Information Management for Health Care Group E Presentation Building Consensus for Electronic Health Records Jacksonville University Online School Nursing NUR353

1. Andrew Collins, Joy Culberson, Veronica George,
Jane Glick and Steven Gumbs

2. What is EMR?
 Digital
paper chart
 Medical & treatment history




Track data over time
Determine when due for check up
Check parameters such BP & vac.
Monitor quality of care within practice
 Difficult
to transfer out of facility
 Little improvement over paper charting
Garrett & Seidman, 2011
2

3. What is EHR?
 Total
health of patient
 Reach beyond initial health organization
 Share health information
 Other providers
 Laboratories
 Specialists


Moves with the patient
Accessed by all involved in patient care
including patients
Garrett & Seidman, 2011
3

4. Advantages of EHR

Contain and share patient information from
all providers
 Reduce medical error
 Improves accuracy
 Clarity of medical records

Available information
 Reduce
 Duplicate tests
 Delay in treatment
 Patient well informed
 Better decisions about care
CMS.gov, 2012
4

5. Drawbacks to EHR

Acquisition costs
 Hardware and software
 Loss of revenue due to decreased productivity
 One study involving several internal medicine
clinics estimated a productivity loss of 20% in the
first month, 10% in the second month, and 5% in
the third month, with productivity subsequently
returning to its original levels.
 Full-time salaries for employees hired to input
existing patient data

Ongoing maintenance costs
5

6. Drawbacks to EHR
 Patient
privacy
 Liability concerns by physician/hospitals with
respect to protecting electronic data
 Inability
to do a thorough “look back” in a
patient’s record without piling through
volumes of data
Wang, Middleton, & Prosser et al., 2003
6

7. Building consensus- Steps to
gaining consensus

Step 1: Assess readiness
 Where is the facility now in terms of automation? Is
anything currently automated? What stage is the facility at
in terms of the HIMSS Analytics Adoption Model?
 Stage 0: Automation exists but not all systems are operating
 Stage 1: Laboratory, pharmacy, and radiology departments






installed
Stage 2: Clinical documentation automated, EMR present
and integrated with clinical data repository
Stage 3: Nursing documentation/flow sheets are in place and
physicians can retrieve/view basic documentation
Stage 4: Computerized provider order entry in place (CPOE)
Stage 5: Barcode medication administration (BCMA) or radio
frequency identification (RFID) implemented
Stage 6: Physician documentation, full clinical decision
support system and picture archiving and communication
system in place
Stage 7: Completely paperless
7

8. Building consensus-Steps to
gaining consensus

Step 1: Assess readiness (continued)
 Is there commitment from administration to
implement EHR?
 Support from administration imperative for
implementation to occur
 Are funds available to implement EHR?
 Cost
 Size, location, system
 Well designed and correct implementation of EHR
will reduce errors, improve quality of
care, increase physician and patient satisfaction
which will lead to lower costs
Haugen & Sebelius, 2008
8

9. Building Consensus- Steps to
gaining consensus
 Step
1: Assess readiness (continued)
 How much experience does the current staff
have with technology?
 For success in implementing EHR, clinician
involvement and acceptance of changes is
imperative
 Resistance to change from medical staff
 Consider technical proficiency of staff when selecting
a system
9

10. Building consensus- Steps to
gaining consensus
 Step
2: Conduct focus groups
 Have representation from all stakeholders
affected by the change involved in the focus
groups
 Members of the focus group(s) identify
needs form a clinical and administrative
perspective.
 Members discuss impact of workflow
 Appoint a leadership team to oversee
implementation
Hebda & Czar (2013)
10

11. Building Consensus- Steps to
gaining consensus
 Step
3: Set goals for the EHR system
 Goals should be “SMART”
 Specific
 Measurable
 Attainable
 Relevant
 Time bound
HealthIT.gov, 2012
11

12. Building Consensus- Steps to
gaining consensus
 Step
3: Set goals for the EHR system
(continued)
 Examples of goals
 Establishment of a focus group
 Selection of EHR system
 Creating a time line
 Allocating resources
 Training hospital staff
 Launching the system
12

13. Building Consensus- Steps to
gaining consensus

Step 3: Set goals for the EHR system (continued)
 Goals should coincide with meaningful use. What is
meaningful use?
 Discrete structured data available through other
healthcare facilities
 Meaningful use Stage 1 criteria








Computer provider medication orders
Medication list
Allergies
Problem list
Discharge instructions
Decision support tools
Growth charts for children
Providing patient electronic health information
Patrick, 2013
13

14. Building Consensus- Steps to
gaining consensus
 Step
3: Set goals for the EHR system
(continued)
 Meaningful use Stage 2 criteria
 Tracking medication from order to
administration
 Secure electronic messaging
 Outpatient lab reporting
 Discharge prescriptions
 Recording clinical notes
 Patient family history
 Exchange of health information
McCartney, 2013
14

15. Building Consensus-Steps to
gaining consensus
 Step
4: Prioritize goals
 Short-term goals
 Focus groups
 Time line
 Selecting vendor
 Long-term goals
 Installing EHR
 Training staff
 Launching system
15

16. Building Consensus-Steps to
gaining consensus
 Step
5: Select a vendor for EHR
 Form a focus group
 Written request
 Demonstrations
 Rank vendors
 Contract
16

17. Building Consensus- Steps to
gaining consensus
 Step
6: Create a plan/timeline for
implementation
 Request input from clinical and support staff
 Perform workflow analysis
 Arrange for workflow redesign
 Create an abstraction plan
 Create a timeline for implementation
17

18. Building Consensus-Steps to
gain consensus
 Step
7: Communicate
 Communication should happen often and to
all employees of the facility throughout the
entire transition to EHR
 When “go-live” is ready to occur, a meeting
should occur whereby the leadership
committee/team assigned by presents the
plan for the entire facility
18

19. Timeline for EHR
implementation
 Nine
to 12 months before go-live
 Obtain support from facility leadership
 Submit request for proposals
 Choose vender and make a shortlist
 Plan training and implementation
 Evaluate current project management
19

20. Timeline for EHR
implementation
 Six to nine months before go-live
 Name a project team and define roles and





responsibilities
Develop workflows
Plan abstraction for transferring paper
information to system
Examine templates and data elements
Evaluate data elements for billing and
patient encounters
Define necessary hardware/software needs
20

21. Timeline for EHR
implementation
 Three
to six months before go-live
 Install hardware
 Assess readiness of staff
 Plan for training of staff and super users
 Compare installation timeline with vender’s
timeline
 Notify patients of new system, explain
benefits and ask for feedback
21

22. Timeline for EHR
implementation
 One
to three months before go-live
 Build and test interfaces
 Test readiness system
 Fill in patient records
 Adjust schedules for patients
 Arrange staff schedules
22

23. Timeline for EHR
implementation
 About
30 days before go-live
 Customize templates
 Decrease patient load for going live
 Test and recheck system, workflows, etc.
23

24. Timeline for EHR
implementation
 From
30 to 120 days after go-live
 Examine provider’s templates in system
 Share protocols among staff
 Create a network with other facilities for
support and feedback
 Discuss with vendor about concerns or
questions
Ehrintelligence, 2012
24

25. Summary
 Learned
what an EMR/EHR are and
their differences
 Benefits and challenges of EHR
 Steps to building a consensus
 Assessment of readiness in a facility
 Process to conduct focus groups
 Importance of setting SMART goals that
coincide with meaningful use
 How to choose a vendor
 Created a plan for implementation
25

26. References
Benefits of ehr's. (n.d.). Definition and benefits of electronic medical records . Retrieved from
http://www.healthit.gov/providers-professionals/electronic-medical-records-emr
EHR implementation timeline for hospitals. (2012, June 14). EHRintelligencecom. Retrieved from
http://ehrintelligence.com/2012/06/14/ehr-implementation-timeline-for-hospitals/
Electronic Health Records. (2012, March 26). - Centers for medicare & medicaid services. Retrieved from
http://www.cms.gov/Medicare/E-Health/EHealthRecords/index.html
Garrett, P., & Seidman, J. (2011, January 4). Health it buzz emr vs ehr what is the difference Retrieved from
http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/
HealthIT.gov. (n.d.). Selecting an ehr system or upgrading an ehr system. Retrieved from
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-2-plan-your-approach
Hebda, T., & Czar, P. (2013). Handbook of informatics for nurses & healthcare professionals (5th ed.).
Boston: Pearson.
McCartney, P. (2013). Meaningful use stages 1 and 2. Health information
technology, 38(January/February), 1st ser., 56.
Mooney, B. L., & Boyle, A. M. (2011, May 10). 10 steps to successful her implementation | medical
economics. Medical Economics. Retrieved from
http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modernmedicine-feature-articles/10-steps-successful-ehr-imple
Patrick, K. (2013, November 7). How to convert paper charting to electronic charting [Personal interview)
Wang, S. (2003). A cost-benefit analysis of electronic medical records in primary care. The American
Journal of Medicine, 114(5), 397-403. doi: 10.1016/S0002-9343(03)00057-3
Zandieh, S. O., Yoon-Flannery, K., & Kuperman, G. J., et al.(2008). Challenges to ehr implementation in
electronic. Journal of General Internal Medicine, 23(6), 755-761. doi: 10.1007/s11606-008-0573-5
26