NORTHERN MINNESOTA NETWORK

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NORTHERN MINNESOTA NETWORK

• Three members
• CAHS, (dba SRHS) MHSI, SMC
• Operate 19 sites in rural areas of Minnesota and
  eastern North Dakota
• Patients served 25,900
• of encounters 105,054
• Formed 2002

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NORTHERN MINNESOTA NETWORK SITES
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NETWORK HISTORY

• Focus Health Information Technology
• Centralized platform, build infrastructure
• Practice Management System
• Electronic Health Record System
• 2004 secure funding, set corporate structure,
  common good
• 2005 selection process RFP, demos, site
  visits, signed on the dotted line.GE Healthcare
  Centricity / CySolutions

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NETWORK HISTORY

• 2006 conducted phased implementation plan -
  Centricity Practice Management 2004
• 2007 prepared for EMR implementation, convert PM
  2004 to CPS 2006
• 2008 SMC first go-live 4-29-08
• MHSI - second go-live 6-17-08
• SRHS third go-live 9-26-08
• 2008 11 clinical sites live, 3 lab interfaces
  live, 2 PACS links, document fax solution

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Early Wins

• There have been TONS of Ah Ha moments
• When we are ordering lab tests, we can see if
  someone had ordered tests the patient hasnt done
  yet (forgot to come in), and get them all done
  together at one draw.
• Prescriptions faxed directly from the exam room
  to the pharmacy, legible, med list updated in the
  chart.
• Preventive care activities are easily checked by
  clicking the protocol button.  We can show the
  patient the standard list of activities for their
  age/sex and which of those need to be done. 
  Ditto for immunizations.
• Flow sheets and graphs allow us to show patients
  how their health measurements (BP, weight, blood
  sugars, etc.) have changed over time in response
  to changes in lifestyle or meds.
• Printed patient instructions allow us to quickly
  provide patients with the plan we want them to
  follow.  The current medication list updated as
  of that appointment means everyone can have a
  current med list in hand after every visit.  This
  reduces medication errors at home, and is very
  helpful when they see other providers
  especially the emergency room.
• Walk-in patients at a satellite office are not
  seen without their chart any more I have the
  same electronic chart access there as I do at the
  home office, making the visit more effective and
  safer.  I dont have to rely on their memory to
  know what meds they are supposed to be on, what
  their allergies are, or what another providers
  advice was at the most recent appointment. 
• Documentation of prescriptions is virtually
  perfect, because you cant forget to document it
  like in a dictated note.  We can easily see the
  path of meds prescribed and discontinued in the
  med list.  For managing controlled substances, we
  can see in one window all the recent refills,
  date, and provider for that Rx, without paging
  through the paper chart

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Current Network Development

• VOIP Systems
• Video Conferencing
• Coding Training
• Record Locator Demonstration Project
• INK Group (In the Know)

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IT Clinical Work Plan

• Optimize
• Laboratory interfaces
• Flow-sheets
• Forms
• Meditech ITS Interfaces
• PM Integration
• Crystal Reports/Quality Improvement Data
• Winscribe Dictation/Transcription
• Swipe Cards/Biometric Log In
• Welch Allyn Interfaces

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IT Clinical Work Plan

• Dentrix Implementation
• Dexis Imaging Installation
• E-Prescribing Sure Scripts Installation
• Install Titan v9.0 release
• Tech Support system logs
• PECSYS
• VR Application CCC/Dragon

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MAINTAINING THE MOMENUM

• Staff must take EMR ownership
• Center leadership must be all in
• Secure adequate resources
• Divide the work
• Address Hardware/network issues ASAP
• Install Service Packs/New Releases
• Optimize software/forms/workflows
• Repeat Trainer Visits for users
• Add features designed to lighten work loads
• Communicate

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Meaningful Use

• CCHIT Certified EMR
• E-Prescribing
• Health Information Exchange
• Use Clinical Data to Improve Patient Health

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Matrix

• Federal
• Minnesota

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EMR Define Performance Metrics

• MN Health Reform Initiative
• MDH contracted with MN Community Measurement
• Expand measures establish state P4P plan
• Add 11 new measures over 3 years
• 6 in specialty care
• Develop database of clinical info build 5
  enhanced measures

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EMR Define Performance Metrics

• Statewide quality measurement system
• Incorporate measures for primary care, preventive
  services, coronary artery and heart disease,
  diabetes, asthma, and depression.
• Reporting system
• Subset of measures, MDH issues public report
  annually as of July 1, 2010
• Incentive payment system
• Developed by January 1, 2010

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Statewide Indicators

• Asthma
• Cancer Screening
• Childhood Immunization (combo 3)
• Chlamydia Screening
• High Blood Pressure control
• Optimal Diabetes Care

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Annual System Costs

• GE Healthcare
• Maintenance Support 75,000
• CySolutions
• Maintenance Support 18,000
• SISU Medical Solutions
• Hosting Services 22,000
• Technical Support 150,000
• DocuTrack
• Maintenance Support 16,000
• Total Annual Hard Costs 281,000

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HIT Incentive Payments

• Medicare
• Medicaid
• Medical Home
• Pay for Performance
• Need to Rebase PPS

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Whats Next

• We are in a transition phase
• We all have EMR work to do
• Well probably never be done
• http//healthit.hhs.gov
• mholmes_at_cook.sisunet.org