How to Keep the Ball Rolling After EHR Implementation

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How to Keep the Ball Rolling After EHR
Implementation

• CHCANYS Region II Conference
• Sunday, July 12, 2009

Wendy Stark, MBA, Executive Director Matthew
Chin, MPA, Managing Director, Operations and
Finance Richard Clarkson, Senior Clinical
Information Analyst
Arlene Lozano García, MIA, CPEHR, Senior Program
Manager, Performance Improvement Alan Mitchell,
Program Manager, Performance Improvement
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Learning Objectives for Today

• Callen-Lordes journey will be presented as an
  example to help health centers adopting HIT
• Understand and address the common pitfalls that
  arise after EHR implementation, including the
  consequences of not keeping the system software
  up-to-date.
• Plan for the ongoing, non-linear HIT lifecycle,
  including how to keep building momentum and
  capacity.
• Leverage multidisciplinary teams on large-scale
  HIT projects to gain maximum benefit and to
  achieve and sustain organization-wide buy-in.

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Callen-Lordes HIT History

• The perfect beginning Callen-Lorde opened with
  an interfaced EHR and EPM with no paper records
  to migrate!
• Customized the EHR to fit practice needs.
• Depended on one person to be database expert and
  process expert
• Things quickly started going wrong.

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The HIT Closet of Shame

• Significant struggles to keep up with software
  upgrades because of customization, lack of human
  resources, lack of capital funding for hardware
  upgrades
• If the organization is struggling overall, HIT is
  not top priority
• Philosophy of trying to protect staff from the
  technology resulted in lack of ownership
• HIT staffer became a one man show
• RISKY BUSINESS!

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The Reality Outside of the HIT Closet of Shame

• Vendor was unused to working with CHC clients.
• Did not have other CHCs to look to for best
  practices.
• Funding was not yet widely available for HIT.
• When HIT fever hit, struggle to figure out how to
  fit in.

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So, what happens when you dont fit into the new
EHR Roadmap?
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Quality Improvement is Not Linear
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EHR Implementation Is Not Linear
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Callen-Lorde is Unique But Not Alone

• Despite readily available best practices and HIT
  funding, things still go wrong!
• Common pitfalls today that result in unsuccessful
  EHR adoption
• The vendor alone provides training leaving
  providers and staff without an internal resource
  to reinforce new workflows
• EHR go-live planning focuses on electronic
  documentation but not improving quality of care
• Due to external pressures EHR goes live
  prematurely, resulting in continuous
  troubleshooting rather than effective use
• HIT in general is viewed as a project rather than
  a long-term program

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HIT/Q Demonstration Project

• Funded by The Altman Foundation, Baisley Powell
  Elebash Foundation, and New York Community Trust
• PCDC developing model to
• Help health centers find the right fit of HIT
  best practices and mold application to their own
  environment
• Tailor expertise, guidance, and tools to fit
  organizational culture
• Challenge health centers to get behind an
  ambitious vision of HIT (beyond normal business
  operations to advancing quality)
• Utilize need for HIT remediation as a catalyst
  for transformational change that meets health
  centers aspirations

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Do you have an HIT Closet of Shame?

• Signs you may need to re-examine your go-live
  success
• Is ownership of processes starting to sit with
  the IT person instead of operations people?
• Do staff feel like the computer gets in way of
  patient care instead of helping improve the
  quality of care?
• Does the EHR function more as an electronic
  post-it than a tool that facilitates reporting?
• Is the vendor support contact really a
  salesperson?
• Have staff developed an entire culture of
  work-arounds to the EHR?
• Is upgrading the EHR something the organization
  is trying to avoid or simply ignoring?

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Forget the Shame Lets Optimize HIT!!

• The beginnings of an EHR remediation project
• What are the root causes of your health centers
  dissatisfaction with EHR?
• What needs to be fixed?
• How will you remediate your EHR adoption across
  the organization? What resources are required? Do
  you need outside help?

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Callen-Lordes Remediation Project

• HIT/Q Scope for Callen-Lorde
• Upgrade HIT systems
• Build people systems to manage organizational
  change
• Build long-term HIT capability and capacity for
  growth

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First Step Migration

• Hadnt upgraded EHR in approximately 4 years
• Extensive planning followed by intense action
  period
• Team formation
• Multi-disciplinary
• Key players
• Managers and Front-line staff
• Urgency and ownership Team holds itself to dates
• Results
• Transformational change in institutional culture
• No more top down
• No more protecting the users from the
  technology
• New values value staff and managers
  participation, buy in, distributed
  responsibility

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A Tipping Point, and a Model

• Success!
• Next steps lab, eRx, KBM templates, tasking,
  document scanning
• Learn the lessons and adapt
• Executive team, management team, content teams
• Decentralize capability for HIT (beyond IT
  Manager and Medical Director)
• Benefits of the new approach
• Executive leadership focuses on strategy, not
  implementation details
• Improves problem-solving capacity
• Emphasizes feedback loop
• Creates a sustainable model

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Callen-Lorde Project Team Structure
Executive Team
PCDC Project Management Services
Management Team
Content Teams ()
Content Team (eRx)
Content Team (Lab)
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How to Do It

• Well-defined team structure
• Project plans generated at the team level
• Team forms, gets trained
• Workflows (As Is and To Be)
• Communication plan demos
• Training of users stress the critical messages
  (Dont touch the globe.)
• Testing
• Go Live
• Incubation
• Techniques for Go Live and beyond
• Superusers and field agents
• Command Center
• Problem logs
• Huddles
• Debrief
• Lessons learned are carried to the other projects

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Callen-Lordes Goal Quality!

• Process
• Stakeholders involved in decision-making
• Debriefing at all team levels
• Clinical
• Integration with existing QA/QI frameworks
• Can more efficiently measure existing indicators
• Can identify and measure a whole universe of new
  indicators
• Capacity for enhanced Clinical Decision Support
• Efficiency gained through planning, analysis, and
  technology
• E.g. Some lab results now turnaround in the same
  day, prescriptions are waiting at the pharmacy,
  etc.

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Challenges

• Overcoming resistance to a structured approach,
  continually
• Team dynamics and attrition
• Achieving buy-in quickly
• Project managers role
• A multi-faceted project competes against itself
• Achieving sustainability at the CHC

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Callen-Lorde Today Technological
AccomplishmentsThe Ball Keeps Rolling!

• Latest version of NextGen v.5.5.27.12 HF1 is in
  use
• Live lab results interface
• ePrescribing pilot launched
• Standardized templates on the way (KBM)

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Callen-Lorde Today Organizational
Accomplishments The Ball Keeps Rolling and
Rolling!

• Embedding new ways in organizational culture
• Time and resources dedicated to training
• Projects are transitioning to programs
• Memorable communication campaigns
• Strategic collaborations growing

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What Still Keeps Us Up at Night Ongoing
Challenges

• Protecting time, especially for providers
• Ongoing cost of continuous quality improvement in
  HIT still unknown
• Sticking to the new ways