Thayer County Health Services CAHFLEX HIT Grant Electronic Medical Record

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Thayer County Health ServicesCAH/FLEX HIT
GrantElectronic Medical Record

• Thayer County Health Services
• Hebron, Nebraska

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Thayer County Health Services

• 5 rural health clinics, one Part B clinic
• 19 bed critical access hospital (CAH)
• 4 full-time Physicians
• 2 full-time PAs,
• 1 part time nurse practitioner
• Located 90 miles from tertiary hospital

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Presentation Overview

• Flex CAH HIT Grant
• The 7 Goals
• Vision of Thayer County Health Services
• Benefits of the EHR
• Concerns to consider
• Lessons Learned

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Flex CAH HIT Grant

• Scope Universal Adoption of EHR by 2014
• Purpose Provide 16 CAHs 1.6 million each
• Establish Connection with Tertiary Facility
• CAH Transparency
• Improve Safety, Quality, Efficiency, and
  Effective use of HIT.
• Challenges to CAH- Financial Investment

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The 7 Goals

• Build a Bridge with EMS
• Improve Effectiveness and Efficiency of CAH
• Improve connectivity with pharmacy
• Connect with tertiary hospital
• Improve connectivity with satellite clinics
• Improve communication with long term care and
  assisted living
• Address safety and security of clinical
  information - Compliance

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Build the Bridge with EMS

• Our responsibility to our patients begins when
  the patient dials 911
• Once the EMS informs us of the patient an
  attachment goes to the E-NARSIS giving the EMS
  information about the patient
• If indicated, the EMS attaches a 12-lead EKG to
  patient and electronically sends it to the
  hospital allowing for not only a pre-hospital
  12-lead EKG but also the arrival of the 12-lead
  EKG prior to that of the patient
• This information in turn can be forwarded to the
  tertiary hospital if needed

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Improve effectiveness and efficiency of the CAH

• Bar-coding implemented
• EMAR
• Vital sign monitors interface with EMR
• CPOE
• Digital medical records
• Physical therapy added to paperless environment
• Home health charts on lap tops in patient home
  using Alltel cards for connectivity
• Telehealth available to specialists

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Improve connectivity with pharmacy

• E-Rx implemented to allow our physicians access
  to necessary patient information
• Through the use of CPOE and Clinical View 24/7
  pharmacy coverage can be obtained using the
  pharmacist at St. Elizabeth in Lincoln
• Our pharmacist can access patient information
  from her lap top computer anywhere using an
  Alltel card. Orders can then be approved remotely
  if needed

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Connect with the Tertiary Hospital

• Tertiary hospitalists are allowed to access
  patient information through Clinical View
• These hospitalists are allowed access only after
  credentialing process complete
• 12-lead EKG can be forwarded to tertiary hospital
  if necessary
• All images are digital allowing hospitalists
  access to any image

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Improve connectivity to satellite clinics

• Currently satellite clinics are located in 5
  towns in two counties
• Each satellite clinic is electronically connected
  to Hebron clinic
• Free exchange of information occurs among each
  clinic

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Improve communication through long term care
facilities

• Each long term care facility in Thayer County has
  access to Clinical View to allow physicians
  patient information
• The Care Home is connected to the Hebron Clinic
  through the use of telehealth making patient
  visits possible from the Care Home
• Assisted living residents were the first to be
  taught on-line appointment scheduling allowing
  them to schedule their own appointments. This
  will then be taught to the community

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Safety and Security of Clinical information

• Proper fire suppression had to be installed in
  server rooms
• Proper temperature control was put in place
• Proper security of server room was necessary
• T1 line installed to Deshler to allow for backup
  server to be in place 12 miles from Hebron
• Employee orientation and re-orientation includes
  computer security policies
• Documentation of access changes
• Inform IT of employee changes

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The Vision

• Totally Paperless
• View Medical Record from Multiple Locations
• Ability to Communicate Across Boundaries
• Providing Continuity of Care
• Empower the Patient
• Improve the quality of care to our patients

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The Benefits of EHR

• Ability to Access records from home, ability to
  allow specialists more access to our patients
  through telehealth
• Ability to Access radiology from home as well
  as allow specialists access to information
• Keep the focus on patient care
• Provide continuity of care
• Facility wide time saver
• Ability to make health information portable
  through use of ZapTag

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Concerns to consider

• Is the software covered by insurance if it is
  destroyed in a natural disaster?
• Is there adequate insurance in the building for
  the hardware?
• Is there adequate fire protection?
• How will the EMR present itself in court?
• How do you present the EMR to insurance companies
  and regulatory agencies?

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Lessons Learned

• EMR implementation is only half the process
• Culture change in a facility is vital to the
  success of the project and should be addressed
  first
• Surround yourself with positive upbeat people and
  change occurs much easier
• People on their own agenda or mission need to
  get off the bus
• The input of the end users is critical to the
  success of the project

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Contact information

• Joyce Beck, Thayer County Health Services
  402-768-4614 or at tchs_at_alltel.net
• IT information contact Dan Engle, Thayer County
  Health Services 402-768-4687 or at
  danielengle_at_alltel.net
• Or visit our website at www.thayercountyhealth.com