Subject Index A Active management, 109 Adjustments in patient schedule ability to learn and adjust to workflows, 73 cost of cutting down patient visits, 75 impact on revenue, 74 managing stress of schedule, 74 medical errors, 74 medical help for patients, 74 patient scheduling plan, 75t projected revenue impact of EMR implementation, 76t revenue, 74 Agency for Healthcare Research and Quality (AHRQ), 118 American Academy of Family Physicians (AAFP), 21, 32, 45 46, 125 American Academy of Pediatrics (AAP), 45 American College of Physicians (ACP), 45, 125, 128 American Health Information Management Association (AHIMA), 45 American Recovery and Reinvestment Act (ARRA), 1 5, 11, 38, 43, 55, 117, 130, 133, 137 138, 140 Application Service Providers (ASP), 39, 42, 44, 136, 140 142 Aprima software, 17, 19 ASP model ambulatory EHR solution, 140 142 B Beneficial system functionality, 109 C CCHIT Certified 2011 Ambulatory EHR, 43 Centers for Medicare and Medicaid Services (CMS), 2, 140 Certification Commission for Health Information Technology (CCHIT), 43, 45 46, 49, 55, 117, 129 130, 141 Chart preparation, 73, 75, 78t duration of patient visit, 75 pre-load vs. scanning, 77 reliability of data pre-loaded, 77 resource cost, 77 spreadsheet, 77 sample transferring medical charts into EMS, 78t 79t CCHIT certified, 16, 43, 45, 55 Clear Health, 56 Clinical decision support (CDS), 6t, 7 8, 49, 128, 130, 133, 141 Clinical outcomes, optimizing, see Optimization Communication breakdown, EMR implementation, 103 with EHR vendor, 59 faltering, among team members, 111 patient, 73, 83, 132, 140, 142 via EMR, 27 The Computer-based Patient Record: An Essential Technology for Health Care, 128 Computerized provider order entry (CPOE), 6 8, 83, 96, 111, 125 Cost for additional functionality, 136 Cultural changes, managing, 94 96 dealing with providers, 95 inclusion, 95 staff turnover, 95 types of provider, 94 N.S. Skolnik (ed.), Electronic Medical Records, Current Clinical Practice, DOI 10.1007/978-1-60761-606-1, C Springer Science+Business Media, LLC 2011 147
148 Subject Index D Decision support, 6 8, 49, 65, 77, 111 112, 117, 128 130, 133, 139, 141, 143 See also Clinical decision support (CDS) Disaster recovery, 39, 106 Down-time, managing, 106 Dragon Naturally Speaking (Nuance Software), 66 E e Clinical Works, 34 Education/training and support, managing, 104 one-on-one teaching, 104 teaching providers, 104 EHR conversion, 57, 143 EHR, current initiatives choosing EHR solution certification, 130 clinical decision support, 130 meaningful use guarantees, 130 structured data, 130 support for coordinated care, 130 development care coordination, 129 interoperability, 128 129 usability, 129 EHR efficiency, 7 9, 25, 61, 64 69, 81, 96, 114, 125 EHR implementation, 20, 57, 60, 62, 69, 134 EHR initiatives/development care coordination, 129 interoperability, 128 usability, 129 EHR planning, 15, 26, 72, 86 87, 91, 93 94, 97, 110, 115 116 See also Pre-implementation planning and workflow analysis EHR pricing, 69 elevation in, 135 EHR provider, characteristics, 137 EHR selection criteria integration, 145 reputation, 145 utility, 144 versatility, 144 process safety of, 126 trusting people in, 125 EHR standardization, 128, 130 Electronic dictation, 65 Electronic Medical Records (EMR) benefits, 18 best aspects, 20 difficulties, 17 hidden costs to, 18 patient interactions, negative effect, 18 patients relations, negative effect, 22 worst aspect, 20 writing and refilling prescriptions, 23 Electronic prescribing (e-prescribing), 67, 83, 139 access to physician s electronic prescription pad, 67 advantages/disadvantages, 67 medical errors, 67 security of printed prescriptions, 67 Electronic prescription pad (e-prescription pad), 67 Electronic visits (e-visits), advantages/disadvantages, 68 E-MD s system, 29 30, 126 EMR selection, 24, 38, 40 41, 45, 47 12-step program in, see 12-Step program in selecting EMR EMR vendors, 21, 41, 43, 46 47, 54, 80, 82, 97, 135 136 End-user license agreement (EULA), 98, 105, 121 End-user speed, 25 26 Enhanced coding, 118 e-prescription, 80, 82 Executive governance, 93 94 peer review, 94 F Federal qualified health centers (FQHC), 3 Financial incentives to incorporate EHRs, 143 Financial outcomes, 86, 115 optimizing, 113 See also Optimization Forms/templates/order sets, managing, 101 102 branching of order sets and protocols, 101 collapsible/explodable forms, 101 FQHC, see Federal qualified health centers (FQHC) FreeMED, 56 G Gantt chart, 89 90 Go-live, 74 75, 77, 80 83, 92, 103 Guidelines for Physician Patient Electronic Communication, 68
Subject Index 149 H Health and Human Services (HHS), 3, 130 Healthcare Information and Management Systems Society (HIMSS), 45, 141 Health information exchanges (HIE), 139 Health Information Technology for Economic and Clinical Health Act, 117 Health information technology (HIT), 38, 58, 60 61, 66, 117, 127 130, 144 becoming meaningful user, 12 13 groups receiving direct assistance from ONCHIT, 13 ONCHIT, 13 Health and Human Services (HHS), 3 health outcomes and policy priorities, 7 12 objectives/measures for improving care coordination, 10t incentives for physicians under Medicaid, 3 5, 4t FQHC, 3 qualification for physicians, 3 incentives for physicians under Medicare, 3 Medicare Advantage (MA) organizations, 3 meaningful use, 5 7 HIT Policy Committee (HITPC), 5 objectives and measures for ambulatory physicians, 6t 7t requirements for stage (1), 4 5 requirements for stage (2), 5 meaningful use of EHRs, definition, 2 Medicare incentive payments for use of certified EHR, 2t Health Information Technology Regional Extension Centers, 12 Health Insurance Portability and Accountability Act (HIPAA), 11 Health outcomes and policy priorities, HIT care coordination, 10 authorized entities, definition by HITPC, 10 objectives and measures, 10t engaging patients and families in health care, 9, 10t objectives and measures, 9t privacy and security protections for personal health information, 11 HIPPA, 10 11 objectives and measures, 11t public health, 12 objectives and measures, 11t 12t quality/safety/efficiency/reducing health disparities, 7 9 activities, physicians, 7 objectives, 8t 9t Health Outcomes Initiative in Comparative Effectiveness (CHOICE), 118 HER cost-effectiveness, 69 HER team, see Transition team Hidden costs, 18, 126 I Imetica, see Aprima software Implementation adjusting patient schedules, 73 availability of super-users, 83 chart preparation, 73 commitment to training, 73 goals, 72 onsite training, 80 83 physician and staff buy-in, 73 quitting process, 72 symptoms or characteristics, 73 value of super-user, 73 Incentives, 2, 116 118 financial, to incorporate EHRs, 143 Medicaid incentives for meaningful use, 4t Medicare and Medicaid payment, 2 optimizing financial outcomes, 117 118 for physicians under Medicaid, 3 5, 4t FQHC, 3 qualification for physicians, 3 for physicians under Medicare, 3 Medicare Advantage (MA) organizations, 3 Incremental roll-outs, managing, 100 Big Bang approach, 100 formal phases, creation of, 100 L Leading Change (John Kotter), 54 M Maintenance, 91 108 managing cultural changes, 94 96 dealing with providers, 95 inclusion, 95 staff turnover, 95 types of provider, 94 managing down-time, 106 disaster recovery, 106 scheduled/unscheduled/catastrophic, 106 managing education/training/support, 104 one-on-one teaching, 104 teaching providers, 104
150 Subject Index Maintenance (cont.) managing forms/templates/order sets, 101 102 branching of order sets and protocols, 101 collapsible/explodable forms, 101 managing incremental roll-outs, 100 Big Bang approach, 100 formal phases, creation of, 100 managing paper parts of record, 106 artifacts, 107 managing policies and procedures, 102 104 all-comers type inbox, 102 communication breakdown, 103 naming documents, 103 new policies, creation of, 102 103 managing process changes coding and billing, 96 CPOE, use of, 96 incremental experiments, 96 start-stop-continue, 97 managing security and compliance, 104 105 audit trails, regular use of, 105 compliance with performance metrics, 105 EULA, 105 managing self documentation, 108 central management/peripheral distribution, 108 managing service requests (SR), 99 100 collecting problems, 99 SR database, use of, 99 managing upgrades, 107 108 10-step cycle, testing and retesting, 108 managing vendors (technical support), 97 98 end-user license agreement (EULA), 98 primary aim, 98 profit/costs, 97 roles executive governance, 93 IT worker bees, 93 peer review, 94 physician champion/super user/problem solver, 92 93 thought leaders/early adopters, 93 Meaningful use criteria, 5, 11, 42, 81, 130, 137 checklist, 81 objectives and measures for ambulatory physicians, 6t 7t Mindset, establishing, 86 91 actionable knowledge, 88 decision cloud, 90 gist reasoning, 89 non-compliance, 90 planning for patients, 87 rational/subjective, thinking, 89 N National Institute of Standards and Technology (NIST), 129 130 O Office of the National Coordinator for Health Information Technology (ONCHIT), 12 13, 117, 129, 143 Onsite training, 80 83 big bang vs. phased roll-out, 80 83 clear self and staff s schedule, 81 conduct surveys, 82 electronic lab results, importance of, 83 follow set agenda, 81 leverage super-users, 82 manage patient expectations, 82 83 meaningful use criteria, checklist, 81 motivate staff, 82 patient communication, 83 phased approach, 80 reduce patient load, 82 secure training space, 82 commitment to training, 80 OpenEMR, 56 Optimization, 108 119 active management, 109 beneficial system functionality, 109 optimizing clinical outcomes barrier to urgent and emergent care, 111 decision support, 111 112 faltering of communication, 111 patient education, 112 optimizing financial outcomes attract new patients, 116 documentation at point of care, 115 116 EMR customization efforts, 115 enhanced coding, 118 incentives, 116 118 information throughout organization, 119 less hassle, 119 managing unpaid work, 118 119 Pay for performance (P4P) programs, 117 reduction in support staff, 116 ROI calculations, 113
Subject Index 151 Theory of Constraints (Goldratt), 114 10-step cycle, 108 109 technical optimization, 109 device planning, 110 managing click-throughs, 110 P Paper parts of record, managing, 106 artifacts, 107 Patient-Centered Medical Home (PCMC), 38, 129 Patient-centric healthcare system, 34, 130 Patient education, 9, 29, 30, 47, 49, 112 Patient portals, 9, 34 Pay for performance (P4P) programs, 34, 38, 47, 117, 139 Physician and staff buy-in, 73 information about benefits of EMR, 74 play environment for users, 73 Physician champions, 27, 41, 58 59, 92, 97 buddy-blitz, 92 champion role, 92 ongoing management functions, 92 Policies and procedures, managing, 102 104 all-comers type inbox, 102 communication breakdown, 103 naming documents, 103 new policies, creation of, 102 103 Portable PC, advantages, 63 Practice Fusion, 20, 55 Practice management system (PMS), 26, 42 43, 138 Practice Partner, 21 22 Pre-implementation planning and workflow analysis beginning, 61 63 code, 66 documenting visit, 64 66 documentation by exclusion, 65 electronic dictation, 65 free typing, 65 point and click, 64 65 electronic prescribing, 67 hand-off, 64 moving patients in right direction, 63 64 notebooks or tablets, 63 patient portal, 67 68 e-visits, 68 legal implication of e-communication, 68 portable PC, advantages, 63 preparing to go paperless, 68 69 basic methods for entering past information, 68 prepping the charts, 69 sticky notes, information, 61 transition team input and buy-in, 60 61 input and creating buy-in, 60 61 laying down ground rules, 60 physician champion, 58 selecting team, 59 senior manager, responsibilities, 59 superuser, 59 Process changes, managing coding and billing, 96 CPOE, use of, 96 incremental experiments, 96 start-stop-continue, 97 R Reflections of leaders on EHR, 123 145 Request for Information (RFI), 47 48 Request for proposal (RFP), 47 48 Return on investment (ROI), 94, 113, 138 Rural health centers (RHC), 4 S Security and compliance, managing, 104 105 audit trails, regular use of, 105 compliance with performance metrics, 105 EULA, 105 Selecting EMR ASPs/SaaS, 44 checklist adequate technical skill and resources, 39 expenses, need for Kia or a Lexus, 40 reasons for need, 40 tolerance for risk, 40 information sources books, 44 45 EMR consultants, 45 EMR ratings and user satisfaction surveys, 46 RFP/RFI, 47 48 specialty-sponsored EMR information, 45 trade shows, 45 web sites, 46 open source and free software open source, 55 proprietary, 55 practice management system (PMS) integrated EMRs, 42 request for proposal (RFP)/Request For Information (RFI), 47 48
152 Subject Index Selecting EMR (cont.) 12-step program, see 12-Step program in selecting EMR understanding certification, 43 CCHIT Certified 2011 Ambulatory EHR, 43 usability, 49 Self documentation, managing, 108 central management/peripheral distribution, 108 Senior manager, 41, 57 59 Service Level Agreement (SLA), 39 Service requests (SRs), managing, 99 100 collecting problems, 99 SR database, use of, 99 Small-practice physicians confusion over best vendor, 144 cost, 143 practice disruption, 144 Software as a Service (SaaS), 39, 42 44 State Children s Health Insurance Program (SCHIP), 4 12-Step program in selecting EMR step 1: identifying decision makers, 41 step 2: clarifying goals, 42 step 3: researching options, 42 step 4: establishing requirements, 47 step 5: narrowing options, 48 step 6: attending demonstrations, 48 50 step 7: checking references, 50 51 step 8: ranking vendors, 51 53 step 9: conducting site visits, 53 step 10: selecting finalist, 53 54 step 11: organizational commitment, 54 purchase/implementation/maintenance costs, 51 vendor characteristics / reputation, 52 step 12: negotiating contract, 54 ARRA certification, 55 contract duration, 54 ICD-10 compliance, 55 ownership transferability, 54 price, 55 Super-users, 83 availability of, 83 characteristics, 83 development and identification, 83 functional areas, 83 leveraging, 82 value of, 73 4 weeks training, 83 T Technical optimization, 109 Theory of Constraints (Goldratt), 114 Towards an Electronic Patient Record (TEPR), 46 Transition team input and buy-in coding and billing, 61 demonstration, 60 questions and concerns, 61 input and creating buy-in, 60 61 laying down ground rules, 60 timeline, 60 workflow procedures, 60 physician champion, 58 choice of, 59 selecting team, 59 front and back-office staff, 60 multi-doctor groups, 60 senior manager, responsibilities, 59 superuser, 59 U Unpaid work, managing, 118 Upgrades, managing, 107 108 10-step cycle, testing and retesting, 108 Usability, 49, 52 53, 126, 128 131, 135, 136, 140, 142 Usability scales, 50 2011 Usability Testing Guide for Comprehensive Ambulatory EHRs, 129 User-satisfaction surveys, 45, 135 V Vendors, EMR, 21, 41, 43, 46 47, 54, 80, 82, 97, 134 135 technical support, managing, 97 99 end-user license agreement (EULA), 98 primary aim, 98 profit/costs, 97 W Workflow analysis beginning, 61 63 code, 66 documenting visit, 64 66 documentation by exclusion, 65 electronic dictation, 65 free typing, 65 point and click, 64 65 electronic prescribing, 67 hand-off, 64 moving patients in right direction, 63
Subject Index 153 notebooks or tablets, 63 patient portal, 67 68 e-visits, 68 legal implication of e-communication, 68 portable PC, advantages, 63 preparing to go paperless, 68 69 basic methods for entering past information, 68 prepping the charts, 69 sticky notes, information, 61 See also Transition team World Vista EHR, 56