EHR Implementation by Clinch River Health

Services, Inc. Clinch River Health Services, Inc.

A Community Health Center in Dungannon, Virginia; population 400, with 3500 active users serviced by three Providers.

Gary E. Michael, MD Family Medicine Physician Medical Director for 17 years National Health Service Corp Alumni

EHR Implementation Plan Phase 1 – Strategic Planning Phase 2 – Partnerships Phase 3 – Staff Evaluation & Education Phase 4 – Define Measurable Outcomes Phase 5 – Review Vendors,Select &

Purchase Phase 6 – EHR Implementation Phase 7 – Revisit Outcome Measures

Phase 1 – Strategic Planning

Board of Directors Accurate and timely data is essential to quality,

data-driven health care. Performance Improvement – 5 year plan

EHR implementation as an organization wide effort to enhance efficiency, increase productivity, but mostly as an innovation to introduce quality tools for better health service delivery with accurate, real-time data collection and reporting.

Financial Review Loss of Revenue due to initial loss of productivity Funding, Grants

Phase 2 - Partnerships EHealth Committee

Developed by the Community Care Network of Virginia focused on the planning for Virginia CHCs to acquire EHR

CareSpark A RHIO located in northeastern

Tennessee – southwestern Virginia A Champion

Phase 3 – Staff Evaluation & Education

Vendor Presentations Staff to evaluate the systems for

Flexibility Presentation Layer Attributes to complete the work we do

Melt away staff fears Examples of how EHR enhances work

performance or the work day. Hunting down paper charts Completing Tracking Logs

Phase 3 – Staff Evaluation & Education

DOQ-IT Evaluate staff skills, organization

readiness Process Analysis

Document: office management, patient/visit specific tasks

Working well, poorly, not at all Barriers to Improvement: workflow, data

entry, integration/interfacing, personnel PDCA cycles, CQI techniques

Phase 3 – Staff Evaluation & Education

Patient Flow Analysis Visit Re-engineering

Process Conversion Paper process converted to EHR process

an ongoing effort as staff learns more, processes can be converted

Aligning Personnel, skills, needs Staff for scanning

Phase 4 – Define Measurable Outcomes

Categories: Cost, Efficiency, Productivity, Satisfaction

Interview all staff for job functions, concerns, work flow, goals of EHR Promotes Staff Buy-in Provides valuable information of

present status of the system/organization

Phase 5 – Review Vendors, Select & Purchase

EHealth Committee Work 25 page EMR Functional Requirements Standards Vendor Presentation with selected

Scenario On-site Visits

Grants – Rural Development IT support TechSoup – for non-profits

Phase 6 –EHR Implementation

Designate a Superuser Works closely with the Vendor before “go-

live” date Or have an on-site IT person and train the

person in daily activities Schedule Preparation

Increase load of RMC before “go-live” date NO patients during training Clinical Template Building 25% scheduling & increase every 2 weeks

Phase 6 –EHR Implementation

Policy Development Chart Messaging Chart Population

Pre-loading Post-loading First visit responsibilities Second visit responsibilities

Desk Top Responsibilities

Phase 6 –EHR Implementation

Policy Development (continued) Front Desk Intake Medical Records Request Orders Management Password Protected Routine Charting System Down System Upkeep

Phase 6 –EHR Implementation

Staff exposure to the EHR prior to “go-live”

Weekly team meetings Share Lessons Learned Skills development Convert OLD processes to EHR

processes

Phase 7 – Revisit Outcome Measures

Outcome Measures being collected and analyzed now after 1 year of “go-live”

General Comments after looking back: Completed the PI project 2 years early EHR captures more information and

documents more work than ever before Lessons Learned Checklist developed and

given to other centers to improve their implementation process

Were We Successful? Productivity

2007 Total Encounters > 2006 Encounters 2007 Diabetes Metrics = 2006 Results

Subpopulation data vs Total Population data

Efficiency Number of daily recorded telephone

messages increased by 25% Rx refill turnaround time reduced by 50% X-ray report turnaround >90% within

48Hours