HEALTH INFORMATION TECHNOLOGY SUMMIT Successful Selection/Implementation Electronic Health Record

Transcription

1 HEALTH INFORMATION TECHNOLOGY SUMMIT Successful Selection/Implementation Electronic Health Record Samuel DeLeon, MD Chief Medical Officer Urban Health Plan

2 Introduction Overview Initial EMR selection/implementation Second EMR selection/implementation Key Points Challenges Conclusion

3 Institutional Demographics ~370 Staff Members 60 FTE providers (~80 providers) 3 practice sites, 2 administrative sites, 5 School Health Program, and 4 offsite programs Primary care (Adult/Pediatrics/OB-GYN) 16 Specialties 2006 Productivity Projections: Users ~28,000 Visits ~150,000

4 What is UHP trying to accomplish with EHR? Manage clinical information more efficiently Performance indicators for providers - tie to incentives, improve peer review process Research- collect accurate/timely data Ultimately manage all organizational information more efficiently -need Enterprise Content Management systems Performance Dashboard: Clinical/Financial/Operational measures

5 Timeline of Events 1993 primary care initiative grant-nys DOH- ended with a PMS (MSI) 1995 Logician- very complicated and we were not ready license EMR (PRAXIS)- nice system but we were still not ready Medical Manager PMS- very well thought out selection/implementation process 2001/2002 Omnidoc from Medical Manager/WebMD August 2005 ~8 providers using Omnidoc-printing out notes- decided to change EHR system November 2005 purchased ecw March 2006 began implementation ecw September 2006 completed implementation of ecw

6 Initial EHR Project Selection/Implementation 2002 Began searching for EHR end 1999 Developed a project team- project manager/cto/cmo/ceo Reviewed many demos with select group of providers Decided on Omnidoc end 2000 for several reasons: 1- one vendor for PMS/EHR 2- EHR integrated with PMS 3- gave us an?? excellent deal

7 Initial Implementation Site Started at Bella Vista Health Center 8 exam rooms 1 physician, Nurse Practitioner, Physician Assistant, Part-time time GYN/Podiatry 5 medical assistants, receptionist, part- time medical records clerk ~10,000 patients visits/year

8 After 3 years implementation We gave up! first sign of trouble: difficulty installing the system Project management from vendor was poor upgrades resulted in system crashes Invoicing problems- vague contract (?(? EXCELLENT DEAL ) Vendor inflexibility System was difficult to use from a provider standpoint-not INTUITIVE Lacked clinical decision support tools Unable to track patient flow Problem list had to be actively managed No flow sheets etc.

9 Why did we fail initially? Very inexperienced-like everyone else EMR systems were either not good or too expensive In the end we based our decision on $$$ (? EXCELLENT DEAL ). Vendor issues -provided poor implementation support (training, software support, etc.) -initially cheap but in the long run more expensive -inflexible -too many sales-people

10 What we accomplished with failure? Project team became better educated Exposed providers to EMR Secured Provider Buy-in Understood the difference between an integrated and interfaced PMS/EHR system Developed an understanding of what kind of vendor we wanted to deal with Helped our first JCAHO survey- problem list/medication list/surgical history/quality Care Guidelines/Allergies/Hospitalizations

11 Overview of Second EHR Selection Process 1st step was easy- team was convinced of change including CEO Quickly outlined a list of vendors based on functionality Demo process Selected system in ~10 weeks Signed contract ~14 weeks

12 New Selection Approach Same Project team- Project Manager, CTO, CMO,CEO Provider user group to view demos Created a must-have list of features- since we had experience!

13 New Selection Approach Must Have list Patient Summary Sheet/Medication list/surgical Hx/preventive health alerts (JCAHO complaint) Templates Discharge summary Prescription system performs drug-drug interactions, formulary check Patient education for medication in English/Spanish Reporting tool- Health Disparities registries/uds reporting PMS must be able to do FQHC billing in NYS

14 New Selection Approach Must Have Pediatric growth charts Ability to customize user views based on job function HIPAA compliance HL7 lab interface Decision support tools and clinical reminders Referrals- ability to track

15 New Selection Approach Must Have Ability to use drawings Flow sheets for OB Redundant servers PMS/EHR fully integrated Electronic signatures Bio-sensor technology authenticate patients and staff Dental Patient Portal

16 Process for selection of new EHR Project manager spoke to multiple customers on the phone Visited two sites Project team visited ecw s main office and had direct discussions with owners Picked a winner

17 New Implementation Strategy Project team-project manager, CTO, CMO, CEO Met with CEO weekly to discuss progress and next steps Negotiated contract with payment attached to milestones Discussed milestones stipulated in vendor contract

18 Vendors Evaluated WebMD- Intergy Misys NextGen ecw Physician Micro System Integrated HealthWare Vista Office EHR Epic Systems

19 2 Vendors Selected Vista/eCW Site visits- VA Bronx for Vista/8 provider Family Practice site and 6 Cardiology group for ecw Spoke to many ecw customers- all of them gave them good to excellent ratings Visited ecw headquarters and interviewed owners

20 ecw EMR cost Hardware Software 70 licenses Maintenance Training- including lost productivity Total purchase, training and first year implementation cost per provider- ~10,000 per staff member- ~2,000

21 Key Points Choose your project manager carefully 1-Knowledgeable about organizational work-flow 2-preferably a provider but not a necessarily a physician 3- Excellent organizational skills 4- Not a techi but with end-user computer kills 5-excellent people skills Need a good IT infra-structure and person to evaluate the system (CTO) Create a project team that manages the project -standardize meeting with agenda, etc

22 Key points Choose your vendor carefully -need a partner Review the contract carefully Involve managers in work-flow re-design and QA monitoring Begin provider education on EMR early Involve providers in the customization process (templates, etc)

23 Key Points Implementation involves merging the EHR/Institutional Practice work flow Do work-flow analysis and re-design Expect to change your work-flow processes -because you need to adapt to EMR-flow -because you can address newly discovered inefficiencies Maintain a back-up paper system

24 Key Points Training is essential- we ve kept one vendor trainer for 4 months and another is still with us. New staff must train before they start work- new employee orientation had to change As upgrades come up, expect to have more training Start identifying in-house house-trainers

25 Key Points Provider Readiness Introduced topic EHR early (1999) Regular update on EHR implementation at staff meetings Improve provider and staff computer skills- introduced MS Outlook 8/2001 DOH provided palm pilots for providers Developed a provider user group- for selection and customization

26 Key Points Provider Readiness Identified Provider Champions and Super- users To encourage use prescription system created contest, awards, etc. Once EMR implemented we provided training, training and training!!!

27 Challenges Getting staff accustomed to new environment Adjusting to newly discovered work-flow inefficiencies Re-deployment of staff- medical records, new positions, etc. QA issues- scanning, labs, referrals, etc Assuring enhancements are completed

28 Challenges Health Disparities Collaborative reporting Identifying/Training in-house trainers Completing the bi-directional laboratory interface Integrating Practice Management System implementation Position equipment to maintain optimal patient care ergonomics issues

29 Benefits to date Legible notes Prescription writing improved Accurate medication, problem list Immediate access to labs, consults Charts immediately available simultaneously to everyone Improved consultative service to satellite providers Ability to discover work-flow inefficiencies quicker Ability to monitor (waiting times, Labs, Referrals, scanned documents) Over-all organizational efficiency improvement

30 Conclusion Senior level commitment key Selection Process is important and difficult but Implementation Process is the key! Have all your manual processes clearly spelled out Pick project manager carefully Dedicated project team Choose your vendor wisely