture and query information relevant to health care quality; Electronic health information exchange capabilities, including integrating such information from other sources into EHR. The benefits and reasons for EHR implementation include: Improving quality, safety and efficiency of patient care; EHR will engage patients and families in their health care; EHR will improve care coordination between multiple providers; Public health will improve; The ability to maintain the privacy and security of patient records will improve; It s the law. Recovery.gov ELECTRONIC HEALTH RECORDS INITIATIVE Technology has changed the way we connect with others, creating wonderful new opportunities. From the Pony Express to During the days of the Pony Express, receiving your mail took weeks. Today, you can receive mail in an instant, electronically, saving time and putting information immediately at your fingertips. From shopping in stores to shopping online It used to be that we had to go to a store to buy something. Today, we can shop online with a world of stores in front of us, increasing our options and changing the way business works. From telephones with operators to smart phones with networks No matter which telephone provider, from AT&T to Verizon, and regardless of the type of phone, from a Blackberry to an iphone, people around the world can all talk to each other with ease. Now, health care technology is changing, too. And this change is good. Electronic Health Records (EHR) will create better connections and health care for everyone. It moves medical documenting into the 21st century. We re part of changing history. Let s get started on this journey together to see LMConnect with Electronic Health Records.

2 ELECTRONIC HEALTH RECORDS101 Lexington Medical Center is embarking on a journey that will greatly improve the quality, safety and experience of patient care. Over the next 2 3 years, we will convert our entire documentation system to Electronic Health Records (EHR), an organized computer system that lets providers see many aspects of a patient s medical history. We call it LMConnect. The EHR rollout is consistent with our hospital s mission of providing quality health services that meet the needs of our community. It s the right thing to do for our patients and a must for our hospital s future. The Benefits of EHR will be significant. It allows providers to access patient charts and exchange clinical information faster. No more pulling charts and waiting on faxes. With EHR, patient information is at our fingertips with the touch of a button. EHR shows potentially dangerous drug interactions and keeps up-to-date lists of diagnoses, medications and allergies. We will have the ability to order and manage lab work electronically. This will cut down on the time patients and providers wait for tests and results. EHR eliminates problems with missing paper charts and poor penmanship. No more looking for stray notes and worrying about not being able to read handwriting. The system will maintain a secure place for health information. EHR will be a HIPAA-safe site with several levels of security. EHRs encourage active and positive patient involvement with their health care records and with their own health management. The Rollout Some LMC physician practices already use EHR. Over the next 2 3 years, the entire hospital network will have EHR. The system will enable health care providers to talk to each other and share information across levels of care. There will be a learning curve. We ll be here with communication and education to make sure everyone is comfortable with this historic change. Providers will be able to send e-prescriptions to pharmacies. As a patient, imagine a prescription ready and waiting for you when you get there. Let s get started on this great path to connect our hospital and patients with the future. 2

3 Rolling Out LMC Electronic Health Records Lexington Medical Center plans a two-pronged approach to implement Electronic Health Records. The first phase establishes EHR for the physician practices and community medical centers, with an expected implementation period continuing throughout the next months. The second phase of implementation for inpatient EHR will occur in the next months. In fact, Lexington Family Practice Ballentine has already launched EHR, documenting completely in EHR and electronically sending orders and receiving results from the LMC Lab. Specific launch dates of each practice have not yet been confirmed, but are being considered very carefully by the Practice Support Services Leadership, incorporating feedback from providers and practice leadership. Practices can expect their initial implementation timeline to span approximately 12 weeks. Many factors were taken into account when considering a system for use in the physician practices and community medical centers. Overall practice efficiency has been an important consideration, so tight information exchange, or talking, with the Vision Enterprise practice management system was essential. The system also needed to be flexible enough to work well with both our smaller and larger practices, preserving their autonomy and uniqueness; while also strong enough to easily connect with an inpatient EHR system. The LMConnect Physician Network EHR is powered by AllScripts Enterprise EHR. Allscripts is the market leader with more than onethird of practicing physicians in the United States using Allscripts ambulatory solutions. With the evolution under way in health care today, it is vital to have a partnership with an industry leader that is committed to securely sharing information across care settings and vendor systems. The second phase of the EHR rollout will involve inpatient implementation. The steering committees are currently narrowing down system choices and will soon choose one that will best fit the needs of Lexington Medical Center. This program will be a robust and flexible tool that will provide consistency across departmental boundaries throughout the hospital system. (See Change is in the Air on page 5.) Information from Non-Network Physician Practices Information from Other Hospitals LMC Hospital Information System (Epic or Cerner) LMC Physician Practices Computerized Physician Order Entry and Clinical Documentation Patient Financial Services 3

4 EHR Q&A What is an Electronic Health Record (EHR)? An EHR is a new way to document care that replaces paper charts. We ll now enter patient information into a secure computer system. The computer will hold information on many important aspects of a patient s medical history. What is CPOE? CPOE stands for computerized physician order entry. It s a leading feature of EHR and a critical way for organizations to demonstrate meaningful use of EHR. CPOE will include medication changes, referrals, along with nursing, radiology/imaging, lab and diet orders. Importantly, CPOE allows you to track a patient s electronic chart to make sure the orders were completed. What are the benefits of Electronic Health Records? There are many. Right now, providers pull charts or have patient information faxed to them. With EHR, that information is at a provider s fingertips in seconds. A provider can type a patient s information into the system, download information such as lab or X-ray results or a prescription to a pharmacy so that it s ready and waiting for a patient. The provider can also access the patient s medical history, diagnoses, medications and allergies. And it ensures that patient records are standardized and legible. Will EHR result in job loss? No. Lexington Medical Center believes we are a great hospital because of our employees. With EHR, what you do may evolve, but the need for you and your skills does not go away. You may spend less time pulling charts and more time administering care. Is an Electronic Health Record secure? Yes. EHR is more secure than a paper chart. The system will be HIPAA-compliant and requires a password and log-in for each user. The ability to view a patient s record is restricted to the practices where the patient has been registered. And not everyone can access all levels of a patient s records. You can also review who has looked at each chart. How will EHRs change daily tasks in the office? The work involved with paper charts will be replaced with electronic tasks. For example, staff will no longer pull charts. Instead, they will enter actions in the computer for a provider to complete such as reviewing results or signing notes. It allows more time to be spent administering care. How am I going to learn to use EHR, ask questions and give feedback? The EHR Education Team will provide relevant and rolespecific training through classroom training, onsite visits and webinars. On demand elearning courses are also available. After EHR implementation, the EHR team will provide onsite support. Avenues for feedback will include a LexLoop link and user group meetings. Can you dictate in EHR? Various forms of documenting will be available including dictating, voice recognition software and discrete documentation using note forms and templates. Where can I access EHR? EHR is accessible anywhere there is Internet connectivity and utilizes the security behind the LMC firewall through Citrix. 4

5 Change is in the Air The implementation of Electronic Health Records system-wide will impact many different areas of care, including enhancing some of the day-to-day responsibilities of LMC s physicians and nursing staff. Similar to the transition from brick and mortar stores to now being able to buy things online, this transition is going to eliminate a few extra steps by taking out the physical constraints of paper, pens and ink, said Dr. Brent Powers, Chief Medical Officer. This will include adjusting workflow to maximize efficiency and reduce downtime between patient care tasks. It will also increase patient safety by creating cross references and checks of therapeutic interventions. Smart alerts will be built into the system to automatically remind and prompt for best practices in care. At the point of care, these best practice care alerts will ensure consistency from one health care provider to another and will also prompt for testing and treatment as reminders. The delivery of care is going to be much more mobile. For example, if a physician is on call and not in the hospital, but an order needs to be processed to facilitate a patient s needs, then that can be done remotely electronically, explained Dr. Powers. In addition, the communication of care will be much clearer on a more basic level because everything will be legible. One example of how EHR will aid in the patient s care will be with their discharge summary. Currently the chart is physically carried from one place to another and at times this information is faxed to the primary care physician. Once EHR is implemented, the discharge summary will be sent electronically the day of discharge to the primary care physician, making follow-up care much safer and efficient. As a result, EHR will allow more time for direct patient interaction, according to Dr. Powers. This will reduce the workload in the delivery of care and increase the time for patient care. Fundamentally, EHR will improve safety, continuity and efficiency of patient care after implementation and optimization system-wide. In addition to the changes from the physician perspective, EHR is going to complement our current nursing processes as well, said Vice President Cindy Rohman. The actual delivery of care won t change, but information will be much easier to obtain. For example, the nursing staff will be able to quickly access previous treatment records from Urgent Care centers or anywhere else in the hospital, allowing them do their job more effectively. Some specific areas where this will be helpful will be with medicine reconciliation from one area of the hospital to another. With full implementation of EHR, patients will no longer have to be relied upon to remember their medication dispensing from one treatment to the next. Staff will no longer have to compare charts, saving time and reducing opportunity for error. An extra step that involves the nursing staff will also be eliminated for physician order entry, since it will be done at point of order. This will create a freer line of communication between physician and pharmacist and be a phenomenal patient safety aid. This system is going to be very helpful at the clinical level. We have spent an enormous amount of time, research and effort in pinpointing a system that is smart, helpful and savvy enough to genuinely enhance patient care, and I believe that we are on the right track to implementing these changes so that they will best help our staff and our patients, said Rohman. 5

6 SUCCESS HEALTH CARE SYSTEMS Sarah Bush Lincoln Health Center EAST CENTRAL ILLINOIS The Sarah Bush Lincoln Health Center uses Electronic Health Records to share patient health information across hospital services, home health organizations, hospice and physician practices. The system includes computerized physician order entry (CPOE) and e-prescribing. Before the EHR system, hospital staff could not access patient records during clinic offhours, despite the fact that the emergency room treated patients around the clock. During the off-hours, emergency room providers could not access critical patient information such as current medications or health history. Their EHR system assigns each patient a problem list to let emergency staff know if they have high cholesterol, joint problems or any other diagnosis clinicians need to know. Having all the information from different locations results in faster treatment and better access to images, enabling better health care. Nemours Children s Health System DELAWARE, FLORIDA, NEW JERSEY AND PENNSYLVANIA Nemours is one of the nation s leading pediatric health systems. Its EHR system has allowed the organization to effectively measure clinical outcomes and quality. EHR benefits have included elimination of legibility errors and unacceptable abbreviations, a decision support/alert system, universal protocol documentation in the operating room, a bar coding system to reduce risk of medication errors and computerized physician order entry. Inova Loudoun Hospital LEESBURG, VIRGINIA Inova Loudoun Hospital s EHR system has had a tremendous impact on care. All lab, radiology and pathology results are now delivered electronically immediately and securely to the EHR system. When a doctor steps into his office, test results are waiting for his prompt review. In addition, the EHR sends prescriptions electronically so that medication is ready and waiting at pharmacies. Doctors there say the EHR system allows them to spend more time with patients and less time with charts. It has also eliminated mundane tasks such as refilling prescriptions, working with charts and posting charges, allowing staff to spend time with people and clinical issues. 6

7 STORIES PHYSICIAN PRACTICES Lexington Family Practice BALLENTINE Lexington Family Practice Ballentine is the first practice in the Physician Network to use Allscripts Electronic Health Records. The practice has used EHR for nearly three years and just celebrated its first anniversary with Allscripts Enterprise EHR. The benefit is the ease at which you can access information, said practice manager Benetta Albaugh. You don t have to pull a chart. At the touch of your fingertips, you have access to all of a patient s lab work, office visits and information from other practices. When a patient arrives for an appointment, front desk staff collects pharmacy information for E-scribe. Then a nurse brings the patient to an exam room and enters vital signs and general history into EHR using a laptop computer. The nurse also verifies the patient s medication, allergies, family and social history in EHR. During the patient s time with a physician, doctors enter into EHR the medication instructions with dosing directions along with orders for studies including X-rays and EKGs. Dr. Scott McKay uses the Dragon function of Allscripts Enterprise EHR to dictate plans for each patient, including exercise, referrals and return visits. The physician s electronic signature is on every correspondence. Additionally, physicians can print out prescriptions or E-scribe them to the patient s pharmacy or mail order service. That features saves time, adds convenience and eliminates problems with illegible handwriting. Albaugh says E-scribe is one of the patients favorite aspects of EHR. The practice enjoys other benefits, too. Because we re integrated with the Lab on EHR, the orders are transmitted to the hospital and results are sent back, said Albaugh. You don t have to wait to receive a piece of paper through a fax machine. As soon as the results are available, they re put in the system. Going forward, the same interface will be available for Radiology. Albaugh adds that if a patient calls with Dr. Rachel Callis-Wolfe of LFP Ballentine uses a computer with EHR during a patient visit. a question or prescription request, phone staff can enter it directly and you can track the process, eliminating keeping up with pieces of paper and sticky notes. LFP Ballentine is about five years old. The practice used paper charts during the first two years. When they began using EHR, staff scanned information from the patient s most recent physical and office visits, plus results from critical testing. They have kept those charts to refer back to if needed, but all new patients receive electronic charts. The Electronic Health Record (EHR) has revolutionized the practice of medicine. We no longer have to hunt for charts or search for the latest X-ray report. The patient s current medication, radiology reports and lab work are all at our fingertips. Soon we will be linked with other practices to improve communication between physicians and, in turn, further improve patient care. Dr. Rachel Callis-Wolfe 7

8 EHR BEFORE & AFTER Sample Scenarios Better Access, Greater Patient Satisfaction Before A patient calls the doctor s office to ask a question or request a medication renewal. Today, staff writes the request in a telephone memo, locates the medical record, pulls the patient s chart and delivers it to the appropriate person. That process can cause delays. After Staff documents the patient s question or request electronically in the call processing module of EHR and tasks it to the appropriate person. There is no risk of a paper telephone memo being lost and no time wasted locating records because the electronic chart is available on-demand. The patient receives a more timely response with less hassle. Before More than 200,000 unique patients visited LMC s physician network and community medical centers in 2010 and 1 in 5 of those patients saw more than one LMC provider. If patient information had to be shared, patient records were requested, faxed or otherwise sent to the next provider. That takes time and introduces the risk that the provider may not have all information necessary to deliver the best care. After Providers of record for a patient will have comprehensive access to the patient s electronic record in a view that each provider can customize. Access to the patient s current health information can enhance the quality of care delivery. Consult notes are automatically available to referring providers. In addition, providers have the ability to secure information if a patient requests that it not be shared. CPOE Before A doctor makes rounds on patient X and needs to place new orders. The doctor must locate the patient s medical record, write orders in the medical record and place it in the chart rack near the unit secretary. The unit secretary transcribes the handwritten orders one-by-one into Meditech, onto the care plan and scans orders to the pharmacy if medications are included. A nurse must then check to verify the orders were transcribed correctly and sign off on the orders. After A doctor makes rounds and during rounds he/she enters orders directly into the electronic system. Electronically, the orders are delivered to the right department instantaneously. Patient Alerts Before A nurse completes a dysphagia screen on a stroke patient. The patient fails the screen. The nurse must write orders for NPO status and a speech therapy consult. The nurse has to locate the paper medical record and handwrite the orders. The medical record goes in the chart rack for the unit secretary to transcribe the orders into Meditech and the care plan, and verify that the orders were transcribed accurately. After A nurse completes a dysphagia screen on a stroke patient. The patient fails the screen and the system automatically sends orders for NPO status and a speech therapy consult. the Words! Connect the key words below that relate to LMConnect and the launch of Electronic Health Records and you could win a prize! Please complete the word find and send to LMC Word Find, Dept: Marketing in interoffice mail. The first 50 employees who send the word find will receive a special LMC gift in interoffice mail. Name Dept. Extension AllScripts Cerna Compliant Computer Connection Documents ELearning Electronic Epic EPrescriptions Health Health Care Information Meditech Records Scan Standardized System Training 8