IHS EHR Indian Health Service Electronic Health Record Michele Miller Warm Springs Health & Wellness...
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Transcript of IHS EHR Indian Health Service Electronic Health Record Michele Miller Warm Springs Health & Wellness...
IHS EHRIndian Health Service Electronic Health Record
Michele MillerMichele Miller
Warm Springs Health & Wellness Warm Springs Health & Wellness CenterCenter
Preparation, Implementation Preparation, Implementation and Lessons Learnedand Lessons Learned
Preparing for InstallationPreparing for Installation Implementation TeamImplementation Team CACCAC OIT Requirements OIT Requirements
SetupSetup EHR CAC & Implementation Training (ABQ)EHR CAC & Implementation Training (ABQ) OIT On-site RPMS-EHR setupOIT On-site RPMS-EHR setup
Go LiveGo Live Looking AheadLooking Ahead
Implementation TeamImplementation Team Clinical Application Coordinator (CAC)Clinical Application Coordinator (CAC) Medical Staff (Clinician)Medical Staff (Clinician) NursingNursing PharmacyPharmacy Lab and RadiologyLab and Radiology Medical RecordsMedical Records Billing/CodingBilling/Coding Information Technology staffInformation Technology staff *Administrator/Executive Leadership**Administrator/Executive Leadership*
Implementation Team RolesImplementation Team Roles
Monitor and Execute Implementation PlanMonitor and Execute Implementation Plan Identify and define Policies and Identify and define Policies and
Procedures Procedures Address staffing and scheduling during Address staffing and scheduling during
transitiontransition Peer Training & MarketingPeer Training & Marketing Design and Approve EHR Menus, Design and Approve EHR Menus,
templates,etctemplates,etc
Hardware/Infrastructure Hardware/Infrastructure upgradeupgrade
RPMS server RPMS server Backup/Training serverBackup/Training server Thin Clients, laptops, pcs?Thin Clients, laptops, pcs? Network Network Lab Interface UpgradeLab Interface Upgrade Workstation Access-EverywhereWorkstation Access-Everywhere Backup PowerBackup Power
Costs Associated with EHRCosts Associated with EHR
WorkstationsWorkstations Laptops, tablets, pc, thin clientsLaptops, tablets, pc, thin clients
Ergonomic workstationsErgonomic workstations Backup ServerBackup Server Backup GeneratorBackup Generator Clinical Applications Coordinator GS 12Clinical Applications Coordinator GS 12 Training / Travel CostsTraining / Travel Costs Software-$0.00Software-$0.00
Elapsed time (in months)
Decisi
on to
imple
men
t EHR
Review
EHR W
ebsit
e
0
Comple
te E
HR Site
Sur
vey
Begin
EHR Site
Tra
cking
Rec
ord
Begin
hiri
ng pro
cess
for C
AC
Establi
sh E
HR Imple
men
tatio
n Tea
m
Attend L
esso
ns Lea
rned
cla
ss
RPMS c
urrent,
CACHE
Begin
phar
mac
y dru
g file
clea
nup
for P
harm
5/7* Beg
in pr
ocur
emen
t pro
cess
for h
ardw
are
Inst
all P
IMS
Optim
ize “P
oint-o
f-Ser
vice”
RPM
S Pac
kage
s
Optim
ize P
CC Erro
r Rep
orts
Inst
all/c
onfigure
Rad
iolo
gy 5.
0, L
ab 5
.2
Inst
all P
harm
acy
5/7
and E
HR GUI
Imple
men
t Pap
erle
ss R
efill
Attend C
AC trai
ning
On-site
Set
up with
Nat
’l EHR T
eam
EHR Super
Use
r tra
inin
g
EHR Go-L
ive
with N
at’l
EHR Tea
m
Full ro
llout
1 2 3 5 8 106 11 12 24
Please note that this is just a general timeline of how long it might take for your site to implement EHR. Every site will be different, and the amount of time it takes to implement EHR depends upon many factors, including size of the facility, services offered at the facility, current state of RPMS and packages installed and utilized.
EHR Planning & Implementation
* Most sites contract for external resources to complete pharmacy file preparation.
Imple
men
t Adv
erse
Rea
ction
Tra
cking
pac
kage
National EHR Training and National EHR Training and Deployment Program Deployment Program
recommends at least 6months recommends at least 6months
Three months of Pharmacy 7.0 utilization Three months of Pharmacy 7.0 utilization before "Paperless Refill" before "Paperless Refill"
Three months of "Paperless Refill" and Three months of "Paperless Refill" and "Coding Queue" before beginning Provider "Coding Queue" before beginning Provider Order Entry (POE) with EHR. Order Entry (POE) with EHR.
Medical Clinic PreparationsMedical Clinic Preparations
Formed TeamsFormed Teams
Practiced EHR Walk-Through(on paper)Practiced EHR Walk-Through(on paper)
Defined RolesDefined Roles
Computers everywhereComputers everywhere
LabLabAll Labs need to be entered in RPMSAll Labs need to be entered in RPMS
On-site LabsOn-site Labs Reference LabsReference Labs State LabsState Labs
Computer Access PointsComputer Access Points
Change from Esig to EHR after Go-LiveChange from Esig to EHR after Go-Live
OIT Help / TrainingOIT Help / Training
EHR CAC & Implementation Team (Set Up) EHR CAC & Implementation Team (Set Up) Training in ABQTraining in ABQ
EHR Onsite Set-Up TeamEHR Onsite Set-Up Team
Onsite Go Live TeamOnsite Go Live Team
EHR for Techies, EHR for Inpatient, EHR for EHR for Techies, EHR for Inpatient, EHR for HIM and Business OfficeHIM and Business Office
Customize order menusCustomize order menus Lab, Pharmacy, RadiologyLab, Pharmacy, Radiology
Setup Referrals/ConsultsSetup Referrals/Consults Progress Note TemplatesProgress Note Templates
Design your ownDesign your own Share with other sitesShare with other sites
User SetupUser Setup ICD/ CPT Pick ListsICD/ CPT Pick Lists
Setup by CACSetup by CAC
Preparation-Customizing Preparation-Customizing TemplatesTemplates
•Templates can be shared with other IHS and VHA facilities
•More Complete Documentation
Training/MarketingTraining/Marketing
EHR Demo Movie EHR Demo Movie VA Training Modules VA Training Modules
ftp://intranetftp.ihs.gov/pub/EHR/ftp://intranetftp.ihs.gov/pub/EHR/ PharmacyPharmacy CPRSCPRS
WebEx DemosWebEx Demos Show and TellShow and Tell
NewslettersNewsletters Web UpdatesWeb Updates Meeting UpdatesMeeting Updates Email QuizzesEmail Quizzes
Implementation StrategyImplementation Strategy
Implementation-Who and WhenImplementation-Who and When Everyone at onceEveryone at once Lab ordering , then radiology ordering, Lab ordering , then radiology ordering,
then pharmacy ordering, then notesthen pharmacy ordering, then notes Bring up one team/dept at a timeBring up one team/dept at a time
Go Live WeekGo Live Week Intense CAC and IT SupportIntense CAC and IT Support Make Appropriate Scheduling AdjustmentsMake Appropriate Scheduling Adjustments Daily Debriefings….Daily Debriefings….
Procedural QuestionsProcedural Questions Technical IssuesTechnical Issues How did it work before EHR?How did it work before EHR? More Training-Email trainingMore Training-Email training
How the Week First GoesHow the Week First Goes
0
20
40
60
80
100
120
Mon
Tue
sW
ed
Thu
rs FriM
on
Tue
sW
ed
Thu
rs
Friday
S tress Level
Growling at CAC’s
Crying, gnashing of teeth
Excited
TGIF
Excited
Medical RecordsMedical Records
Filing notes in chart during the transition?Filing notes in chart during the transition? Print And File Chart Copies? Batch Print?Print And File Chart Copies? Batch Print? Release Of Information?Release Of Information? Outside Consults? Scanning? Outside Consults? Scanning? When to stop pulling the chart When to stop pulling the chart
Medical Records SupervisoryMedical Records Supervisory
Daily Report: Unsigned OrdersDaily Report: Unsigned Orders Daily Report: Unsigned NotesDaily Report: Unsigned Notes Retracting /Correcting Incorrect EntriesRetracting /Correcting Incorrect Entries Paper P&P changed to Electronic P&PPaper P&P changed to Electronic P&P Sensitive Pt TrackingSensitive Pt Tracking Medical Records Supervisor: Business Medical Records Supervisor: Business
rules/HIPAArules/HIPAA Who can view which parts of EHRWho can view which parts of EHR Works cooperatively with RPMS Site ManagerWorks cooperatively with RPMS Site Manager
Business OfficeBusiness Office
No Hard Copy to Wait forNo Hard Copy to Wait for No more missing E&M CodesNo more missing E&M Codes EHR Notes Are LegibleEHR Notes Are Legible Great Opportunity For Improved Great Opportunity For Improved
Provider Documentation & Increase Provider Documentation & Increase Billing/CollectionsBilling/Collections
Medical ClinicMedical Clinic
Using templates/graphs instead of flow sheetsUsing templates/graphs instead of flow sheets Using the Scheduling GUI for visual routing of pt Using the Scheduling GUI for visual routing of pt
flowflow Selecting ICD/CPT codesSelecting ICD/CPT codes RemindersReminders Voice RecognitionVoice Recognition
Dragon NaturallySpeakingDragon NaturallySpeaking
Vista ImagingVista Imaging
Staff Changes at Warm SpringsStaff Changes at Warm Springs
More Nurse Aids after EHRMore Nurse Aids after EHR From 2 to 7From 2 to 7
Medical Records Staff Medical Records Staff PCC Data Entry PCC Data Entry (temporarily reassigned)(temporarily reassigned)
Benefits Coordinator Benefits Coordinator (temporarily reassigned)(temporarily reassigned)
Medical Department Medical Department (temporarily reassigned)(temporarily reassigned)
• Nurse aidsNurse aids• Medical ReceptionistMedical Receptionist
Shifted to scanning documents into VistA ImagingShifted to scanning documents into VistA Imaging
Next StepsNext Steps
EHR v1.1EHR v1.1 CPHAD (Public Health Activity Reporting CPHAD (Public Health Activity Reporting
System)System) Electronic Dental Record (EDR)Electronic Dental Record (EDR) Visual PHN System (VPS)Visual PHN System (VPS) VistARADVistARAD
Clinical Applications Clinical Applications Coordinator (CAC)Coordinator (CAC)
Coordinates EHR ImplementationCoordinates EHR Implementation New Position / RoleNew Position / Role Works cooperatively with Site Manager and Works cooperatively with Site Manager and
Medical RecordsMedical Records EHR User SupportEHR User Support TrainingTraining Customizes EHRCustomizes EHR WorkflowWorkflow
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