Top 10 Keys to a Successful EHR Practice

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Top 10 Keys to a Successful EHR Practice

• By
• David Gregory
• Medical eSolutions

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Whats in a name

• EHR Electronic Health Record
• EMR Electronic Medical Record
• A Rose by ..

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Focus Areas

• Definition of Success
• Selection Process
• Implementation Process

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Definition of Success-Start With

• Three Immutable Laws of EHRs
• Must reduce the Doctors workload
• Must improve Healthcare
• Must pay for itself in a reasonable period of
  time (e.g., lt3 Years)

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Must reduce the Doctors workload

• Chart while with patient
• Templates and Template creation
• Interoffice Communiqués
• Lab Reviews
• Phone Encounters
• Chart by exception
• Pull Forward

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Must reduce the Doctors workload

• Drug formularies and code scrubbing
• Increased potential for Physician delegating
  responsibility for colleting histories and ROS
• Patient educational materials with logging
• Letter generation with logging
• ePrescribing

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Must improve Healthcare

• Built in support for AHRQ and other guidelines
• Lab and Referral Tracking
• Flow Sheets
• Physician coverage within practice
• Health Risk Assessment Tools
• Know Your Number
• Framingham

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Must improve Healthcare

• Allergies Drug, food, insect, etc
• Drug Interactions Drug drug drug condition
  drug food/beverage/sunlight
• Does it extend to OTC and herbals
• Drug dosage
• Drug off-label usage
• Medical drawings and mark up
• Camera support

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Must Improve Healthcare Health Maintenance
Rules/Alerts

• Primary Trigger Events
• Diagnoses
• Treatments
• Age
• Sex
• Secondary Trigger Events
• Vitals
• Lab Results
• Insurances

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Health Maintenance RulesOutput

• PM scheduling
• EMR encounter
• Phone Lists
• Mail Merge
• Patient Portal Message

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Must pay for itself in a reasonable time period

• More accurate EM coding
• More complete capturing of codes
• Improved office efficiency
• Chart pulls and storage space
• Inter office communications
• More encounters and procedures through health
  maintenance rules
• Cash flow
• Charting complete before patient leaves office

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Must pay for itself in a reasonable time period

• Eliminate or restrict dictation or voice
  recognition such as Dragon
• Acceptable for HPI, examinations and letters
• Do not use dictation to enter any data element
• You might want to query or report on
• Might be required for billing or P4P

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Selection Process

• Establish financial mindset
• Chevrolet
• Volvo
• Ferrari
• Identify desired major functionality and
  Categorize into
• Essential
• Important
• Nice to have
• Want in the future

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Determine Practice Management Strategy

• Buy EHR from current PM company
• Replace PM and EHR at the same time
• Integrate EHR with current PM which is from
  different vendor

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Dont forget to evaluate

• Multi-office support
• Printing
• Office views
• Support for out of practice encounters
• Hospital
• Nursing Home
• Hospice

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Dont forget to evaluate

• Referral Letters
• Formatting and styles
• Choice of what info to include
• Off the-shelf reporting
• Ad-hoc reporting
• What data fields are reportable
• What data fields can be used to restrict queries
• Can you export to Excel, etc

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Dont forget to evaluate - Continued

• Work flow and Work Flow Management
• Patient Data input Bubble charts
• Patient Portal
• CCHIT certification
• Support for CCR
• Growth plans
• New offices
• Licensing schemes for growth

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Dont forget to evaluate - integrations

• Labs
• Hospitals
• RHIOs
• GRITS
• Diagnostic equipment
• Practice Management
• P4P in the future
• Discrete Data capture

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Identify all costs

• Integrations
• Application and Integration support
• On-going hardware maintenance/support
• Office Modifications/furniture
• Broadband
• Software upgrades (e.g. antivirus, etc)
• On-going training

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Final Selection

• Get quickly to short list of 3.
• Use your network to get recommendations
• Use CCHIT certification
• Use Vetters such as AC Group KLAS
• http//www.acgroup.org/pmsehrreport.html
• http//www.healthcomputing.com/
• Use functionality importance ratings
• car analogy

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Final selection - Continued

• Physician needs to practice charting major
  encounter types hands on from cradle to grave
• Network in your community to see if anyone has
  experience with Vendor
• Conduct site visits. Site should be
• Same specialty
• Fully using the same version of EHR
• For at least 6 months
• Check Quality of support
• Who provides for Hardware and Software?
• Check Stability of company

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Final selection - Continued

• Involve everyone and get commitment
• It is like pregnancy, either the practice uses an
  EHR or it does not.
• It is like a professional marriage
• You will put tons of time and money into it.
• You will see and use it daily
• Be leery of arranged marriages
• Divorce will be unbelievably expensive and time
  consuming

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Implementation

• Biggest key to success
• More EHR fail because of implementation than
  selection
• Dont sweat the selection. Sweat the
  implementation
• Major Implementation components
• Installation
• Configuration and Customization
• Training
• Staff Commitment
• Project Management

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Installation

• Who provides Hardware?
• When is it installed?
• Who tests and how is it tested?
• Who coordinates Broadband, HVAC, power and
  security
• Who verifies the adequacy of the above

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Configuration and Customization

• Who is responsible for Physician Templates?
• Who is responsible for workflow configuration?
• How much customization before go-live?
• How much consistency between physicians and how
  enforced?

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Configuration and Customization

• Is staged implementation practical.
• Practice Management then EHR
• By facility
• Lab Integrations
• RHIO and hospital integrations
• Patient Portal

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Training

• Configuration and customization training
• User Training
• Dress Rehearsals
• Go-live
• Post go-live training
• Typically 6 to 9 weeks after go-live
• Periodic
• New releases
• New employees

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Training Gotchas

• Inadequate training
• Quality of trainer
• Trainee commitment

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Practice Commitment

• Make sure all parties ready for commitment
• Make sure all parties committed to change and
  what it means to them
• Learning new procedures and processes
• Team play
• Riding out hiccups
• Be ready to prune bad apples

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Project Manager

• You must have a Project Manager to manage
  implementation!

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Project Manager

• Must work/report to practice
• Must be delegated responsibility and AUTHORITY
• Must have take charge personality

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Project Manager Duties

• Develop implementation project plan with all
  tasks
• Remember implementation questions?
• Manage implementation resources, schedule and
  budget
• Single point of contact with all vendors
• Identify and address lapses in progress/commitment
  
• Periodic status meetings
• If it is not in writing it was never said

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Top 10 Keys to Success

• Address immutable laws
• Must reduce the Doctors workload
• Must improve Healthcare
• Must pay for itself in a reasonable period of
  time
• Categorize functionality by need and decide your
  financial model (e.g. car type)
• Make sure you have total cost picture

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Top 10 Keys to Success

• Do not buy with out hands-on experience and site
  visit
• Get buy-in from key users and commitment to adapt
  to EHR best practices
• Designate Implementation Project Manager
• Have regularly scheduled project meetings

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Top 10 Keys to Success

• Get lots of good training and have dress
  rehearsal
• Budget and schedule post go-live training along
  with periodic training there after
• Continuous Improvement Committee
• Commitment with willingness to prune bad apples
• Have a champion/cheerleader

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Just Do It
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Questions

• David Gregory
• Medical eSolutions
• dgregory_at_MedicaleSolutions.com
• 404 277-3717