The Basics of EHR Implementation: Developing a Solid Plan for your Practice

1. The Basics of EHR Implementation: Developing a Solid Plan for your Practice Dr. Martha Riddell and Dr. Carol Ireson Meaningful Use Advisors, Kentucky REC Martha.Riddell@uky.edu Clires0@email.uky.edu 859-323-3090

2. Where to begin • Patients should be the primary beneficiaries of HIT • However-- • physicians, nurses, therapists, social workers, aides, and other clinicians are the primary users.

3. The Steps to Effective Use of HIT • Adopt – Assess – Plan – Select • Utilize – Implement – Effective Use • Exchange – Readiness – Interoperate

4. Key Components in Planning • Hardware • Software • People • Policy • Process

5. People, policy, and process are often described as contributing 80 percent to the success of HIT…… • even though they are the elements most often overlooked as health care delivery organizations approach HIT

6. Start up and Planning Conduct project planning session Define project scope - what you are trying to accomplish - ID short term goals - ID long term goals

7. Who is at the planning table Identify project team - develop a roles and responsibilities matrix

8. Define set meeting times for: • - Physician team (bi-weekly) • - Primary site(s) staff (at least weekly) • - Practice staff (entire staff as a group or by office) — at least monthly

9. Importance of Goal Setting

10. Getting ready for change • Conduct a readiness assessment of people and technology • Assess computer skills of staff

11. Define a process for reporting and tracking issues • -Software issues • - Interface issues • - Workflow process issues

12. Engaging your patients • Marketing plan for the patients • - determine a plan for communicating to your patients your EHR

13. Identify Key Processes • Make a list of all processes, or • Use post-it notes to record processes as they are performed and then arrange them on a wall or large piece of (e.g., examining room) paper • Follow the patient flow!

14. Mapping your current processes • Paper workflow • Clinical process

15. Understand current major paper workflows • - Charts • - Lab results • - Prescriptions • - initial • - renewals • - Referrals • - Consults • - Others

16. Process Mapping • Identify processes to be mapped; e.g., those that will be impacted by the HIT being acquired • Use individuals who actually perform the process; they know it best and need to own the impending change • Instruct persons on process mapping – why it is being done and how it is done

17. Process Mapping 4. Map currentprocesses. Avoid identifying opportunities for improvement now, or critical controls built into current processes may be overlooked • Validate maps to ensure they reflect current processes, all variations, and the information payload • Collect all forms and reports that are part of processes to be automated through HIT

18. Process Mapping • Obtain benchmark data to define expectations for change and for use in evaluating the benefits achieved later • Identify potential problems in current workflows and processes and determine their root cause • Identify changes that may resolve problems today

19. Process Mapping • Identify potential problems in current workflows and processes and determine their root cause • Identify changes that may resolve problems today • Educate about HIT and EHR and identify further changes that will be possible

20. Process Mapping • Educate about HIT and EHR and identify further changes that will be possible • Document changes by creating improved • Use new processes to create use case scenarios to identify HIT functional specifications, and later to build out the HIT application to achieve improvements

21. Process Mapping • Test new workflows and processes • Train all on new workflows and processes • Incorporate changes into policy and procedure Finally Conduct benefits realization and celebrate successful change/correct course as necessary

22. Clinical process analysis • Process mapping for clinical processes is difficult because the processes to be mapped are performed mentally • One method that is used is “thinking aloud”

23. Process mapping and vendors • Some vendors may request that you supply them with the maps of current processes. But beware • Many HIT vendors still do not put much attention, if any, on supporting their customers with workflow and process improvement

24. What to Map • Scheduling/check-in and check-out • Patient intake • Results review • H&P/encounter notes • Care planning/guidelines • Medication management: medication list maintenance/ prescribing/refills • Provider orders • E&M coding • Charge capture • Patient instructions/education • Patient follow up/health maintenance • Reporting/quality improvement

25. CURRENT PROCESS Referral Source No Patient Information Sent Contacts UKMDs to schedule visit Contacts SP office schedules & collects pt info Info not sent to clinic by office Contacts specialist clinic schedules visit UKMDs contacts SP who collects pt info SP Does not send info to clinic SP does not contact PCP Visit not completed SP completes patient visit SP contacts PCP SP does not send patient information to referring source Dictates note and send by snail mail SP sends patient visit summary to Referral Source Phone Call

26. Basic Systems Flow Chart

27. Review current maps to identify: • Bottlenecks • Sources of delay • Rework due to errors • Role ambiguity • Duplications • Unnecessary steps • Cycle time

28. PROCESS FOR EMRs Referral Source No Patient Information Sent Contacts UKMDs, schedule visit & sends electronic pt info to secure server Contacts SP office schedules visit & sends electronic pt info to secure server Contacts specialist clinic schedules visit & sends electronic pt info to secure server Visit not completed SP clinic accesses pt info & completes patient visit & completes templated visit note that is sent to secure server SP clinic sends no visit info to secure server Referral Source accesses patient visit summary from secure server

29. Barriers to Overcome: using the REC resources • Cost – group purchasing • Selecting the Right Product – technical assistance in goal setting, process mapping • Change –assistance with process and workflow redesign

30. Barriers to Overcome: using the REC resources • Learning Curve – assistance in skills assessment • Standards- assistance in identifying certified products • Privacy and Security – expertise in HIPAA and HITECH privacy and security requirements

31. Barriers to Overcome: how the REC can help • Loss of Productivity - Recognize that some loss of productivity will be inevitable during the learning curve—plan for it

32. Next Steps • Selecting a vendor – group purchasing through Health Bridge Tri-state REC • Implementing the EHR – assistance in working with vendors

33. Post Install • Working toward meeting meaningful use measures • Collecting data regarding return on investment

35. How to reach your REC • If you are in a light blue, dark blue, or red county contact Kentucky Regional Extension Center 2333 Alumni Park Plaza Suite 200 Lexington, KY 40517 Toll free: 888-KYR-ECEHR Phone: (859) 323-3090 Fax: (859) 257-9366 KYREC@uky.edu

36. How to reach your REC • If you are in a white county contact Tri-state REC : 11300 Cornell Park Drive, Suite 360 Cincinnati, OH 45242 Phone number:513-469-7222, option 3 Fax number:513-469-7230 • Email: rec@healthbridge.org

37. Questions?