Shannon Rykaceski Director of Opera4ons CCFHCC
PRESENTER BIO Shannon Salicce Rykaceski Director of Opera4ons for the Catholic Chari4es Free Health Care Center (CCFHCC), located in PiCsburgh, PA. Prior to this posi4on, Ms. Rykaceski has held posi4ons at the CCFHCC of Consultant, EHR Integra4on and, most recently, Dental Manager. She received her Bachelor of Arts degree from the University of PiCsburgh. Ms. Rykaceski oversees all day to day opera4ons for the CCFHCC.
CCFHCC AT A GLANCE Opera4onal in November, 2007 Volunteer In Medicine Model Func4onal Pa4ent Management and Electronic Health Record since opera4onal Func4onal Electronic Volunteer Management sosware since 2007 Served over 20,000 medical and dental pa4ents providing over 43,000 visits since 2007 Serve between 800 850 medical and dental pa4ents each month
CCFHCC AT A GLANCE MEDICAL Primary Care Primary Care Visits Health Screenings Chronic Disease Management Medical Therapy and Management Health Promo4on and Educa4on Nutri4on and diet Counseling Specialty Care Cardiology, Dermatology, ENT, Endocrinology, Gynecology, Ophthalmology, Orthopedics, Physical Therapy, Podiatry, Psychiatry and Counseling, Rheumatology and Urology Advanced levels of Care Health System FAP (Financial Assistance Programs) Applica4on Process
CCFHCC AT A GLANCE DENTAL Dental History Medical History Medica4ons Allergies Dental Treatment Plan Procedure notes X- rays Referrals
CCFHCC AT A GLANCE PHARMACY Medica4on reconcilia4on Prescribing Pa4ent Educa4on Forms Consent Forms Medica4on Assistance ID number Pharmacy related Documents
LEARNING OBJECTIVES Gain an understanding of Electronic Health Record (EHR) pla]orms and capabili4es for free and charitable clinics Generate ideas for EHR implementa4on at respec4ve free and charitable clinic Insight into a tool box for implementa4on of an EHR
EMR vs EHR vs PHR Electronic medical records (EMRs): digital versions of the paper charts in clinician offices, clinics, and hospitals. EMRs contain notes and informa4on collected by and for the clinicians in that office, clinic, or hospital and are mostly used by providers for diagnosis and treatment. EMRs are more valuable than paper records because they enable providers to track data over 4me, iden4fy pa4ents for preven4ve visits and screenings, monitor pa4ents, and improve health care quality. (www.healthit.gov) Electronic health records (EHRs): built to go beyond standard clinical data collected in a provider s office and are inclusive of a broader view of a pa4ent s care. EHRs contain informa4on from all the clinicians involved in a pa/ent s care and all authorized clinicians involved in a pa4ent s care can access the informa4on to provide care to that pa4ent. EHRs also share informa4on with other health care providers, such as laboratories and specialists. EHRs follow pa4ents to the specialist, the hospital, the nursing home, or even across the country. (www.healthit.gov) Personal health records (PHRs) : contain the same types of informa4on as EHRs diagnoses, medica4ons, immuniza4ons, family medical histories, and provider contact informa4on but are designed to be set up, accessed, and managed by pa/ents. Pa4ents can use PHRs to maintain and manage their health informa4on in a private, secure, and confiden4al environment. PHRs can include informa4on from a variety of sources including clinicians, home monitoring devices, and pa4ents themselves. (www.healthit.gov)
Ra4onale for EHR
The EHR Evolu4on Process OrganizaConal Needs A. Individual Stakeholders (Internal and External) B. Assessment Process C. Training D. Implementa4on E. Outcomes F. More Training!!!!!
In the Beginning..
EMR to EHR 2007 2010 Happy with the early version of the EMR Everyone was basically sa4sfied with the use. Health Center leadership recognized the need to be proac4ve in regard to the emerging clinical repor4ng requirements and needs ar4culated by stakeholders at all levels. Opportuni4es vs. Challenges
CRITICAL NOTE TIMELINE Expecta4on was a 2-3 month full- 4me project management ini4a4ve Reality was a 4-5 month full- 4me project management ini4a4ve
ASSESSMENT FuncConal Needs 1. Eligibility 2. Front Office 3. Medical 4. Medical Special4es 5. Dental 6. Pharmacy 7. External Stakeholders
Assessment Training Methods A. Cri4cal success factor was an internal project manager who had primary responsibility for working with the SoSware vendor throughout the process. This individual was vital in mee4ng(s) with each func4onal work group to learn how the sosware was being u4lized. B. The SoSware vendor then provided the project manager with a team of staff to interpret the assessment data and develop a test site for ongoing developmental trial and error.
ASSESSMENT REVEAL Significant varia4on in the volunteer use of the sosware NO STANDARDIZATION. Inability of some of the Volunteers to ar4culate what they needed to becer serve the CCFHCC and most importantly, our pa4ents. TOOL BOX: Highly func4oning Project Manager
DEVELOPMENT Brainstorm WISH list Staff and volunteer brainstorming sessions Just in 4me educa4on with volunteers Dream BIG!!!!!! Dream BIG!!!!! Dream BIG!!!!!!
Test Site Development Interdisciplinary Project Team As the CCFHCC defined the func4onal and wish list outcomes for the sosware upgrade, the test version was a criccal success factor in engaging our stakeholders and determining ability to implement proposed capability. TOOL BOX: Test Site of the various proposed solu4ons (upgrades)
Staff Customized videos "How to" Binders Volunteers Customized videos. Create pocket sized quick reference job aides for clinical volunteers. Created job aide binders for non- clinical volunteers. TRAINING Materials Training Plan Administra4on of Training Training Time line: each staff had a scheduled 1-1 training period to complete both the visual walk- through and the hands- on training in the test site as well. Training Time line: each volunteer group was blocked during the first hour or so of their volunteer dates and were walked through the test site in small groups. Every volunteer was tracked as far as the number of hours spent in training. A spreadsheet was developed to both schedule the volunteer training and to assist with the coordina4on of blocking the schedule during training 4mes. Volunteers had the opportunity to sign up for addi4onal training as needed. Customized training videos developed by the sosware company. Visual walk- through with trainer. Hands- on in test sight (much more extensive with staff in order to support volunteers). Customized training videos developed by the sosware company. Visual walk- through with trainer. Distributed pocket sized quick reference job aides for clinical volunteers. Distributed and reviewed job aide binders for non- clinical volunteers. Scheduled 1 full week of onsite support from the sosware company during the launch.
OUTCOMES 1. Pa4ent records management 2. Eligibility management 3. Clinical data storage and management 4. Clinical outcome studies standards 5. Collabora4on with community partners and vendors for data retrieval and outcome management for health status indicators 6. Con4nuum of Care
IN THE END - CHALLENGES 1. Volunteer Demographic Considera4ons 2. Computer SoSware and Hardware 3. Timeliness
WHAT WE LEARNED This can be done! CriCcal Success Factors: PROJECT MANAGER INCLUSION COMMUNICATION PROCESS and TRAINING
EVOLUTION Dental Upgrade Medica4on/Allergies in Dental IPV Screening Automated confirma4on calls Regular sosware maintenance releases to stay advanced
CONCLUSION Learning ObjecCves Gain an understanding of Electronic Health Record (EHR) pla]orms and capabili4es for free and charitable clinics Generate best prac4ce for EHR implementa4on at respec4ve free and charitable clinic Insight into a tool box for implementa4on of EHR