Planning for Your EHR: Answering the Tough Questions

Planning for Your EHR:
Answering The Tough Questions

Martin Sizemore
Director, Healthcare Strategy
Perficient, Inc.

EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any
form or medium without express written permission of Access Intelligence, LLC is prohibited.

Agenda
• Introduction and Background
• People
– Are we “do it yourselfers” or do we need outside help?
– Is the project leader committed to success?
– What is the level of staff readiness for an EHR?
– Can we get outside help?
• Process
– Will an EHR impact our regular workflow?
– What is the impact on our billing – faster or slower?
• Technology
– What about the total cost of ownership?
– Can’t we just do all of this stuff over the web?
– What about security and privacy management?

8/17/2011 form or medium without express written permission of Access Intelligence, LLC is prohibited.

Ten Key Issues in Healthcare Systems
1. How to create a patient’s health record
2. How to build a lifelong health history for a patient from
information stored in multiple, diverse systems
3. How to manage identity and authorities
4. How to identity a patient (or a healthcare professional) uniquely
and reliably
5. How to “join up” different systems on different platforms
6. How to interconnect diverse systems and how to make them
interoperate
7. How to communicate with remote systems
8. How to reuse legacy systems
9. How to achieve flexibility and agility
10. How to achieve performance and scalability


Our view of the EHR evolution
• Connected systems – Software networks that span
applications, devices, services, and healthcare
organizations to help streamline processes, improve
knowledge sharing and reduce costs
• Information-driven software – New applications that
dramatically improve the way healthcare workers find,
organize and act on information, facilitating better
collaboration and quality of care
• Collaborative environments – Rich interfaces and new
experiences that help improve collaboration and
consultation for healthcare workers and patients using
high-quality audio, video and natural language


Current State Assessment
• Ambulatory Care - Doctor’s Office Visit
– Customer satisfaction is low but volumes of activity
remain high, building pent-up frustration
– Processes that are non-value-added to the patient are
relatively high cost to the provider
• Tasks are highly repetitive and clerical in nature
• Routine tasks are medium to high in complexity
• Manual hand-offs between processes create a
high probability of failure and rework


Current State Assessment
– Quality problems appear at the outset of the process
and get worse as activities unfold
• Simple, routine manual tasks are most susceptible
to error
• Standard patient data, manually input across
disparate systems is error prone – at risk for
improper coding


Typical Practice Workflow
– Processes are not standardized. Each office institutes its
own procedures
• Standardization appears to stem from outside influences only –
insurance carriers, regulators
• There are disparate systems, inconsistent policy interpretation,
duplication of effort, user confusion
– Critical processes are not documented, providing few
controls and little discipline
• Critical tasks require specific expertise, but are typically mastered by
only one or two staff members
• Consistent quality assurance cannot be monitored or maintained
• Utilization of staff managed via the “Walking Around” method
– Each process, if done correctly, would significantly
differentiate a provider’s service offerings


Technology Used Inconsistently
– Practices lose efficiency by inconsistent or
inefficient use of technology

• Generic out-of-the-box Electronic Health Record
(EHR) applications are set up to meet unique office
policies
• Technology is used for record keeping only. Work
processes remain manual in nature


Know Your Technology Style Is A
Key Starting Point
“Do It Yourself” types Outside Help
• Install your own PCs and • Want to avoid managing
servers my own servers, but
• Don’t mind the weekly willing to manage local
Microsoft Windows updates
PCs
• Back-up the computers on a
regular basis and know how • Need to focus on what we
to do a system restore do best, not managing
• Like to train office staff on our own IT
Windows and new
applications
• Don’t want to manage
the constant updates
from anyone


Is the project leader committed to
success?
• Patience, patience, patience (especially around
patients)
• It will take time to master – by each of us
• Continuous improvement – can I accept making
mistakes and learning from them?
• It will take a plan for when things don’t work
exactly right – power out, Internet connection
down, staff illness or vacation


What is the level of staff readiness
for an EHR?
• Make an honest healthcare IT skills
assessment of each staff member
– Level of Microsoft Windows knowledge
– Ability to learn the EHR software application –
navigate the screens, print the reports, etc.
– Understanding of key data elements and
importance of data accuracy
– Confidence in working with computers


Can we get outside help?
• Funding
– Can we get funding help at the local level?
– Can we get funding help at the Federal level?
• Consulting
– Do we need help to get the EHR implemented?
– Do we need to evaluate or update our workflows?
• IT Help
– Can we just hire temporary IT help to get the software
going?
– Do we need periodic or annual maintenance help?


How will an EHR impact our regular
workflow?
• Is our current workflow documented and well understood
by the staff?
• Can the software be changed easily to meet our current
process?
• Should we change our process to follow the software?
How hard will it be to adapt?
• When do we need to create and maintain hard copies of
information?


What is the impact on our billing –
faster or slower?
• Does the billing portion of the application support both
ICD-9 and ICD-10?
• Can we send 4010 and 5010 transactions to health plans
and insurance companies?
• Can we send or receive electronic Continuity of Care
documents to participate in a Health Information
Exchange (HIE)?
• Can we check insurance eligibility quickly and easily?


Technology
• Technology
– What about the total cost of ownership?
• Assess the hidden costs – administration and oversight of the
system, project planning, annual maintenance, archiving of
old records
– Can’t we just do all of this stuff over the web?
• Good choice – with the right vendor and understanding of the
pros and cons
• What happens with the internet connection is down?
– What about security and privacy management?
• Must be planned, reviewed and tested – frequently


Set goals for
your EHR implementation
• People
– Experienced staff elevated from clerical tasks and routine, rules-based
decision making
– User held responsible for basic data integrity
– Workflow activity levels monitored to better balance staff workload
– Time available for cross training and knowledge transfer
• Process
– Standardized, measurable, repeatable processes that work across a
broad range of ambulatory services
– Once and done processing – touch data once, QA once, set
appointment once, etc.
– Straight through processing – eliminate bottlenecks, rework, clerical,
duplicate and repetitive tasks


Where do you want to go
in the future?
• ePrescribing – may be a necessity
• Online physician referrals
• Portable medical records
• Patient data entry of personal details and interfaces to home monitoring
devices
• Online reporting, email notifications and medical reminders
• Security enabled, multi-tiered online access to patient records
• Rules based automation of scheduling, insurance eligibility verification, data
capture, diagnostic and procedural coding, and billing
• Centralized recordkeeping for improved security, system-wide access and
business continuity
• Practitioner access to affiliated facilities and professionals regardless of
location


Q&A
• How much time do you plan to spend on
implementing your EHR?
• What is your budget for training?
• How will you decide if the implementation
is a success? (Determine this answer
before you start)


Planning for Your EHR: Answering the Tough Questions

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