Jerome H Carter

1
Jerome H Carter
Disclosure of Financial Relationships

• Has no relationships with any entity producing,
  marketing, re-selling, or distributing health
  care goods or services consumed by, or used on,
  patients.

2
Successful EHR Implementation in a Small Office
II - Best Practices

• Jerome H Carter, MD,FACP
• CEO, NTM Informatics, Inc
• Atlanta, GA

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Guiding Principles

• EHR implementation ALWAYS results in change
• Once initiated, change is continual
• Change may be planned or unplanned
• Lack of planning causes misery and possibly a
  failed implementation
• The most problematic types of change are
  alterations in workflow and standardization of
  care across ALL providers.
• You cant necessarily have it your way.

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Planning is Essential

• Create structure
• Administrative and clinical leadership should be
  formalized. Too much democracy is
  counter-productive.
• Select a method for making difficult decisions
  and stick with it.
• A team-based approach is best.

5
Accept Change as a Way of Life

• Prior to EHR implementation begin to standardize
  common activities
• New patient intake
• Disease-based preventive care
• Lab results review
• Consultation requests
• Rx refills
• Look for differences between providers and
  determine how significant those differences are.

6
Workflow is the Key

• Smooth transition to an EHR requires that the
  features and functions of the EHR match the way
  you do things.
• The EHR will FORCE changes in the way you do
  things
• Workflow analysis - the steps required to get any
  particular task done - requires a lot of time and
  being picky.
• If properly done, workflow analysis will make the
  job of selecting the right EHR product much
  simpler.

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Workflows Come in Two Flavors

• Group across individuals. Ex. patient visit
• Personal individual ways of accomplishing
  tasks. Ex. - review of abnormal labs
• Both types of workflow are disrupted by an EHR
• There is no easy way to change workflows. It
  takes time, planning, and sweat.

8
Dont Rush Things

• Start planning early at least 6 months in
  advance
• Devote time to practice analysis, workflow
  analysis and product evaluation prior to deciding
  on a specific EHR product.
• Actual EHR implementation should be scheduled to
  occur over a three to six-month period (for
  practices of five or fewer providers)
• Allow for a honeymoon - the use of the more
  advanced features of the EHR and activities such
  as quality improvement will come later.

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Technology issues

• Interfaces usually take time. Make sure they are
  working properly before you go live with the EHR.
• Buy a faster server that you think youll need.
• Wireless networks should be tested for security
  issues. The test results should be written down
  as part of your practice security policy.

10
Disaster Recovery and Business Continuity

• This means more than just the ability to backup
  your files.
• If your server dies it should not require more
  than 2 hours to get back on-line and ready to do
  business
• Best approach is to encrypt data and store it
  off-site
• Use fault-tolerant servers
• At a minimum servers with mirrored drives
• Buy special insurance for hardware and business
  interuption

11
Security

• The HIPAA Security Rule applies to your system
• If your EHR is to be a legal record you MUST
  adhere to the HIPAA Security rule
• Insurance policies rarely cover data loss or
  breaches
• Minimum requirements
• Virus software, firewall
• Written security policies
• Staff training for security issues
• Staff rules for data access
• Measures taken for rule violations
• Disaster recovery plan

12
Chart migration

• Decide on the chart migration method that youre
  going to use.
• Big Bang every patient goes in on day one.
• Phased
• Patients entered by medical record number
• Patients entered by next appointment
• Patients entered by provider
• Decide what information will be moved from the
  old chart
• Dictate chart summary and load into EHR
• Scan key, labs, x-rays etc. NOT EVERYTHING!
• Whatever method of migration you select make sure
  that it is consistent across all providers.

13
Vendor Issues

• Vendors should provide
• Training ( at least 2 cycles)
• Local superuser
• Workflow analysis assistance
• Advice/planning for chart migration
• Choose vendor
• More than 3 years in business
• At least a good regional presence (6-10 states)
• Growing revenues
• True RD budget

14
Quality Improvement

• Quality improvement takes time
• It requires data in an analyzable form
• This requires entering data into the system in
  specific ways.
• Ask the vendor to clarify how various data entry
  options affect the later usability of the data

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Get help

• Workflow analysis, process improvement, and EHR
  technology are highly technical areas that few
  physicians are familiar with.
• Dont waste time and money- get help from those
  who know.
• Doctor's Office Quality - Information Technology
  (DOQ-IT) is available through many state medical
  care foundations and is free.
• DOQ-IT offers assistance with EHR selection, for
  those who want to tackle this on their own there
  are plenty of books and resources available
• www.acponline.org/EHR