Implementation of an Integrated Electronic Health Record at Gottlieb Memorial Hospital

Transcription

1 Implementation of an Integrated Electronic Health Record at Gottlieb Memorial Hospital

2 Background The Problem The Health Information Technology for Economic and Clinical Health (HITECH) Act provides the Department of Health & Human Services (HHS) with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health IT, including electronic health records (EHR) and private and secure electronic health information exchange (HealthIT.gov, 2013). Starting in 2011 Medicare and Medicaid implemented an EHR Incentive Program that rewarded healthcare organizations who not only implemented an EHR, but also demonstrated meaningful use by means of achieving specific objectives through three evolving stages: Stage 1 : Data capturing and sharing Stage 2: Advance clinical processes Stage 3: Improved outcomes Additional integration of GMH and LUMC into one health system evidenced the need to have one cohesive medical record that could be easily accessed at both campuses to further streamline patient care. Resource: HealthIT.gov. (2013). Policymaking, Regulation & Strategy: Meaningful Use. Retrieved from

3 Project Aim Statement Implement an Integrated Electronic Health Record (Epic) that would serve as the universal source to document and obtain information as it pertains to patient care at both LUMC and GMH campuses with an emphasis on patient safety, specifically, the use of computerized physician order entry (CPOE).

4 Project Goal Meaningful Use Goal: 30% of orders were entered in Epic by Medical Staff (or authorized provider) one week post Epic go-live. Internal Goal: 60% of orders were entered in Epic by Medical Staff (or authorized provider) one week post Epic go-live.

5 Solutions Implemented Leadership Full medical staff leadership support DOC EMR & Physician Oversight Committee Voice of Design Nursing leadership facilitated transformation of existing paper order sets into versions that could be incorporated in the EHR Education Specific curriculum to each user type Early training, retraining, and refreshers Tools: information documents, guides, how-to s, electronic e-learning, modules, test/training environment, one-on-one lessons Workflow/Planning All departments mapped workflow Interdisciplinary meetings to identify how work in each department correlated with each other; most department tasks result from physician orders Utilized and optimized LUMC pre-existing Epic build for GMH Extensive review of order sets and process stimulations Nursing staff & physicians updated/validated Support Super-users specific to all user types; medical students assigned to floors, medical staff lounge and provided hands on training to medical staff Command Center: 24/7 Assistance at Epic go-live Real time issues resolution Post go-live support (4 weeks) Process in place for users to request assistance on as needed bases

6

7 Result Analysis One week post Epic go-live CPOE exceeded both the meaningful use (30% usage) and internal (60% usage) goals, achieving 81.65% of all inpatient orders being ordered via CPOE. Six weeks post Epic go-live CPOE had increased to 83.17%, a 39% change or a 23.17% increase from the internal goal. Most current data, 32 weeks post go-live, demonstrates a continued high compliance with CPOE remaining around 80% usage. Implementation and high usage of CPOE satisfied Stage 1 criteria of meaningful use.

8 Lessons Learned Lab, nursing and pharmacy workflows, which are heavily dependent on physician orders, are continuously evolving. Mirroring an Academic Medical Center s EHR build for a community hospital s EHR results in re-evaluation of both facilities current practices and procedures often resulting in improvement. Earlier integration of departments at both campuses/standardizing as many tasks as possible prior to EHR implementation would alleviate re-work and accommodate better data for evaluation. A multidisciplinary team dedicated to evaluating, revising, and planning order sets is necessary for efficiently and effectively implementing CPOE. There will never be a time when CPOE will be 100%.

9 Next Steps Increase order entry by authorized provider to 90%. Hire CMIO to increase physician and clinician engagement. Continue to work with medical staff, lab, nursing and pharmacy to further integrate both campuses workflows and processes with an emphasis on standardization. Ongoing collaboration to ensure changes in one campus s Epic software/ehr is also completed in the other campus s Epic software/ehr. Work on satisfying Stage 2 criteria of meaningful use. Additional optimization of Epic software at both campuses.

10 Content Information Various departments/areas/groups contributed to the Epic storyboard including: IS, Nursing, Pharmacy, Lab, Medical Staff, Administration, QMR, IOT, Optimization team. GMH s QMR will direct any questions or comments to appropriate individuals. Please contact S ext. 2133, SAVANNA_STOUT@lumc.edu.