ambulatory ehr implementation at ucsf medical center brian herrick, m.d. july 18 th, 2008 slide...

Ambulatory EHR Ambulatory EHR Implementation at Implementation at

UCSF Medical CenterUCSF Medical Center

Brian Herrick, M.D.Brian Herrick, M.D.July 18July 18thth, 2008, 2008

Slide Recognition to Russ Cucina M.D., William Slide Recognition to Russ Cucina M.D., William Hersh M.D., Angelina Chang, and Kathy LehtoHersh M.D., Angelina Chang, and Kathy Lehto

OutlineOutline

Implementation resourcesImplementation resources Implementation lessons from the Implementation lessons from the

literatureliterature Implementation chasmImplementation chasm UCSF Medical Center EHR UCSF Medical Center EHR

implementationimplementation

Choosing EHR (Adler, 2005)Choosing EHR (Adler, 2005) Identify decision makers in a practiceIdentify decision makers in a practice Clarify goalsClarify goals Write a Request for Proposal (RFP)Write a Request for Proposal (RFP) Review proposals to narrow the fieldReview proposals to narrow the field Vendor demonstrationsVendor demonstrations Check referencesCheck references Rank the vendorsRank the vendors Site visitsSite visits Select finalistSelect finalist Solidify organizational commitmentSolidify organizational commitment Negotiate contractNegotiate contract

ResourcesResources

eHealth Initiative EHR Master Quotation eHealth Initiative EHR Master Quotation Guide (2005): Guide for obtaining vendor Guide (2005): Guide for obtaining vendor quotesquotes

EMR Guide for Small and Mid-Sized EMR Guide for Small and Mid-Sized Practices (2006): Detailed implementation Practices (2006): Detailed implementation guide for smaller practicesguide for smaller practices

DOQ-IT University DOQ-IT University (elearning.qualitynet.org): Free on-line (elearning.qualitynet.org): Free on-line courses developed by Centers for courses developed by Centers for Medicare and Medicaid Services (CMS)Medicare and Medicaid Services (CMS)

ResourcesResources

AAFP resource:AAFP resource:

http://www.centerforhit.org/http://www.centerforhit.org/

ACP resource:ACP resource:

http://www.acponline.org/running_practce/tehttp://www.acponline.org/running_practce/technology/ehr/roadmap/chnology/ehr/roadmap/

AAP resource:AAP resource:

http://www.aapcocit.org/http://www.aapcocit.org/

Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality websitewebsite

http://www.centerforhit.org/

http://www.acponline.org/running_practce/technology/ehr/roadmap/

http://www.acponline.org/running_practce/technology/ehr/roadmap/

http://www.aapcocit.org/

Implementation Guidelines and Implementation Guidelines and LessonsLessons

HIMSSHIMSS CEO Survival guideCEO Survival guide AAFP EHR Pilot ProjectAAFP EHR Pilot Project

HIMSS Ambulatory Paperless HIMSS Ambulatory Paperless Clinics (2007)Clinics (2007)

Project management must includeProject management must include– Development of scanning/abstracting Development of scanning/abstracting

policypolicy– Create shared need in practiceCreate shared need in practice– Analyze workflowAnalyze workflow– Develop implementation planDevelop implementation plan– Facilitate third-party interfacesFacilitate third-party interfaces– Template development Template development – TrainingTraining

CEO Survival Guide to EHR CEO Survival Guide to EHR Systems (2006)Systems (2006)

Develop a vision for Patient CareDevelop a vision for Patient Care Understand environmental factors Understand environmental factors

affecting EHR systemsaffecting EHR systems Become aware of the supports Become aware of the supports

available for EHR system planning, available for EHR system planning, acquisition, and implementation: acquisition, and implementation: ONCHIT, DOQ-IT, Medicare QIOs, ONCHIT, DOQ-IT, Medicare QIOs, AHRQ, AAFP, CCHITAHRQ, AAFP, CCHIT

Develop an EHR system organizational Develop an EHR system organizational strategystrategy

Identify clinical championsIdentify clinical champions

CEO Survival Guide to EHR CEO Survival Guide to EHR Systems (2006) cont.Systems (2006) cont.

CommunicationCommunication Implement work process transformationsImplement work process transformations Develop training plansDevelop training plans Develop capital and operating budgets to Develop capital and operating budgets to

support acquisition, implementation, and support acquisition, implementation, and ongoing managementongoing management

Select the applicationSelect the application Implementation: Incorporate EHR systems Implementation: Incorporate EHR systems

into clinical and administrative operationsinto clinical and administrative operations Prepare for the future: PHRs, RHIO/IHEPrepare for the future: PHRs, RHIO/IHE

Brief Report of the AAFP’s EHR Brief Report of the AAFP’s EHR Pilot Project: Key Learnings Pilot Project: Key Learnings

from Six Small Family Practices from Six Small Family Practices (2005)(2005)Keys to success:Keys to success:

1. Building a Community of Learners1. Building a Community of Learners 2. Planning/re-designing practice workflows2. Planning/re-designing practice workflows 3. Starting with “Easy Wins”3. Starting with “Easy Wins” 4. Connectivity increases the value of an EHR i.e. 4. Connectivity increases the value of an EHR i.e.

pharmacies, labspharmacies, labsBarriers:Barriers: 1. Partial implementation1. Partial implementation 2. Variability among medical practice and 2. Variability among medical practice and

physician stylesphysician styles 3. The lack of structured data entry3. The lack of structured data entry

Implementation Chasm Implementation Chasm (Lorenzi 2008)(Lorenzi 2008)

DesignDesign

Systems must be customized to Systems must be customized to accommodate the activities of accommodate the activities of workers and the workers must also workers and the workers must also change their practiceschange their practices

Examples at UCSF MC: Vital Sign Examples at UCSF MC: Vital Sign Capture and UCare Note WriterCapture and UCare Note Writer

Vital Sign CaptureVital Sign Capture

Tablet or PCTablet or PC Wireless or hard wiredWireless or hard wired Dynamap with Temp, HR, BP, and O2 Dynamap with Temp, HR, BP, and O2

SatSat Importation to the EHR flow sheetImportation to the EHR flow sheet

UCare Note WriterUCare Note Writer

UCSF developed web application for UCSF developed web application for clinical documentation.clinical documentation.

UCNW acquires patient context and UCNW acquires patient context and other data from the EHR to import other data from the EHR to import into the documentinto the document

Other design features. Other design features.

Import of Vital Signs from UCare- range calculation over last 24-hour

Import of Lab Results from UCare- last 24 hours of basic labs- structured visual representations

Save draft within Note Writer

Publish “Preliminary” Note (resident)

Publish “Final” Note (attending)- resident and attending notes as one unified note

Required Fieldsnote cannot be published to UCare without themService Chiefs may define resident and attending requirements

“Copy-forward” controls- Service Chiefs may forbid or permit carry-forward of

information day to day

Template Development by Service Chiefs- web-based template design- changes can be made real-time

DNU Abbreviation DNU Abbreviation CorrectionCorrectionClinician writes a note containing DNU abbreviations

DNU Abbreviation DNU Abbreviation CorrectionCorrectionNote Writer guides clinician through correcting abbreviations

DNU Abbreviation DNU Abbreviation CorrectionCorrectionOn sending the note to UCare, UCare Note Writer takes clinician through a dialog to correct DNU abbreviations

Clinician’s choices• accept automatic fixes• manually fix

Submitting the note to UCare with the DNU Abbreviations in place is not an option and is prevented

Implementation Chasm Implementation Chasm (Lorenzi 2008)(Lorenzi 2008)

ManagementManagement

Capacity for changeCapacity for change Context of changeContext of change

Vendors have limited knowledge of Vendors have limited knowledge of both capacity and context, both capacity and context, therefore it is important to therefore it is important to organizations take responsibility for organizations take responsibility for these issuesthese issues

OrganizationOrganization

Operational-organizational issues: Operational-organizational issues: downtimes, workflow changes, help downtimes, workflow changes, help desk, perception of IT department desk, perception of IT department not listening to or being not listening to or being disconnected from the operational disconnected from the operational needsneeds

AssessmentAssessment

Organizational readiness, assessing Organizational readiness, assessing the immediate context for the immediate context for implementation, evaluating the implementation, evaluating the implementation in formative and implementation in formative and summative mannerssummative manners

UCSF Ambulatory EHR Pilot UCSF Ambulatory EHR Pilot ImplementationImplementation

Pilot of Ambulatory administrative Pilot of Ambulatory administrative functionality to 6 practices in a functionality to 6 practices in a variety of specialtiesvariety of specialties

Functionality Deployed: Functionality Deployed: – Viewing labs, reports, radiology, Viewing labs, reports, radiology,

inpatient documentation, outpatient inpatient documentation, outpatient transcriptiontranscription

– Patient trackingPatient tracking– Vital sign captureVital sign capture– Documentation of Point of Care TestingDocumentation of Point of Care Testing

EMR Ambulatory EMR Ambulatory User SurveyUser Survey

Summary and Results: April Summary and Results: April 20082008

CIS DepartmentAmbulatory Team

April 24, 2008

UCSF Medical Center

Goals of AssessmentGoals of Assessment

What functions are being utilized?What functions are being utilized? Who is using the functions and where Who is using the functions and where

are they using them?are they using them? What are some of the hurdles?What are some of the hurdles? Users wish list?Users wish list?

Respond to concerns, questions, Respond to concerns, questions, and gap in knowledgeand gap in knowledge

EMR Ambulatory User EMR Ambulatory User SurveySurvey

The EMR Ambulatory Planning Committee (APC) and Clinical Information The EMR Ambulatory Planning Committee (APC) and Clinical Information Systems (CIS) Department sponsored a user survey to solicit feedback from Systems (CIS) Department sponsored a user survey to solicit feedback from UCSF Medical Center physicians and staff utilizing EMR in the ambulatory UCSF Medical Center physicians and staff utilizing EMR in the ambulatory setting. An email request for participation was sent to all ambulatory practices setting. An email request for participation was sent to all ambulatory practices that have engaged in the planning and/or completion of a EMR installation. that have engaged in the planning and/or completion of a EMR installation.

This is the first survey taken since launching EMR Ambulatory. Questions were This is the first survey taken since launching EMR Ambulatory. Questions were developed by the APC and CIS Department and captured using a a web-based developed by the APC and CIS Department and captured using a a web-based tool, tool, www.SurveyMonkey.comwww.SurveyMonkey.com. The survey was open from April 7-21, 2008. Users were . The survey was open from April 7-21, 2008. Users were informed that their feedback would only be shared with the APC and CIS Department. informed that their feedback would only be shared with the APC and CIS Department. Survey results would be summarized at the department level so that individual names Survey results would be summarized at the department level so that individual names can be kept confidential. can be kept confidential.

This presentation summarizes the responses received. Data has been This presentation summarizes the responses received. Data has been corrected for general user errors. All free text comments have been retained. corrected for general user errors. All free text comments have been retained. Any questions regarding the survey can be addressed by the CIS Department – Any questions regarding the survey can be addressed by the CIS Department – Ambulatory Team.Ambulatory Team.

April 2008 Results

INTRODUCTION

Survey DemographicsSurvey Demographics Approximately 375 users Approximately 375 users

received the survey received the survey requestrequest– 98 responses received, a 98 responses received, a

26% response rate26% response rate– Physicians were the Physicians were the

highest responders to the highest responders to the surveysurvey

– Back Office staff includes Back Office staff includes a range of usersa range of users

26 practices received the 26 practices received the survey requestsurvey request– Practices represent those Practices represent those

which the CIS-Ambulatory which the CIS-Ambulatory Team has worked with to Team has worked with to datedate

– Predominant practices Predominant practices which responded include:which responded include:

Lakeshore Family MedicineLakeshore Family Medicine OB/GYN practicesOB/GYN practices Pediatric practicesPediatric practices Vascular SurgeryVascular Surgery

SUMMARY: DETAILS

* : Other Category represents users who identified themselves by a staff role that was not a role type provided in the survey. Many are licensed staff. Some of these roles may be considered back office staff, however, the users do not identify themselves as such in the survey.

Roles Represented

Back Office, 19%

Front Office, 9%

Physicians, 31%

Nurses, 15%

Nurse Practitioners,

11%

Practice Manager, 4%

Other *, 11%

OverviewOverview Positive feedback on being surveyedPositive feedback on being surveyed

– Significant response rate across rolesSignificant response rate across roles– ““Step in right direction”Step in right direction”

Strong desire to go chartless across organizationStrong desire to go chartless across organization– Actively using EMRActively using EMR– A sense of “waiting” for functionality and enterprise-wide useA sense of “waiting” for functionality and enterprise-wide use– EMR has high potential, however, lacks robust functionalityEMR has high potential, however, lacks robust functionality– Many suggestions for improvement receivedMany suggestions for improvement received

Continued dependency on STORContinued dependency on STOR– Desire to eliminate need for two systemsDesire to eliminate need for two systems– Desire for better user interface in EMRDesire for better user interface in EMR

Many system hurdles deter greater use of EMRMany system hurdles deter greater use of EMR– Data retrieval is quicker in STOR due to perceived EMR Data retrieval is quicker in STOR due to perceived EMR

system limitations (slow login) system limitations (slow login) – More accurate user information could be captured after More accurate user information could be captured after

system hurdles are resolvedsystem hurdles are resolved

SUMMARY: OVERVIEW

Response Summary: Response Summary: PhysiciansPhysicians

Most physicians who responded reside in primary care (Family practice, OB/GYN, Most physicians who responded reside in primary care (Family practice, OB/GYN, Pediatrics practices). Their hurdles and wish list indicate a desire for functionality that Pediatrics practices). Their hurdles and wish list indicate a desire for functionality that would increase efficiency and that they have seen as standard practice in other would increase efficiency and that they have seen as standard practice in other healthcare institutions.healthcare institutions.

Usage / FunctionalityUsage / Functionality

Location Most UsedLocation Most Used– Private Offices, 63.0 %Private Offices, 63.0 %– Exam Rooms, 55.6%Exam Rooms, 55.6%– Back Office, 51.9 %Back Office, 51.9 %

Functionality Most UsedFunctionality Most Used– Patient Lists (Census, Group, Schedules, Patient Lists (Census, Group, Schedules,

Personal Lists)Personal Lists) – Results Viewer (Flow sheet, Lab data, Results Viewer (Flow sheet, Lab data,

etc.) etc.) – Document DisplayDocument Display

Functionality Least UsedFunctionality Least Used– Notes to Self Notes to Self – PPD Reports (Custom flow sheet PPD Reports (Custom flow sheet

reports) reports) – Notes without VisitsNotes without Visits


Location Most UsedLocation Most Used– Private Offices, 63.0 %Private Offices, 63.0 %– Exam Rooms, 55.6%Exam Rooms, 55.6%– Back Office, 51.9 %Back Office, 51.9 %



etc.) etc.) – Document DisplayDocument Display


reports) reports) – Notes without VisitsNotes without Visits

HurdlesHurdles

System (slowness, cumbersome System (slowness, cumbersome login)login)

Cumbersome access to notes, Cumbersome access to notes, flow sheets, and reportsflow sheets, and reports

Primitive note writingPrimitive note writing Lab data is buried in EMRLab data is buried in EMR

HurdlesHurdles

System (slowness, cumbersome System (slowness, cumbersome login)login)

Cumbersome access to notes, Cumbersome access to notes, flow sheets, and reportsflow sheets, and reports

Primitive note writingPrimitive note writing Lab data is buried in EMRLab data is buried in EMR

Wish ListWish List Scanning documentsScanning documents Faxing documentsFaxing documents Notes for patient lists, non-visits, Notes for patient lists, non-visits,

phone callsphone calls Documentation templatesDocumentation templates Prenatal recordsPrenatal records E-mail alerts and remindersE-mail alerts and reminders Electronic prescriptionsElectronic prescriptions

Wish ListWish List Scanning documentsScanning documents Faxing documentsFaxing documents Notes for patient lists, non-visits, Notes for patient lists, non-visits,

phone callsphone calls Documentation templatesDocumentation templates Prenatal recordsPrenatal records E-mail alerts and remindersE-mail alerts and reminders Electronic prescriptionsElectronic prescriptions

Usage / Functionality

Wish List

Hurdles

SUMMARY: DETAILS

Response Summary: NPsResponse Summary: NPs


Location Most UsedLocation Most Used– Private Offices, 72.7 %Private Offices, 72.7 %– Exam Rooms, 54.5%Exam Rooms, 54.5%



etc.) etc.) – Patient TrackingPatient Tracking


reports) reports) – Inbox (Transcriptions requiring Inbox (Transcriptions requiring

signature, documents on hold, inbox signature, documents on hold, inbox coverage) coverage)


Location Most UsedLocation Most Used– Private Offices, 72.7 %Private Offices, 72.7 %– Exam Rooms, 54.5%Exam Rooms, 54.5%



etc.) etc.) – Patient TrackingPatient Tracking




HurdlesHurdles

System (slowness, System (slowness, cumbersome login)cumbersome login)

Need for trainingNeed for training

HurdlesHurdles


Need for trainingNeed for training

Wish ListWish List

Progress notesProgress notes Sending results to Sending results to

providers through EMRproviders through EMR Body templatesBody templates

Wish ListWish List

Progress notesProgress notes Sending results to Sending results to

providers through EMRproviders through EMR Body templatesBody templates


Wish List

Hurdles

SUMMARY: DETAILS

Most nurse practitioners who responded reside in the OB/GYN practices and in Most nurse practitioners who responded reside in the OB/GYN practices and in Urology-Oncology. They have a strong desire for progress note functionality. Urology-Oncology. They have a strong desire for progress note functionality. However, they may not be aware of the documentation options currently available However, they may not be aware of the documentation options currently available to them.to them.

Response Summary: NursesResponse Summary: NursesNurses who responded represent a range of primary and specialty care practices. Nurses who responded represent a range of primary and specialty care practices. Their frequent access to patient data has led to a strong desire for tools that support Their frequent access to patient data has led to a strong desire for tools that support better documentation and coordination of care. A reliance on printing still exists.better documentation and coordination of care. A reliance on printing still exists.


Location Most UsedLocation Most Used– Back Offices, 83.3 %Back Offices, 83.3 %– Private Offices, 41.7 %Private Offices, 41.7 %

Functionality Most UsedFunctionality Most Used– Results Viewer (Flow sheet, Lab data, Results Viewer (Flow sheet, Lab data,

etc.) etc.) – Patient Lists (Census, Group, Schedules, Patient Lists (Census, Group, Schedules,

Personal Lists)Personal Lists) – Chart Summary ViewChart Summary View

Functionality Least UsedFunctionality Least Used– PPD Reports (Custom flow sheet PPD Reports (Custom flow sheet



– Flow sheet Charting (Vitals, Point of Flow sheet Charting (Vitals, Point of Care Testing, PPD documentation) Care Testing, PPD documentation)


Location Most UsedLocation Most Used– Back Offices, 83.3 %Back Offices, 83.3 %– Private Offices, 41.7 %Private Offices, 41.7 %

Functionality Most UsedFunctionality Most Used– Results Viewer (Flow sheet, Lab data, Results Viewer (Flow sheet, Lab data,

etc.) etc.) – Patient Lists (Census, Group, Schedules, Patient Lists (Census, Group, Schedules,

Personal Lists)Personal Lists) – Chart Summary ViewChart Summary View





HurdlesHurdles System (slowness, cumbersome System (slowness, cumbersome

login)login) Difficulty locating reportsDifficulty locating reports Developing patient lists in order Developing patient lists in order

to complete patient care follow-to complete patient care follow-up up

Having complete patient Having complete patient information in one area or system information in one area or system

HurdlesHurdles System (slowness, cumbersome System (slowness, cumbersome

login)login) Difficulty locating reportsDifficulty locating reports Developing patient lists in order Developing patient lists in order

to complete patient care follow-to complete patient care follow-up up

Having complete patient Having complete patient information in one area or system information in one area or system

Wish ListWish List

Scanning documentsScanning documents Document phone conversationsDocument phone conversations Ability to paste patient's test Ability to paste patient's test

report to the mercury messagereport to the mercury message

Wish ListWish List

Scanning documentsScanning documents Document phone conversationsDocument phone conversations Ability to paste patient's test Ability to paste patient's test

report to the mercury messagereport to the mercury message


Wish List

Hurdles

SUMMARY: DETAILS

Response Summary: Front Response Summary: Front OfficeOffice

Front office staff who responded commonly need to retrieve patient information for other Front office staff who responded commonly need to retrieve patient information for other users. They show a strong desire for consistent use of EMR throughout their practice. As users. They show a strong desire for consistent use of EMR throughout their practice. As users who access multiple applications, front office staff are proponents for using EMR as users who access multiple applications, front office staff are proponents for using EMR as the sole repository of patient information.the sole repository of patient information.


Location Most UsedLocation Most Used– Front Office, 100.0 %Front Office, 100.0 %

Functionality Most UsedFunctionality Most Used– Patient TrackingPatient Tracking– Patient Lists (Census, Group, Schedules, Patient Lists (Census, Group, Schedules,


etc.) etc.)

Functionality Least UsedFunctionality Least Used– Chart Summary ViewChart Summary View– Flow sheet Charting (Vitals, Point of Flow sheet Charting (Vitals, Point of

Care Testing, PPD documentation) Care Testing, PPD documentation) – Inbox (Transcriptions requiring Inbox (Transcriptions requiring



Location Most UsedLocation Most Used– Front Office, 100.0 %Front Office, 100.0 %



etc.) etc.)

Functionality Least UsedFunctionality Least Used– Chart Summary ViewChart Summary View– Flow sheet Charting (Vitals, Point of Flow sheet Charting (Vitals, Point of

Care Testing, PPD documentation) Care Testing, PPD documentation) – Inbox (Transcriptions requiring Inbox (Transcriptions requiring


HurdlesHurdles


HurdlesHurdles


Wish ListWish List

Doctors need to use EMR Doctors need to use EMR to look up patient to look up patient records so that staff can records so that staff can eliminate printing reports eliminate printing reports from STORfrom STOR

Wish ListWish List

Doctors need to use EMR Doctors need to use EMR to look up patient to look up patient records so that staff can records so that staff can eliminate printing reports eliminate printing reports from STORfrom STOR


Wish List

Hurdles

SUMMARY: DETAILS

Response Summary: Back Response Summary: Back OfficeOffice

Back office staff who responded cover a broad range of positions, including Back office staff who responded cover a broad range of positions, including administrative and licensed personnel. Hence, they use a variety of EMR functions and administrative and licensed personnel. Hence, they use a variety of EMR functions and have more interaction with non-UCSF organizations. There is also a strong desire for and have more interaction with non-UCSF organizations. There is also a strong desire for and reliance on printing.reliance on printing.


Location Most UsedLocation Most Used– Back Offices, 85.7 %Back Offices, 85.7 %– Front Office, 50.0 %Front Office, 50.0 %


Personal Lists)Personal Lists) – Patient TrackingPatient Tracking– Results Viewer (Flow sheet, Lab data, Results Viewer (Flow sheet, Lab data,

etc.) etc.)




– Notes without VisitsNotes without Visits


Location Most UsedLocation Most Used– Back Offices, 85.7 %Back Offices, 85.7 %– Front Office, 50.0 %Front Office, 50.0 %


Personal Lists)Personal Lists) – Patient TrackingPatient Tracking– Results Viewer (Flow sheet, Lab data, Results Viewer (Flow sheet, Lab data,

etc.) etc.)




– Notes without VisitsNotes without Visits

HurdlesHurdles

System (slowness, System (slowness, access)access)

Unable to printUnable to print

HurdlesHurdles

System (slowness, System (slowness, access)access)

Unable to printUnable to print

Wish ListWish List Scanning documentsScanning documents Faxing documentsFaxing documents Input vitals automatically from Input vitals automatically from

blood pressure machine to the blood pressure machine to the computercomputer

Access between EMR and other Access between EMR and other applications (Blackberry, PACS)applications (Blackberry, PACS)

Wish ListWish List Scanning documentsScanning documents Faxing documentsFaxing documents Input vitals automatically from Input vitals automatically from

blood pressure machine to the blood pressure machine to the computercomputer

Access between EMR and other Access between EMR and other applications (Blackberry, PACS)applications (Blackberry, PACS)


Wish List

Hurdles

SUMMARY: DETAILS

Response Summary: Response Summary: Practice MgrsPractice Mgrs

Few practice managers responded to the survey. Those who did voiced concern with Few practice managers responded to the survey. Those who did voiced concern with managing and facilitating process workflow, given the current state of EMR managing and facilitating process workflow, given the current state of EMR functionality. They offer a broad view of the potential and anticipation EMR brings to a functionality. They offer a broad view of the potential and anticipation EMR brings to a practice.practice.


Location Most UsedLocation Most Used– Back Office, 100.0 %Back Office, 100.0 %– Private Offices, 100.0 %Private Offices, 100.0 %


Personal Lists)Personal Lists)

Functionality Least UsedFunctionality Least Used– Notes to Self Notes to Self – Notes without VisitNotes without Visit– PPD Reports (Custom flow sheet PPD Reports (Custom flow sheet





Location Most UsedLocation Most Used– Back Office, 100.0 %Back Office, 100.0 %– Private Offices, 100.0 %Private Offices, 100.0 %


Personal Lists)Personal Lists)

Functionality Least UsedFunctionality Least Used– Notes to Self Notes to Self – Notes without VisitNotes without Visit– PPD Reports (Custom flow sheet PPD Reports (Custom flow sheet




HurdlesHurdles System (slowness, access)System (slowness, access) Need to duplicate work in Need to duplicate work in

shadow charts because shadow charts because waiting for future waiting for future functionality (Note Writer)functionality (Note Writer)

Current tools do not support Current tools do not support workflow documentationworkflow documentation

HurdlesHurdles System (slowness, access)System (slowness, access) Need to duplicate work in Need to duplicate work in

shadow charts because shadow charts because waiting for future waiting for future functionality (Note Writer)functionality (Note Writer)

Current tools do not support Current tools do not support workflow documentationworkflow documentation

Wish ListWish List Scanning documentsScanning documents Faxing documentsFaxing documents Fully functioning EMR Fully functioning EMR

product for Ambulatoryproduct for Ambulatory Ability for inpatient users to Ability for inpatient users to

have access outpatient datahave access outpatient data

Wish ListWish List Scanning documentsScanning documents Faxing documentsFaxing documents Fully functioning EMR Fully functioning EMR

product for Ambulatoryproduct for Ambulatory Ability for inpatient users to Ability for inpatient users to

have access outpatient datahave access outpatient data


Wish List

Hurdles

SUMMARY: DETAILS

Response Summary: OtherResponse Summary: OtherThe “Other” role was created after receiving feedback from users early in the collection process. The “Other” role was created after receiving feedback from users early in the collection process. These users, who did not identify with the available role types, include These users, who did not identify with the available role types, include social workers, specialists, social workers, specialists, research aides, coordinators, technicians, and supervisorsresearch aides, coordinators, technicians, and supervisors. Their feedback reflects the experience of . Their feedback reflects the experience of retrieving information down stream after patient data has been entered into EMR by others.retrieving information down stream after patient data has been entered into EMR by others.


Location Most UsedLocation Most Used– Back Offices, 71.4 %Back Offices, 71.4 %– Front Office, 42.9 %Front Office, 42.9 %– Private Offices, 42.9 %Private Offices, 42.9 %

Functionality Most UsedFunctionality Most Used– Patient Lists (Census, Group, Patient Lists (Census, Group,

Schedules, Personal Lists)Schedules, Personal Lists) – Patient TrackingPatient Tracking– Results Viewer (Flow sheet, Lab data, Results Viewer (Flow sheet, Lab data,

etc.) etc.)





Location Most UsedLocation Most Used– Back Offices, 71.4 %Back Offices, 71.4 %– Front Office, 42.9 %Front Office, 42.9 %– Private Offices, 42.9 %Private Offices, 42.9 %

Functionality Most UsedFunctionality Most Used– Patient Lists (Census, Group, Patient Lists (Census, Group,

Schedules, Personal Lists)Schedules, Personal Lists) – Patient TrackingPatient Tracking– Results Viewer (Flow sheet, Lab data, Results Viewer (Flow sheet, Lab data,

etc.) etc.)




HurdlesHurdles System (slowness, access)System (slowness, access) Unable to printUnable to print Difficulty navigating; Need Difficulty navigating; Need

for trainingfor training Drilling down to view and Drilling down to view and

write noteswrite notes

HurdlesHurdles System (slowness, access)System (slowness, access) Unable to printUnable to print Difficulty navigating; Need Difficulty navigating; Need

for trainingfor training Drilling down to view and Drilling down to view and

write noteswrite notes

Wish ListWish List Scanning documentsScanning documents Faxing documentsFaxing documents Radiology reportsRadiology reports Less drill down to view and write Less drill down to view and write

notesnotes Alerts that reduce user error Alerts that reduce user error

(writing in wrong patient chart, (writing in wrong patient chart, closing without signing)closing without signing)

Wish ListWish List Scanning documentsScanning documents Faxing documentsFaxing documents Radiology reportsRadiology reports Less drill down to view and write Less drill down to view and write

notesnotes Alerts that reduce user error Alerts that reduce user error

(writing in wrong patient chart, (writing in wrong patient chart, closing without signing)closing without signing)


Wish List

Hurdles

SUMMARY: DETAILS

Next StepsNext Steps

Coordinate response to system Coordinate response to system performance-related hurdles with performance-related hurdles with Field Services Field Services

Address the need for additional Address the need for additional training with practicestraining with practices

Determine what wish list items can Determine what wish list items can realistically be offered in the near realistically be offered in the near futurefuture

Decide on the frequency of future Decide on the frequency of future surveyssurveys

NEXT STEPS

Next Steps cont.Next Steps cont.

Proposed Action: Distribute mass communication to all practices

Proposed Action: Schedule training sessions to specific practices

Proposed Action: Practice and direct user communication

Proposed Action: Contact each user directly

Overarching Issues Practice Action Item (and any specific comments)

Timing Out See Below: Send communication to all practices:A new time-out policy has been created and will be effective by late May 2008. Provide specific information on the new time-out policy to all practices.

Faxing See Below: Send communication to all practices:This is a newly approved special project. CIS Team will follow-up with practices in Fall 2008.

Scanning See Below: Send communication to all practices:The IT-CIS Department is developing this as a special project with HIMS. CIS Team will follow-up with practices in Fall 2008.Include text on which ideas from the survey can be resolved using scanning functionality.

Future Functionality & Potential Enhancements

See Below: Send communication to all practices:We received many great ideas from the survey. Provide all practices with a sampling of the ideas. They would be considered as future functionality and potential enhancements.

Training - All Functions Needed See Below: Meet 1-on-1 with practices.Ask them to consider scheduling general training sessions for these practices.

Training - Accessing STOR & Other Applications

See Below: Meet 1-on-1 with practices.Determine next steps after training is provided and whether hardware needs to be reassessed.

Training - Flow chart/Flow sheet Related See Below: Meet 1-on-1 with practices

Training - Notes Related See Below: Meet 1-on-1 with practices

Training - Printing Difficulties See Below: Meet 1-on-1 with practices

Training - Misc. See Below: Meet 1-on-1 with practices

Slow Login/System Performance See Below: Meet 1-0n-1 with practices.Offer to re-assess their hardware, either for whole practice or for users who need it per survey input.

Send communication to Practice: Slow Log-in may be due to LCJ user interface. Future CEUI should resolve slow system performance issues, reducing time by approximately 15 seconds.

Specific Action Items for Amb Team See Below: Contact users directly

Proposed Action: Distribute mass communication to all practices

Proposed Action: Schedule training sessions to specific practices

Proposed Action: Practice and direct user communication

Proposed Action: Contact each user directly

ConclusionConclusion

There are many resources to assist in There are many resources to assist in the selection and implementation of an the selection and implementation of an EHREHR

With an understanding of the With an understanding of the management capacity and management capacity and organizational structure, and with organizational structure, and with thoughtful technical design and regular thoughtful technical design and regular assessments, a successful assessments, a successful implementation of an EHR can be implementation of an EHR can be achieved.achieved.

ambulatory ehr implementation at ucsf medical center brian herrick, m.d. july 18 th, 2008 slide...

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ambulatory ehr implementation

ehr systems

detailed implementation

ehr adler

implementation guidelines

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ehr system planning

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