Realizing the Promise of your EHR

Debra McGrath, Director of IT Services for HFP and President, DMP Consulting

Suzanne Cohen, Director of Member Services for HFP

Network HIT ProjectHRSA Funded as a Health Center Controlled

Network10 health center participants (grantees)4 EMRs – NextGen, Centricity, EHS, Practice

PartnerGoals – in 3 years:

100% Implementation of certified EHR100% Attestation to MU100% at least one site PCMH recognized100% exceeding Healthy People 2020 on at

least one clinical quality measure (tobacco cessation)

Our approachIndividualized assessments and workplansTailored approach to EMR optimizationNetwork contracted with i2i Systems for

population health management and data warehouse softwareImplementation in 2 cohorts, based on

readinessUse of highly skilled, health-center

experienced consultantsLocally focused network enables high touch,

in-person approach

10 months in…challenges, priorities and lessons learned

Information Management ToolsJust as MS Office offers a suite of tools, high

functioning ambulatory practices need a suite of tools.What to expect from each system and why is it

importantEHR’s are good at:

• Storing and retrieving data• Reporting structured data• Allowing for multiple members of the care team to view and

use patient data at the same time• Display patient data in a variety of ways depending on the

user’s role and function in the organization.• Eliminate double documentation and entering the same

information over and over again

Information Management ToolsIntegration is a key success factor particularly

with the PM, Patient Portal and EHR. Integration vs. interfacingSeparate functions for various systems:• PM systems • EHR• Population management• Reporting

Incorporating IT tools into the practice must be an intentional process that includes careful planning, work flow design, training and post go-live follow up and revision.

Vendor ManagementBroad spectrum of EHR Vendors and deployment models

Software as a Service (SaaS)Hosted by the vendorHosted by a third partyServers hosted locally by the health centerValue added resellers (VARs)

Strategic trajectory of vendorVoice of the customerHow does the vendor keep its customers informed

What can you expect from the vendor?How do you insure your information technology will keep up

and support the work of the health center?

EHR ChallengesMany organizations do not implement EHR

correctly the first time aroundDon’t be afraid to admit it and work on

optimizing it.May have lost processes that worked when

using paper e.g. lab and referral logsEHR implementation is not a once and done

process and requires ongoing updating, revising and refreshing of the system, work flow design and training.

EHR ChallengesHow to look at the cost of the decisions

(value vs. cost)Software purchases can appear expensive until

opportunity, staff time and lost productivity are considered

How are is the EHR incorporated in decision making? Are you making a decision and then considering how it will impact IT or are you considering the impact on IT as you make the decisions?

EHR ChallengesCreating a change management process is a critical

success factorRequire all change requests come through a governing

committee using a request formAllow for committee review of requests for change and

approve or disapprove the requestsCommunicate the status of a requestOnce a change is approved determine the need to form

a team to make the change and the need for trainingCreate an action plan, assign a responsible person,

timeline and develop a training and post go-live plan.Consider the impact of any change on the workforce,

operations and IT.

EHR GovernanceOversight and management of the patient record

often are not incorporated into an EHR implementation

Health Information Management CommitteeStructured, regular chartered committee that is

responsible for the integrity of the medical recordIncorporates a change control process to ensure

standardized use of the EHR and input from the clinical and operations team.

Ensures changes to the EHR and how it is used are communicated to the clinical and operations team

Ensures the continued and ongoing development of the EHR

HIMC Roles and FunctionExecutive leadership and sponsorshipStrategic planningProject managementNetworking and system managementSecurity/HIPAA complianceInterface ManagementTelecommunicationsReporting and database managementClinical informaticsApplication management and expertiseTrainingHelpdesk Support

Staffing requirementsLeadership and management of team. Inspires

team to maintain focus on organizational values, goals and objectives. Ensures performance of all team members, provides feedback to team members to ensure staff development and growth. Interacts with and manages the various software and hardware vendors; provides vendor management.

Strategic Planning. Proactively identifies projects, continuously updates understanding of hardware and software trends, provides recommendations as appropriate to keep FPCN up to date, participates in and leads long term, medium term and short term planning for HIT, leads HIMC.

Staffing requirementsProject Management. Collaborates with leadership

to gather stakeholders, develop timelines with stakeholders, identifies roles and functions needed for a project, identifies tasks and assigns to appropriate team members, manages timeline to keep project on time and within budget, identifies and quantifies risks, reports risks to the stakeholders

Networking and Systems Management. Manages servers, applying updates as needed to ensure performance standards, manages and maintains the wide area network, local area networks and wireless systems. Monitors error logs for interfaces.

Staffing requirementsSecurity. Stays up to date on HIPPA

requirements. Writes a security policy and maintains it up to date based on regulations and requirements. Configures and manages security in EHS

Interface management. Gathers requirements for interfaces, manages interface builds, testing and timeline, monitors interfaces for errors management and updates as needed.

Staffing requirementsReporting and Database Management: Highly skilled and

knowledgeable regarding data fields, database configuration and report writing

Clinical Informatics: Translates clinical requirements to technical team including report writer, sets expectations with clinical team regarding technical capabilities. CQI Offers workflow solutions. Acts as a liaison between IT and clinical departments Develops testing plans for all forms and changes prior to putting

them in production. Monitors and manages the testing process with clinical

staff/leadership Develops requirements for interfaces and manages testing of

interfaces.

Staffing requirementsApplication management. Highly skilled

and knowledgeable regarding functionality of all software applications. Maintains and updates all software configurations to support needs of the clinical staff.PM/EHRDental SoftwareDocument managementFax ServerPatient portalPopulation managementReporting software

Staffing requirementsTraining. Provides application training for new

employees as well as ongoing training for established employees and staff on all software applications. Creates curricula, job aides and uses various means (in person, classroom and remote or GoToMeeting) to deliver training. Provide remediation and refresher training when appropriate.

Helpdesk Support. Provides real time support to end-users. Manages the HelpDesk software and ensures the development of a knowledgebase related to lessons learned from trouble shooting and fixing end user problems. Collaborates to provide support remotely and as quickly as possible. Uses a customer service approach with end-users.

WorkflowThe MA-Provider Dyad is KeyEnhancing the MA role and creating stable

MA-Provider teams is the key to high performing ambulatory practice.

In addition to adding specific tasks to the MA role such as documenting a patient’s smoking status, calculating and entering a BMI or ensuring that a BP is taken at every visit, the MA must be empowered and charged with responsibility for certain aspects of the encounter and overall patient management.

WorkflowThe MA-Provider Dyad is KeyConsider the teaming of MA’s and providers

carefully. Do not partner a new MA with a new provider, do not put a provider who is not particularly organized with a disorganized MA, use the “opposites attract” theory

Do provide ample opportunity for feedback with quantifiable goals for both the MA and the provider making sure the MA has an equal voice.

Typical Processes that Need to be RevisedPatient panel definition and management for each

provider-MA teamReferral managementDocument managementOrder and results reconciliationDocumenting phone encountersPatient flow from check in to check outImmunization managementIncorporating meaningful use requirements such as

access to an electronic copy of their chart, providing a clinical visit summary, and medication and problem list management.

Lessons LearnedEveryone has EHR challenges, there is no

perfect EHROptimization is an ongoing processHaving the right tool for the job is a critical

success factorUnderstand strengths and weaknesses of

staff and get them in the right seatsGovernance, oversight, monitoring and

feedback are the keys to success.