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.eduClires0@email.uky.edu859-323-3090

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.

The Steps to Effective Use of HIT Adopt

– Assess – Plan – Select

Utilize – Implement – Effective Use

Exchange – Readiness – Interoperate

Key Components in Planning Hardware Software People Policy Process

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

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

Who is at the planning table Identify project team - develop a

roles and responsibilities matrixDefine Role Define

Responsibility

Project Manager

Physician champion

Billing rep

Super user

Clinical staff

Others

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

Importance of Goal Setting

Getting ready for change

Conduct a readiness assessment of people and technology

Assess computer skills of staff

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

Engaging your patients

Marketing plan for the patients

- determine a plan for communicating to your patients your EHR

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!

Mapping your current processes Paper workflow

Clinical process

Understand current major paper workflows

- Charts - Lab results - Prescriptions

- initial - renewals

- Referrals - Consults - Others

Process Mapping

1.Identify processes to be mapped; e.g., those that will be impacted by the HIT being acquired

2.Use individuals who actually perform the process; they know it best and need to own the impending change

3.Instruct persons on process mapping – why it is being done and how it is done

4. Map current processes. Avoid identifying opportunities for improvement now, or critical controls built into current processes may be overlooked

5.Validate maps to ensure they reflect current processes, all variations, and the information payload

6.Collect all forms and reports that are part of processes to be automated through HIT

Process Mapping

7. Obtain benchmark data to define expectations for change and for use in evaluating the benefits achieved later

8. Identify potential problems in current workflows and processes and determine their root cause

9. Identify changes that may resolve problems today

Process Mapping

10.Identify potential problems in current workflows and processes and determine their root cause

11.Identify changes that may resolve problems today

12.Educate about HIT and EHR and identify further changes that will be possible

Process Mapping

16.Educate about HIT and EHR and identify further changes that will be possible

17.Document changes by creating improved

18.Use new processes to create use case scenarios to identify HIT functional specifications, and later to build out the HIT application to achieve improvements

Process Mapping

19.Test new workflows and processes

20.Train all on new workflows and processes

21.Incorporate changes into policy and procedure

Finally

Conduct benefits realization and celebrate successful change/correct course as necessary

Process Mapping

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”

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

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

Referral Source

Contacts specialist clinic schedules visit

SP completes patient visit

Contacts SP office schedules &collects pt info

Contacts UKMDs to schedule visit

SP sends patient visit summary to Referral Source

SP contacts PCP

SP does not contact PCP

UKMDs contacts SP who collects pt info

Info not sent to clinic by office

SP does not send patient information to referring source

No Patient Information Sent

SP Does not send info to clinic

Visit not completed

Dictates note and send by snail mail

Phone Call

CURRENT PROCESS

Basic Systems Flow Chart

Review current maps to identify:

Bottlenecks Sources of delay Rework due to errors Role ambiguity Duplications Unnecessary steps Cycle time

Referral Source

Contacts specialist clinic schedules visit & sends

electronic pt info to secure server

SP clinic accesses pt info & completes patient visit & completes templated visit note

that is sent to secure server

Contacts SP office schedules visit & sends electronic pt info to secure server

Contacts UKMDs, schedule visit & sends electronic pt info to secure server

Referral Source accesses patient visit summary from

secure server

SP clinic sends no visit info to secure

server

No Patient Information Sent

Visit not completed

PROCESS FOR EMRs

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

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

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

Next Steps

Selecting a vendor – group purchasing through Health Bridge Tri-state REC

Implementing the EHR – assistance in working with vendors

Post Install

Working toward meeting meaningful use measures

Collecting data regarding return on investment

How to reach your REC

If you are in a light blue, dark blue, or red county contact

Kentucky Regional Extension Center2333 Alumni Park Plaza Suite 200Lexington, KY 40517Toll free: 888-KYR-ECEHRPhone: (859) 323-3090Fax: (859) 257-9366KYREC@uky.edu

If you are in a white county contact

Tri-state REC : 11300 Cornell Park Drive, Suite 360Cincinnati, OH 45242

Phone number:513-469-7222, option 3

Fax number:513-469-7230 Email: rec@healthbridge.org

How to reach your REC

Questions?