MINISTRY OF HEALTH ELECTRONIC MEDICAL RECORDS

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1 MINISTRY OF HEALTH ELECTRONIC MEDICAL RECORDS MEXICO CITY November 10, 2010

2 OVERVIEW Why Electronic Medical Records (EMR)? Planning, Implementation & Challenges Observed Outcomes Valuable Lessons 1

3 EMR US ADOPTION RATES (Nov 09) 90% of Hospitals have no functional comprehensive EMR Mostly large hospitals and teaching hospitals do Top Barriers to EMR Adoption inadequate capital (73%), maintenance costs (44%) and physician resistance (36%) Source: 2

4 US GOVERNMENT REQUIREMENTS Regulatory Compliance HR 3590 Patient Protection and Affordable Care Act passed March 21, 2010 requires EMR implemented in hospitals by 2015 Required for Medicare reimbursement Reimbursement for Quality (Core Measures & HCAPS) 3

5 WHY ELECTRONIC MEDICAL RECORD? (EMR) Primary Goals of EMR Improve Communication Quality & Patient Safety Operational Excellence & Efficiency Analysis of Aggregate Data US Government Requirements 4

6 QUALITY & PATIENT SAFETY Communication between clinicians Timely accurate information Ability to create clinical decision alerts Positive Patient Identification (PPID) Allows incorporation of clinical protocols to implement evidence based medicine 5

7 IMPACT OPPORTUNITY EXAMPLE 6

8 OPERATIONAL EFFICIENCY & EFFECTIVENESS Allow greater information for Cost Accounting Systems & Inventory Systems Case Cost for Top 10 Clinical Diagnosis Signing of Verbal Orders Timely transfer of information from results reporting and decrease in lost information and duplication 7

9 ANALYSIS OF AGGREGATE DATA Clinical Trends Population Characteristics Research Opportunities Data Extraction Required Reporting to Governmental Agencies 8

10 PEOPLE, PROCESSES & TECHNOLOGY Installation is hard, and mainly technical Implementation is really hard, and mainly organizational Transition (lasting change) is incredibly hard and purely human Transformation is a state of profound new personal and enterprise thought and behavior which accompanies the strategic acceptance of information technology 9

11 PLANNING, IMPLEMENTATION & CHALLENGES 10

12 GUIDING PRINCIPLES PLANNING EMR is not a financial system EMR is not just an IT system EMR is an organization-wide CHANGE initiative to: Improve processes Put best practices and clinical guidelines into action It requires commitment from the entire organization 11

13 PROJECT KEYS TO SUCCESS PLANNING LEADERSHIP Involved governance structure Demonstrate strong executive support Educate clinicians about benefits Define and manage goals and expectations CULTURE COMMUNICATION COLLABORATION Create cultural shift; quality trumps autonomy Train and support with cultural sensitivity Manage resistance at every step Communicate frequently and often SAFE & OPTONAL DESIGN Focus on process solutions Involve pertinent stakeholders Indentify, evaluate all workflows Standardized nomenclature No sacred cows we ALL must comply 12

14 STRATEGIC DECISION STEPS PLANNING Visioning Preparing Go-live Optimizing Identify the major quality & operational drivers for adoption Position for Success Identify if physician usage % should be mandated by physician leadership Understand the work required to be successful Physician leadership approval Identify executive sponsor, steering committee and workgroup, physician leadership model Complete process labs, order set assessments to prepare clinical operations Complete training for physicians and clinicians Effective go live support from experts, resident coaches, IT and EMR teams Monitor & report compliance with usage of EMR Regular communication of benefits Confirm support model after go-live Execs monitors usage metrics with IT Status reporting Process improving Ongoing training and education of updates Physicians Clinical staff Support Planning 13

15 GOVERNANCE STRUCTURE PLANNING Executive Committee Strategic, Resources, Scorecard Steering Committee COO, CPCO, CMO, COO-CMMH, ICU-MD Staff: IT Dept Operational, Bi-weekly, Decisions Team Lead Readiness Team Directors, Managers Team Lead Readiness Team Directors, Managers Taskforces - PRN Team Lead Readiness Team Directors, Managers OR ICU MD Note: Shared services are part of facility level workflows. 14

16 FINANCIAL COSTS PLANNING Software Wireless Computers On Wheels Customized Software Staff Training 15

17 REACHING THE GOAL PLANNING Results Database Lab, Pharmacy, Radiology 100% paper Basic Clinical Documentatio n 50% paper, 50% electronic Critical Care Tools, Clinical Alerts, Data Sharing 10% paper, 90% electronic Evidencebased, Bar Coding Meds with Patient POE 100% electronic 16

18 IMPLEMENTATION TIMELINE Category Future Orders All ancillary orders including Lab, Rad, Pharmacy, Patient Care Order Sentences to support Physician Order Entry Evidence-based order sets Electronic Ordering for the Enterprise Electronic Ordering Pilot Program 17

19 IMPLEMENTATION TIMELINE Category Future Clinical Documen tation EMR Vital Signs & I&O Pain Scores Clinical Nutrition Respiratory Clinical Notes Physician Documentation Results Reporting Evidence Based Medicine Database Clinical Decision Support Care Planning Tools Clinical Documentation Interactive Flowsheet with ICU integration Physician Documentation Clinical Documentation Procedural department documentation Clinical Data Warehouse 18

20 FACILITY COMMUNICATION PLAN IMPLEMENTATION Who What Leadership Physicians Presentation Presentation Clinical Staff Presentation, Flyers, Downtime Procedures Support Staff Presentation, Flyers, Downtime Procedures 19

21 METHODS OF TRAINING One-on-One training Classroom and group training Web based training How-to flyers on key subjects and processes Videos available to walk users through functions Future Web Based Training Course Development One course takes approximately 60 hrs to create from build to approval process to publication 20

22 CHALLENGES & MANAGEMENT Challenges Staff turnover increases Physician adoption Productivity decreases Poor implementation Patient satisfaction (temporary) Management Training, communication, leadership support Training, communication, leadership support Workflow analysis, training Governance, planning, support, scorecard Satisfaction Tool, training 21

23 OBSERVED OUTCOMES Clinical Quality Value Physician Benefits Business Value 22

24 CLINICAL QUALITY VALUE Information from all sources is coordinated and presented in a single clinical document Computing ability of the system assists the clinical staff with decision making and minimizing errors Documentation is immediately available to all care providers Quality is improved by eliminating errors that occur on handwritten records 23

25 CLINICAL QUALITY VALUE Physician and Clinical Staff documentation becomes specific to patient conditions Documentation template is generated for anticipated level of care in conjunction with evidence based medicine Content is designed to enhance quality of care and efficiency Patient care workflow is improved 24

26 PHYSICIAN BENEFITS Physicians will be able to view and include the patient specific data gathered by other care providers Chief Complaint, Vital Signs, Allergy, Medication History, Family History, Past Medical History, Lab results, etc. Monitoring of the patient and documentation can be completed episodically in real time or remotely 25

27 BUSINESS VALUE Documentation enabling semi-automated professional coding Documentation utilizes structured clinical content and feeds professional coding based on CMS guidelines Enhances coders ability to accurately and efficiently code improve documentation and charge capture Creates a structured documentation system to teach medical students, residents and new staff 26

28 VALUABLE LESSONS Physicians on board Focus on quality over finance Role of leadership Long-term benefit vs. short-term resistance 27