Treating EHR Pain: Time to Replace It?

Transcription

1 American College of Physicians Internal Medicine 2014 Treating EHR Pain: Time to Replace It? Faculty Professor: Nareesa A. Mohammed-Rajput, MD, MPH, FACP Disclosure: Has no relationship with any proprietary entity producing health care goods or services consumed by or used on patients. Clinical questions to be addressed: 1.Focus on re-implementation, training, adding features, workflow changes, and changing EHRs. 2.Once you have determined EHR pain points, how do you re-implement an EHR you are already using? 3.How do you go about adding features to your EHR? Are there Meaningful Use implications to adding modules? 4.How do you go about fixing bad workflow? 5.What is involved with changing EHRs? Can it be done and not negatively impact Meaningful Use reporting? Posted Date: April 11, American College of Physicians. All rights reserved. Reproduction of Internal Medicine 2014 presentations, or print or electronic material associated with presentations, is prohibited without written permission from the ACP.

2 Objectives Treating EHR Pain: Time to Replace It? Nareesa Mohammed Rajput, MD, MPH, FACP Medical Director of Clinical Informatics Suburban Hospital Identifying problems with EMR Adding functionality to your current EMR Optimizing your current EMR Changing to a new EMR 2 Identify the problem Training issues Inadequate training Bad workflow Lack of optimization Lack of functionality Incompatible EHR Is each person appropriately trained for their role Do people have what they need to do their job? 3 4 Fixing Bad Workflow Optimizing current EHR 1. Decide what processes to examine 2. Create a preliminary flowchart 3. Add detail to the flowchart 4. Determine who you need to observe and interview 5. Do the observations and interviews Source: learningcommunity/howdoievaluateworkflow,_ppp,_pdf.pdf Training is adequate Workflows are optimized Making current EHR work more efficiently 5 6 1

3 How to get ideas on optimization Types of Optimization Requests Work with vendor or vendor specific consultant Go to vendor specific user group meeting Network with other users of the system Break fix Enhancement Vendor development 7 8 Criteria to rank optimization requests Adding new features to EMR Patient safety Physician productivity Revenue impact Compliance Organizational impact Work effort required to build/implement Training is adequate Workflows are optimized current system is fully optimized what other functionality can the vendor offer? 9 10 Before going live with new features Resources for help BACK UP your current data Thoroughly test the upgrade prior to going live with it o how does it affect data collection? How does it affect current workflows? Resort back to your backed up data if EHR upgrade fails. EHR vendor Consultants Regional Extension Center Clinical Informaticist

4 Out with the old... Selection process Required functionality Purchasing Cost Ongoing maintenance cost Data conversion Hardware needs Find a specific problem to be addressed with implementation of the EMR Finding a new vendor Site visits to established practices Evaluation criteria o cklist.pdf Create standard demo scenarios Hosting Data ownership External o data is hosted in the cloud o software is accessed via internet o can have a per month cost Internal o data is hosted on local servers o software is owned by practice o up front cost to purchase with ongoing maintenance fees 15 Practice owned data o if you change EMR vendors, you get the data to convert Vendor owned data o if you change EMR vendors, you do not get the data to convert 16 Backup Strategy/Downtime Strategy Support Questions Backup Strategy for data o Cloud based, is there redundancy? o Locally hosted, where is the backup? Downtime Strategy o Develop processes for what to do when the system goes down in both planned and unplanned situations Help with break fix issues during Go Live Help with post go live optimization issues Help with training pre Go Live and ongoing training Help with hardware and devices Help with interfaces Help with data conversion

5 Functionality Analytics Patient Portals o Appointments o Refills o Clinical questions o Results e Prescribing Registries How is the data collected to report for meaningful use Who is going to extract the data and run analytics for submission for Meaningful Use Who is going to collect and analyse data for PCMH? Options local vs. third party Interfaces Data Conversion Laboratory interfaces Diagnostic imaging interfaces Device interface ipad/tablet interface Mobile phone interface ADT to local hospital Health information exchange Square peg/round hole Identify data elements that are to be converted How far back do you want to convert? Cost to extract data and load into new EHR Sunset plan for old EHR system Peripheral considerations Resources Scanning solution Faxing workflow Billing Record sharing with other providers Chart Pull Policy 1. American EHR Partners 2. Meaningful Use Participation Timeline and Guidance/Legislation/EHRIncentivePrograms/Participation Timeline.html#.UvWU1fldWVH 3. Meaningful Use Pocket Guide Pocket Guide pdf 4. Regional Extension Centers regional extension centers 5. Electronic Health Records, Second Edition Edited by Jerome H. Carter, MD, FACP

6 Thank you for your attention! Questions? Comments? Medical Informatics Committee Course Curriculum Nareesa Mohammed Rajput, MD, MPH, FACP Informatics Curriculum (Room 414 CD) Informatics Curriculum (cont d) (Room 414 CD) Diagnosing EHR Pain: Can I Fix It? (PN 031) Thursday, 7:00 8:00 am Treating EHR Pain: Time to Replace It? (MTP 117) Thursday, 8:15 9:15 am Implementing emessaging, Non Visit Based Care, and Social Media to Engage Patients and Improve Care (MTP 107) Thursday, 11:15 am 12:45 pm Preparing for Meaningful Use State 2 and Beyond (PN 003) Friday, 11:15 am 12:45 pm Best Practices for Optimizing Your EHR: Lessons from the Field (PN 033) Saturday, 11:15 am 12:45 pm Implementing Quality Measures and Clinical Guidance into the EHR to Improve Patient Care (PN 004) Saturday, 2:15 3:45 pm ACP Resources American EHR Practice Time Line (MU, ICD10, PQRS, VBP) an_practice_timeline/ ICD 10 Resources nt_coding/coding/icd10.htm Where to find answers to your questions at IM2014 College Resource Center Briefings in the Exhibit Hall Tools for Practice Improvement Thursday, 4:05 pm Friday, 3:55 pm Saturday, 1:05 pm Tools to Meet Federal Requirements and Reporting Friday, 4:05 pm Saturday, 12:55 pm ACP staff experts will be on hand to answer questions and discuss concerns