Realizing the Promise of your EHR

1. Realizing the Promise of your EHR Debra McGrath, Director of IT Services for HFP and President, DMP Consulting Suzanne Cohen, Director of Member Services for HFP

2. Network HIT Project • HRSA Funded as a Health Center Controlled Network • 10 health center participants (grantees) • 4 EMRs – NextGen, Centricity, EHS, Practice Partner • Goals – in 3 years: • 100% Implementation of certified EHR • 100% Attestation to MU • 100% at least one site PCMH recognized • 100% exceeding Healthy People 2020 on at least one clinical quality measure (tobacco cessation)

3. Our approach • Individualized assessments and workplans • Tailored approach to EMR optimization • Network contracted with i2i Systems for population health management and data warehouse software • Implementation in 2 cohorts, based on readiness • Use of highly skilled, health-center experienced consultants • Locally focused network enables high touch, in-person approach

4. 10 months in…challenges, priorities and lessons learned

5. Information Management Tools • Just as MS Office offers a suite of tools, high functioning ambulatory practices need a suite of tools. • What to expect from each system and why is it important • EHR’s are good at: • Storing and retrieving data • Reporting structured data • Allowing for multiple members of the care team to view and use patient data at the same time • Display patient data in a variety of ways depending on the user’s role and function in the organization. • Eliminate double documentation and entering the same information over and over again

6. Information Management Tools • Integration is a key success factor particularly with the PM, Patient Portal and EHR. • Integration vs. interfacing • Separate functions for various systems: • PM systems • EHR • Population management • Reporting • Incorporating IT tools into the practice must be an intentional process that includes careful planning, work flow design, training and post go-live follow up and revision.

7. Vendor Management • Broad spectrum of EHR Vendors and deployment models • Software as a Service (SaaS) • Hosted by the vendor • Hosted by a third party • Servers hosted locally by the health center • Value added resellers (VARs) • Strategic trajectory of vendor • Voice of the customer • How does the vendor keep its customers informed • What can you expect from the vendor? • How do you insure your information technology will keep up and support the work of the health center?

8. EHR Challenges • Many organizations do not implement EHR correctly the first time around • Don’t be afraid to admit it and work on optimizing it. • May have lost processes that worked when using paper e.g. lab and referral logs • EHR implementation is not a once and done process and requires ongoing updating, revising and refreshing of the system, work flow design and training.

9. EHR Challenges • How to look at the cost of the decisions (value vs. cost) • Software purchases can appear expensive until opportunity, staff time and lost productivity are considered • How are is the EHR incorporated in decision making? Are you making a decision and then considering how it will impact IT or are you considering the impact on IT as you make the decisions?

10. EHR Challenges • Creating a change management process is a critical success factor • Require all change requests come through a governing committee using a request form • Allow for committee review of requests for change and approve or disapprove the requests • Communicate the status of a request • Once a change is approved determine the need to form a team to make the change and the need for training • Create an action plan, assign a responsible person, timeline and develop a training and post go-live plan. • Consider the impact of any change on the workforce, operations and IT.

11. EHR Governance • Oversight and management of the patient record often are not incorporated into an EHR implementation • Health Information Management Committee • Structured, regular chartered committee that is responsible for the integrity of the medical record • Incorporates a change control process to ensure standardized use of the EHR and input from the clinical and operations team. • Ensures changes to the EHR and how it is used are communicated to the clinical and operations team • Ensures the continued and ongoing development of the EHR

12. HIMC Roles and Function • Executive leadership and sponsorship • Strategic planning • Project management • Networking and system management • Security/HIPAA compliance • Interface Management • Telecommunications • Reporting and database management • Clinical informatics • Application management and expertise • Training • Helpdesk Support

13. Staffing requirements • Leadership and management of team. Inspires team to maintain focus on organizational values, goals and objectives. Ensures performance of all team members, provides feedback to team members to ensure staff development and growth. Interacts with and manages the various software and hardware vendors; provides vendor management. • Strategic Planning. Proactively identifies projects, continuously updates understanding of hardware and software trends, provides recommendations as appropriate to keep FPCN up to date, participates in and leads long term, medium term and short term planning for HIT, leads HIMC.

14. Staffing requirements • Project Management. Collaborates with leadership to gather stakeholders, develop timelines with stakeholders, identifies roles and functions needed for a project, identifies tasks and assigns to appropriate team members, manages timeline to keep project on time and within budget, identifies and quantifies risks, reports risks to the stakeholders • Networking and Systems Management. Manages servers, applying updates as needed to ensure performance standards, manages and maintains the wide area network, local area networks and wireless systems. Monitors error logs for interfaces.

15. Staffing requirements • Security. Stays up to date on HIPPA requirements. Writes a security policy and maintains it up to date based on regulations and requirements. Configures and manages security in EHS • Interface management. Gathers requirements for interfaces, manages interface builds, testing and timeline, monitors interfaces for errors management and updates as needed.

16. Staffing requirements • Reporting and Database Management: Highly skilled and knowledgeable regarding data fields, database configuration and report writing • Clinical Informatics: Translates clinical requirements to technical team including report writer, sets expectations with clinical team regarding technical capabilities. • CQI • Offers workflow solutions. • Acts as a liaison between IT and clinical departments • Develops testing plans for all forms and changes prior to putting them in production. • Monitors and manages the testing process with clinical staff/leadership • Develops requirements for interfaces and manages testing of interfaces.

17. Staffing requirements • Application management. Highly skilled and knowledgeable regarding functionality of all software applications. Maintains and updates all software configurations to support needs of the clinical staff. • PM/EHR • Dental Software • Document management • Fax Server • Patient portal • Population management • Reporting software

18. Staffing requirements • Training. Provides application training for new employees as well as ongoing training for established employees and staff on all software applications. Creates curricula, job aides and uses various means (in person, classroom and remote or GoToMeeting) to deliver training. Provide remediation and refresher training when appropriate. • Helpdesk Support.Provides real time support to end-users. Manages the HelpDesk software and ensures the development of a knowledgebase related to lessons learned from trouble shooting and fixing end user problems. Collaborates to provide support remotely and as quickly as possible. Uses a customer service approach with end-users.

19. Workflow The MA-Provider Dyad is Key • Enhancing the MA role and creating stable MA-Provider teams is the key to high performing ambulatory practice. • In addition to adding specific tasks to the MA role such as documenting a patient’s smoking status, calculating and entering a BMI or ensuring that a BP is taken at every visit, the MA must be empowered and charged with responsibility for certain aspects of the encounter and overall patient management.

20. Workflow The MA-Provider Dyad is Key • Consider the teaming of MA’s and providers carefully. Do not partner a new MA with a new provider, do not put a provider who is not particularly organized with a disorganized MA, use the “opposites attract” theory • Do provide ample opportunity for feedback with quantifiable goals for both the MA and the provider making sure the MA has an equal voice.

21. Typical Processes that Need to be Revised • Patient panel definition and management for each provider-MA team • Referral management • Document management • Order and results reconciliation • Documenting phone encounters • Patient flow from check in to check out • Immunization management • Incorporating meaningful use requirements such as access to an electronic copy of their chart, providing a clinical visit summary, and medication and problem list management.

22. Lessons Learned • Everyone has EHR challenges, there is no perfect EHR • Optimization is an ongoing process • Having the right tool for the job is a critical success factor • Understand strengths and weaknesses of staff and get them in the right seats • Governance, oversight, monitoring and feedback are the keys to success.