The Basics of EHR Implementation: Developing a Solid Plan for your Practice

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The Basics of EHR Implementation Developing a
Solid Plan for your Practice

• Dr. Martha Riddell and Dr. Carol Ireson
• Meaningful Use Advisors, Kentucky REC
• Martha.Riddell_at_uky.edu
• Clires0_at_email.uky.edu
• 859-323-3090

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Where to begin

• Patients should be the primary beneficiaries of
  HIT
• However--
• physicians, nurses, therapists, social workers,
  aides, and other clinicians are the primary
  users.

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The Steps to Effective Use of HIT

• Adopt
• Assess
• Plan
• Select
• Utilize
• Implement
• Effective Use
• Exchange
• Readiness
• Interoperate

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Key Components in Planning

• Hardware
• Software
• People
• Policy
• Process

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• People, policy, and process are often described
  as contributing 80 percent to the success of
  HIT
• even though they are the elements most often
  overlooked as health care delivery organizations
  approach HIT

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Start up and Planning
Conduct project planning session Define
project scope - what you are trying to
accomplish - ID short term goals - ID
long term goals
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Who is at the planning table

• Identify project team - develop a roles and
  responsibilities matrix

Define Role Define Responsibility
Project Manager
Physician champion
Billing rep
Super user
Clinical staff
Others
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• Define set meeting times for
• - Physician team (bi-weekly)
• - Primary site(s) staff (at least weekly)
• - Practice staff (entire staff as a group or by
  office) at least monthly

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Importance of Goal Setting
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Getting ready for change

• Conduct a readiness assessment of people and
  technology
• Assess computer skills of staff

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• Define a process for reporting and tracking
  issues
• -Software issues
• - Interface issues
• - Workflow process issues

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Engaging your patients

• Marketing plan for the patients
• - determine a plan for communicating to your
  patients your EHR

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Identify Key Processes

• Make a list of all processes, or
• Use post-it notes to record processes as they are
  performed and then arrange them on a wall or
  large piece of (e.g., examining room) paper
• Follow the patient flow!

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Mapping your current processes

• Paper workflow
• Clinical process

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Understand current major paper workflows

• - Charts
• - Lab results
• - Prescriptions
• - initial
• - renewals
• - Referrals
• - Consults
• - Others

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Process Mapping

1. Identify processes to be mapped e.g., those that
   will be impacted by the HIT being acquired
2. Use individuals who actually perform the process
   they know it best and need to own the impending
   change
3. Instruct persons on process mapping why it is
   being done and how it is done

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Process Mapping

• 4. Map current processes. Avoid identifying
  opportunities for improvement now, or critical
  controls built into current processes may be
  overlooked
• Validate maps to ensure they reflect current
  processes, all variations, and the information
  payload
• Collect all forms and reports that are part of
  processes to be automated through HIT

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Process Mapping

• Obtain benchmark data to define expectations for
  change and for use in evaluating the benefits
  achieved later
• Identify potential problems in current workflows
  and processes and determine their root cause
• Identify changes that may resolve problems today

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Process Mapping

1. Identify potential problems in current workflows
   and processes and determine their root cause
2. Identify changes that may resolve problems today
3. Educate about HIT and EHR and identify further
   changes that will be possible

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Process Mapping

1. Educate about HIT and EHR and identify further
   changes that will be possible
2. Document changes by creating improved
3. Use new processes to create use case scenarios to
   identify HIT functional specifications, and later
   to build out the HIT application to achieve
   improvements

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Process Mapping

• Test new workflows and processes
• Train all on new workflows and processes
• Incorporate changes into policy and procedure
• Finally
• Conduct benefits realization and celebrate
  successful change/correct course as necessary

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Clinical process analysis

• Process mapping for clinical processes is
  difficult because the processes to be mapped are
  performed mentally
• One method that is used is thinking aloud

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Process mapping and vendors

• Some vendors may request that you supply them
  with the maps of current processes.
• But beware
• Many HIT vendors still do not put much attention,
  if any, on supporting their customers with
  workflow and process improvement

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What to Map

• Scheduling/check-in and check-out
• Patient intake
• Results review
• HP/encounter notes
• Care planning/guidelines
• Medication management medication list
  maintenance/ prescribing/refills
• Provider orders
• EM coding
• Charge capture
• Patient instructions/education
• Patient follow up/health maintenance
• Reporting/quality improvement

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CURRENT PROCESS
Referral Source
No Patient Information Sent
Contacts SP office schedules collects pt info
Contacts UKMDs to schedule visit
Info not sent to clinic by office
Contacts specialist clinic schedules visit
UKMDs contacts SP who collects pt info
SP Does not send info to clinic
SP does not contact PCP
Visit not completed
SP completes patient visit
SP contacts PCP
SP does not send patient information to referring
source
Dictates note and send by snail mail
SP sends patient visit summary to Referral Source
Phone Call
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Basic Systems Flow Chart
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• Review current maps to identify
• Bottlenecks
• Sources of delay
• Rework due to errors
• Role ambiguity
• Duplications
• Unnecessary steps
• Cycle time

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PROCESS FOR EMRs
Referral Source
No Patient Information Sent
Contacts SP office schedules visit sends
electronic pt info to secure server
Contacts UKMDs, schedule visit sends electronic
pt info to secure server
Contacts specialist clinic schedules visit
sends electronic pt info to secure server
Visit not completed
SP clinic accesses pt info completes patient
visit completes templated visit note that is
sent to secure server
SP clinic sends no visit info to secure server
Referral Source accesses patient visit summary
from secure server
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Barriers to Overcome using the REC resources

• Cost group purchasing
• Selecting the Right Product technical
  assistance in goal setting, process mapping
• Change assistance with process and workflow
  redesign

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Barriers to Overcome using the REC resources

• Learning Curve assistance in skills assessment
• Standards- assistance in identifying certified
  products
• Privacy and Security expertise in HIPAA and
  HITECH privacy and security requirements

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Barriers to Overcome how the REC can help

• Loss of Productivity - Recognize that some loss
  of productivity will be inevitable during the
  learning curveplan for it

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Next Steps

• Selecting a vendor group purchasing through
  Health Bridge Tri-state REC
• Implementing the EHR assistance in working with
  vendors

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Post Install

• Working toward meeting meaningful use measures
• Collecting data regarding return on investment

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How to reach your REC

• If you are in a light blue, dark blue, or red
  county contact
• Kentucky Regional Extension Center
• 2333 Alumni Park Plaza Suite 200
• Lexington, KY 40517
• Toll free 888-KYR-ECEHR
• Phone [phone]
• Fax [phone]
• KYREC_at_uky.edu

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How to reach your REC

• If you are in a white county contact
• Tri-state REC
• 11300 Cornell Park Drive, Suite 360
• Cincinnati, OH 45242
• Phone number513-469-7222, option 3
• Fax number513-469-7230
• Email rec_at_healthbridge.org

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• Questions?

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