Implementation is Not Enough: Keys to EHR Optimization

Transcription

1 Implementation is Not Enough: Keys to EHR Optimization Supported via a National Cooperative Agreement with U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care 1

2 Casey Alrich, MPH, CPHIMS Director of the Keys to Quality HCCN Supports HIT and QI training and TA for NCA program of HRSA Certified Professional in Health Information Management Systems (HIMSS)

3 Implementation is Not Enough: Keys to EHR Optimization Supported via a National Cooperative Agreement with U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care 3

4 Quick Definitions MU Meaningful Use, the CMS EHR Incentive program PCMH Patient centered medical home (not particular to any accreditation body) HIT Health information technology EHR Electronic health record PM Practice management ONC Office of the National Coordinator CQM Clinical quality measure

5 Goals and Objectives 1. Understand the importance and benefits of a comprehensive HIT needs assessment 2. Identify the necessary steps and team members for an internal HIT assessment 3. Identify the primary components of a HIT needs assessment 4. Identify the building blocks of proper HIT governance

6 Drivers of Health Information Federal: Technology CMS Meaningful Use Incentive program Quality reporting requirements Medical home designation programs Local Pay for performance initiatives Health Information Exchange and data warehousing initiatives

7 Adoption of Health IT Health Center EHR Practice Mgmt Biz Intelligence Reporting Tools HR, Pharma, Etc Larger Health Community Data Warehouse Patient HIT Health Info Exch Patient Portal HL7 Interfaces Health Records Direct Message Smart Devices Lab Interfaces Pop Mgmt

8 Issues with Health IT 1.Usability 2.Interoperability 3.Costs 4.Security and privacy

9 Issues with HIT - Usability Effectiveness, efficiency and satisfaction with which users can achieve a set of tasks in a particular environment. HIMSS Usable system is one that is intuitive, forgiving of mistakes, and supports through background operations JAMA survey 78 lost minutes/week cleaning up EHRs/charting

10 Issues with HIT Usability Beyond providers usability of systems for RNs, MAs, front desk staff, managers Patients having issues with portal design

11 Issues with HIT - Interoperability ONC major focus on interoperability KLAS report finds that less than half of EHRs work together 82% of providers report success creating their own interoperability work-arounds Levels of interoperability Between provider entities Between internal HIT products (EHR, PM, portal, business intelligence tools, pharma)

12 Issues with HIT - Costs Adoption Costs Rip & Replace Decreased Productivity Interfaces Maintenance Costs

13 Issues with HIT Security and Privacy HIT Risk Assessment Risk Monitoring Secure Processes Secure PHI

14 Issues with Health IT 1.Usability 2.Interoperability 3.Costs 4.Security and privacy 5.Absolute Necessity

15 Assess, Govern and Optimize HIT Continuous HIT Assessment HIT Governance HIT Optimization

16 Internal Health IT Assessment Benefits of an internal assessment: Useful to bring whole group together to discuss Identifies needs and detrimental practices Identifies resources and facilitators to care Identify risks related to privacy and/or auditing Quickly evaluate resource allocation Critical to resource planning going forward

17 Health IT Assessment Team Roles of an internal assessment: Executive leadership (CEO, CFO, CIO or COO) Operations (clinical manager, practice manager) Clinical (CMO, provider champion, RN supervisor) IS (application manager, data analyst) IT (helpdesk, network manager, training staff) QM (quality manager, P&S officer)

18 Planning for an HIT Assessment Logistics of internal assessment: Meeting space - enough to accommodate all involved, comfortable, projector Time - a full day if at all possible (not all necessary all the time), feed people, frequency Documents: MU reports PCMH reports CQM reporting Minutes from QM cmte, medical cmtes, etc.

19 Components of an HIT Assessment 1. System Infrastructure 2. System Governance 3. Clinical Quality Management and Reporting 4. Health IT Work Flows

20 Components of Each Section Overview Importance of this section Issues covered by section Discussion Collect staff opinions/exp. Connect to strategic priorities Metrics Tie discussion to physical reality Track progress/growth over time

21 Components of an HIT Assessment 1. System Infrastructure 2. System Governance 3. Clinical Quality Management and Reporting 4. Health IT Work Flows

22 System Infrastructure Overview What are the major HIT systems How housed, connected, supported Discussion Metrics HIT systems by site; new initiatives; connectivity issues; helpdesk support; training; vendor Number of sites; products/versions; users; downtime reports; support FTEs; compliance reports

23 Examples of Infrastructure System Issues NAP conundrum: New sites coming online that need to transfer over to the EHR System capacity: New population health management software Staff turnover: High clinical staff turnover requires new training program Downtimes/slowdowns: Poor network performance leads to lost productivity

24 Components of an HIT Assessment 1. System Infrastructure 2. System Governance 3. Clinical Quality Management and Reporting 4. Health IT Work Flows

25 System Governance Overview How do you oversee HIT adoption/use How to ensure privacy and security Discussion HIT governance structure; integrity of the EHR; safeguards for PHI; data security Metrics Privacy and security audit findings; helpdesk reports; chart audits (tools and findings)

26 Examples of System Governance Issues Minding the store: No one group critically assesses use/need related to health IT Vulnerabilities: Privacy and security risks may exist and health center could be open to fines or grant conditions Inconsistent EHR use: May lead to poor data capture, inefficiencies, and provider frustration

27 Components of an HIT Assessment 1. System Infrastructure 2. System Governance 3. Clinical Quality Management and Reporting 4. Health IT Work Flows

28 Clinical Quality Management and Reporting Overview How HIT captures and reports quality of care HIT as a barrier/facilitator for CQI Discussion What are the critical data/quality reporting programs; how CQI reports shared with staff; reporting capacity Metrics MU reports (EPs and more); PCMH scores; common reports and reporting schedule; UDS report

29 Examples of CQM and Reporting Issues Meaningful Use: Training EPs on MU objectives, changing tools and work flows PCMH: Making the necessary changes for PCMH recognition and maintenance Ad-hoc CQM reporting: Funders and emergencies determine CQM reporting Shifting UDS: Planning for UDS changes and growing implications of UDS results

30 Components of an HIT Assessment 1. System Infrastructure 2. System Governance 3. Clinical Quality Management and Reporting 4. Health IT Work Flows

31 Health IT Work Flows Overview Does HIT enhance or hinder work flows Work flows to take advantage of HIT Discussion Front desk/intake; PCMH processes; use of care teams; panel management; orders reconciliation Metrics PM reports (access, productivity); MU objectives; open charts; order sets

32 Examples of Health IT Work Flow Issues Exploding schedule: Dozens of appointment types, frequent missed appts MU frustration: High number of clicks to capture MU information, poor rates Care coordination: Building effective teams to manage population health Referrals!: Managing and tracking referrals becomes an FTE black hole

33 Health Information Management Committee Poor governance/communication at the root of most health IT issues Governance breaks down silos Allows for targeted allocation of resources Aligns health IT priorities with larger strategic plan Shared ownership of health IT balance between IT/IS and clinical

34 Health Information Management Committee (cont.) Q: What does an HIMC have in common with horseshoes and hand grenades? A: Close counts!

35 HIMC Membership Cross-section of health center staff: Operations, financial, IT/IS, clinical staff Important voices related to: clinical work flows, expenditures, system integration, HIT strategic priorities System must be in place to track: Roles, attendance, meeting notes, assigned tasks and scheduling

36 HIMC Membership HIMC Roles Chair leadership, manage meetings Operations clinic ops and staffing HIMC Roles Secretary take notes, group Provider clinical perspective, user Compliance privacy and security IT systems, networking IS helpdesk support, training Finance coding, budgeting *Note: indicates roles and not necessarily membership App Manager development, change management QI/QA CQM reporting, initiatives

37 HIMC Charter Maintains HIMC focus and sets expectations 1. Guiding Principle 2. Goals and Objectives 3. Committee Structure 4. System Infrastructure 5. Communication Plan

38 Timelines and Project Planning Develop a timeline of impending HIT projects to support planning Project planning allows prioritization in a world of constrained resources Projects: Adoption Maintenance Optimization

39 7/11 Clinician Mtg. MU Training HIMC planning for HIT updates 7/18 Allscripts MU2 package live End of July: Pt. Portal:operational planning Mid Sept. Pt. Portal go-live Review MU dashboards with clinical teams and evaluate workflows/op erations Begin MU2 365 capture May June July August Sept. Oct. Nov. Dec. Jan /13 or 6/20 Allscripts v.13 upgrade IT Budget review: kiosk, printers Early June: Pt. portal demo for HIMC Early- mid Aug. 4-6 week portal implementation (instillation) Oct. 1 deadline to begin 90 d. MU capture; Send out reminder eblast to providers 12/31 end of 2014 MU reporting period ICD-10 planning; MU stage 2 365; new call center tools [Health Center] HIMC 2014 HIT Timeline

40 Adoption: Project Planning Identify new products going live Financial, staffing, networking implications Maintenance: Post go-live: what needs to be done? Training, ongoing staffing, system testing, eval Optimization: Review helpdesk requests, user feedback, grant opportunities

41 Maintain HIMC Progress Maintain regular, weekly items for discussion Ongoing maintenance, not just new projects Larger projects should be broken out to subcommittees Clearly identify actionable items in notes Rotate membership when necessary Continually assess relationship to clinic strategic priorities

42 HIT Optimization First Steps Build Coalition Begin talks with stakeholders Achieves buy-in from key actors Assess Informally Dig into sections and metrics solo Will inform thorough assessment Introduce Governance Create timelines, plan projects Yield quick results

43 Where can I find HIT Optimization Services? Community Health Partners for Sustainability provides free technical assistance services to health centers, regardless of FQHC status Levels of support: Multi-day onsite HIT assessment Guided HIT assessment conference call Tools and templates to support selfassessment Peer-to-peer connections with other FQHCs

44 HIT Optimization Resources ONC EHR Implementation Resources Many useful templates and guides, not just for those implementing Safety Net Medical Home Initiative Good templates and tools for HIT work flow

45 Q&A If you have a question please type your question into the comment box in the Go To Webinar control panel and it will be relayed to the presenters.

46 For More Information Casey Alrich, MPH, CPHIMS Health IT and Quality Improvement (215) Centre Square East 1500 Market St. Philadelphia, PA 19102