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The Electronic Record: Planning is Crucial!

The Electronic Record: Planning is Crucial!. Lynn Edwards. MBA, RHIT, CHSP. Vision Statement. To assist you with the planning & organization of your electronic health record by utilizing available resources to benefit patient care. Goal and Objective.

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The Electronic Record: Planning is Crucial!

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  1. The Electronic Record: Planning is Crucial! Lynn Edwards. MBA, RHIT, CHSP CSRHA 2009 L. Edwards

  2. Vision Statement • To assist you with the planning & organization of your electronic health record by utilizing available resources to benefit patient care. CSRHA 2009 L. Edwards

  3. Goal and Objective • Better understanding of what it takes to plan and implement an electronic medical record in an acute and clinic setting • Envision what is best for your facility - Electronic vs hybrid CSRHA 2009 L. Edwards

  4. Basic Functions of EMR Systems • Order entry/management • Health information and data • Ancillary results management • Decision support • Electronic communications & connectivity • Patient support • Administrative processes – chart audit • Reporting & population health management CSRHA 2009 L. Edwards

  5. Provide Organization Education/Awareness • Develop proposal • Select timing • Affected areas • Impact • Opportunities • How to initiate planning • Education • Meetings • Webinars CSRHA 2009 L. Edwards

  6. Organizing • Committee • Surveys • What are your needs, expectations • Who to include • When • How and How much • Management of users • Number & structure of document titles • Indexing CSRHA 2009 L. Edwards

  7. Committee Considerations • What departments and personnel to include in planning from the ground up • Software and hardware selection process; determining need and bottom line – • Include demos from several companies • Program compatibility issues • Back-file scanning…making it work for you CSRHA 2009 L. Edwards

  8. Committee Considerations continued • Policy and procedure changes • Legal health record • Late effects on release of information, workflow, access, retention and destruction • FTE savings…fact or fiction CSRHA 2009 L. Edwards

  9. Who to include? • Representatives from: • Support services • Physicians • Nurses • Managers • Board • Administration • IT CSRHA 2009 L. Edwards

  10. Buy-in • Education & Training – “convincing” and Communication • Paperless • No storage • Less Employees • Ease of use • State the vision and long term direction • Buy-in CSRHA 2009 L. Edwards

  11. Software and Hardware • After you determine what is needed • Choosing a program • Compatibility issues – bridges & cost • EHR, hybrid, paper – archival scanning • Technical support- hardware, cost • Scheduling, on-call assistance • Scanners • Forms, Labels CSRHA 2009 L. Edwards

  12. Scanning • When to scan – complete, signed, versions? Separation at scanning • Concurrent or retro or both • Indexing and labeling • How far back • Outside scanning – have it done on premises = control CSRHA 2009 L. Edwards

  13. Scanning continued • Any problem can impede progress • Tracking completed record • How will you handle photos, etc. • Consents • Color • Clarity • Destruction – fact or fiction? CSRHA 2009 L. Edwards

  14. Policies & Procedures • What is your legal health record? • HIPAA security • Access • Retention • Destruction • What labeling is required • How will you index documents CSRHA 2009 L. Edwards

  15. HIM Issues • Maintaining workflow • Maintaining quality • Storage issues • Increased quality review • P&Ps • Disclosure Log CSRHA 2009 L. Edwards

  16. HIM Issues continued • Downtime • Indexing – by diagnosis & not patient complaint • Scary issues • Guarantor • Phantom findings • Patient record found in another patients record – • Admission errors CSRHA 2009 L. Edwards

  17. Late Effects • Release of Information • Use of outside vendors, access, training • Workflow • Late receipt of records • Rescanning • Access • Non-users – physician, administration • Vendors • Delivery systems – satellite delay CSRHA 2009 L. Edwards

  18. Late Effects continued • Retention • Destruction CSRHA 2009 L. Edwards

  19. FTE Savings – Fact or Fiction • Brilliant idea • Lost ½ FTE • And, the ability to backscan • No real savings –24/7 • Quality • Time to check & index • Paper, storage CSRHA 2009 L. Edwards

  20. Our System • Host System • Digital-One & Sphere • Decentralized then centralized • All areas exclude clinic • Physician buy-in CSRHA 2009 L. Edwards

  21. DigitalOne – Patient Chart CSRHA 2009 L. Edwards

  22. DigitalOne – Audit Trail CSRHA 2009 L. Edwards

  23. DigitalOne – Print/Fax/Email CSRHA 2009 L. Edwards

  24. Typical Workflow • Document • Prep • Scan • Machine maintenance • Document feed • Shingled documents • Jam problems • Index • Proper labeling • Buy-in CSRHA 2009 L. Edwards

  25. Typical Workflow continued • Quality Check & Release • Early – check every step & watch for training needs • Monitor and give feedback • Initiate counseling and discipline • Initiate quality check & accountability • 1 clerk initiates • 2 clerks check • 1 HIM clerk reviews • Feedback to Admissions CSRHA 2009 L. Edwards

  26. How to respond to go-live problems • Lengthened timeline • One-on-one training and support ($) • Improved physician review, oversight, testing • Intensive cooperation effort with vendor to address functionality concerns • 24/7 support – technical, documents, etc CSRHA 2009 L. Edwards

  27. Additions/Modifications • HIPAA statement on access to system • What to do with “celebrities” • Limitations to users according to “need to know” • Removal of access • Indexing modification • Chart order • Add Disclosure Log CSRHA 2009 L. Edwards

  28. Today’s Situation • Intensive quality control • Same # of employees – expand to 7 days • Same storage issues • Ease to provide records- also problematic • Paper chart reviews CSRHA 2009 L. Edwards

  29. Today’s Situation • Lack of use by providers • Still poor legibility – coders, billing • Need to auto-feed lab, x-ray, transcription • Look at available options to your system • Tablets • Cost • Physician office involvement/RHIO • Advantages/Disadvantages CSRHA 2009 L. Edwards

  30. Benefits • Ease of access • Release of Information • Patient care • Billing • Coding • Physicians • QA studies • Reviewing agency access - RAC CSRHA 2009 L. Edwards

  31. Summary • Success based on usability, ease of access, buy-in, change of habits • Quality control • Close involvement of organizational medical record committees. • Universal vision • Administrative support • Persistence!!! EMR often painful, especially early. Wounds heal slowly. • Communication! Commitment! CSRHA 2009 L. Edwards

  32. Contact • Lynn Edwards (909) 878-8217 • lynn.edwards@bvchd.com CSRHA 2009 L. Edwards

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