Delivering Technology With

High Adoption

Polly Peterson, MBA, IT Director

Gina Howlett

Objectives

• How to engage providers & other staff in projects to drive

adoption and involvement in implementation projects.

• How to meet regulatory needs by embedding

requirements into standard process.

• How to use technology options to meet differing

workflows while keeping the technology manageable.

• The importance of embedded support staff in the

“gemba”/work area to support implementations.

Winona Health Services

• Nonprofit healthcare provider serving Winona and the surrounding

areas.

• 99-bed hospital and 13 specialty clinics

• More than 1,100 employees including nearly 100 physicians and

associate providers

• 140-bed nursing home, 60-apartment assisted living community and

20-apartment assisted living community for memory care.

• HIMSS Stage 6 Designation for Inpatient, HIMSS Stage 7 for

Ambulatory, 2014 Most Wired Recognition (10th yr of recognition)

• Cerner partner since 2003

Lean Culture: Continuous Systems

Improvement

Customer Safety and Value #1

Use CSI as a strategy

Systems thinking

Management by fact

Everyone is engaged

Baldrige criteria platform

Lean Management System

Process Improvement

• All staff daily – Gemba where the work is done

• Std–FOCUS Boards – everyday and everyone

• Metrics – Mgmt by Fact – Data starts here

• Kaizen, Continuous Improvement Projects, 5S, A3,

FOCUS board A3s and Just-Do-Its

• 3P – Process, Product, People – New/Redesign

• Accountability = Sustainment

Why Electronic Documentation?

• Meaningful Use Stage 2 o Core Objective: “Provide clinical summaries for patients for each office visit.”

o Menu Objective: “Record electronic notes.”

• CMS/billing requirements o E&M codes and documentation to support codes

• ICD-10 preparation o Immediate feedback for providers

• Increased operating costs o Added requirements increase transcription time & dictated lines

• Adoption models o HIMSS

o Most Wired

Provider Documentation Event

• Interdisciplinary involvement

o 9 providers across all service lines

o HIM coding and quality staff

o Nursing

o IT

o Leadership

• Week long event

o Current state review

o Ideal state

o Risk analysis

o Future state

o Solution planning & demonstration

Event Results

• Plan to purchase & rollout Dragon with multiple options for providers

• Plan to customize EMR workflow & view by specialty

• Templates identified for electronic documentation for each service

line and department

• Standards updated for documentation content & turnaround time

• Plan to embed quality within workflow

• Identified physician champions for go-live & commitment to pilot

Technical tools & plan

• Cerner’s Dynamic Documentation o Standard templates and custom templates (H&Ps, progress, procedure,

discharge, death notes, etc)

o Maintained Powernote usage in ED

• Nuance’s Dragon with two microphone choices o Powermic

o Wireless options

o Enterprise edition of Dragon included Vsync integration with Cerner

• Multiple microphone placement locations o Patient rooms

o Provider offices

o Care team “pod” areas

Pilot

• 9 providers from planning event

• 2 providers each day with 1-on-1 support as issues were identified

• Resolved technical issues & updated training materials

• Reduced stress of providers and created champions

• Created confidence in the go-live

IT and Support Model

• Outsourced IT to Cerner since 2010

o HelpDesk

o Application new build and support

o Remote-hosting

• Growth in Super User model to support growth in

applications/process changes

o Driven by high need of partnership in order to successfully drive change

• Added key meetings like Integrated EMR

• Goal is seamless integration within the organization

“Winona Health involves key suppliers that are

embedded as staff and collaborators in the

strategic and performance review process.

Cerner uses the organization’s quality tools,

follows standards, and participates in problem

solving and continuous improvement events.

The Cerner team is located on site and has the

same accountability measures as the

organizational staff.”

Leveraging Technology: “Winona Health has a strong technology

presence, best practice relationship with the electronic medical record

vendor, successfully uses telemedicine, and has received significant

technology recognition (“most wired” and HIMSS Level 6). Capitalizing

on this strategic advantage was an observed strength.”

Super User Role

• Nominated users in each service line or department

• Need to meet the qualifications

o Moderate computer skills

o Approachable and comfortable in answering questions from peers

o Open to new ideas

o Active listener

o Positive approach to change

o Proactive problem solver

o Patient while teaching others

o Well respected by peers

o Good communication skills

Super User Role Expectations

• Validates EMR build content and workflows in testing with IT

• Provides input for training content

• Prepare for changes to dept/unit processes and workflows

• Assure dept/unit is aware of changes or updates to content used by their teams

• Conduit back to informatics with changes to EMR to improve processes and workflows

• Key contact in dept/unit day of go lives for additional functionality

• Identifies impact changes to EMR will have to other depts processes and workflows

• Participates in super user forums and integrated EMR meetings

Training Programs & Support

• 1-on-1 for providers and new employees

• Classroom or web-based for nursing and support

• Support staff rounding

• Message center pool

• Tips of the week

• Quarterly reviews

• Leadership 1-on-1s to review metrics

• Learning Live o Tracks usage and suggests learning materials to user

o Video clips and wiki page documents

o We can also display organizational announcements to users

Go-Live

• Nearly 100 providers live across all service lines

• IT support in each department for two weeks

• Daily review of issues & training tips

• Daily metrics of adoption

• High stress & long hours

Outcomes of Physician Documentation

• Reduced transcription staff by 11 FTEs within one month of go-live

o $450,000 annual salaries savings

• Decreased contract costs with Nuance

o $322,800 annual contract savings

• Ability to give patient provider’s plan of care at end of visit

• Decreased turn-around time for safer patient care on transitions of care

• Standardized workflow and content

• Increase E&M levels with increased standards of content in notes

Other Key Learnings

• Importance of interdisciplinary work & feedback

o HIM view of note (ie professionalism, accuracy)

o Right role, right work (ie nursing staff completing Family History)

• Importance of adapting the workflows

o Successful providers have changed their workflow instead of just adding in a new

tool to an old workflow

o Involve the patient when possible

• Technology is complicated

o Dragon/Vsync/Cerner integration can be difficult to navigate

o Consider and train on all situations for the providers (ie home use)

Questions?