implementing an emr implications for clinicians, it and management david bolt coo and director of...
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Implementing an EMR
Implications for Clinicians, ITand Management
David BoltCOO and Director of Planning
and Business Development
Lewis County Primary Care System
Vanceburg – Tollesboro – Flemingsburg - Maysville
VanceburgTollesboro
Flemingsburg
Garrison
Laurel
Fleming County
Lewis County
Mason County
Maysville
Lewis County Family Health CenterEleanor Johnson Women’s CenterLewis County Family Dental Center
Fitness First and Rehab CenterLewis County Primary Care Center Pharmacy
Tollesboro Family Health CenterTollesboro Clinic Pharmacy
Fleming County Family Health CenterMaysville OB/GYN and Family Health Center
Garrison Elementary School ClinicLaurel Elementary School ClinicCentral Elementary School Clinic
Tollesboro Elementary School ClinicLewis County Middle School ClinicLewis County High School Clinic
Frame Relay Cloud
384 PVC Data
Connection
Internet TeleRadiology Office
TeleRad, MRI and Internet
Connection
Vanceburg FHC
Garrison Elementary
School Clinic
Tollesboro Elementary
School Clinic
Laurel Elementary
School Clinic
Lewis Co. Middle School
Clinic
T-1s Data and
VideoT-1 Video Only
Kentucky TeleHealth Network
University of Kentucky
University of Louisville
Video
Video
Dental Clinic
Rehab Center
Women, Children &
MH/SA Sxs.
Flemingsburg Family Health
Center
Tollesboro FHC & Pharmacy
T-1s Data and VideoFiber Optic
Connectivity Data Only Vanceburg
Campus
Comprehend Maysville
Comprehend Vanceburg
FCH
T-1 Video Only
T-1 Video Only
Circa: 2005
Eastern State
HospitalMaysville
OB/GYN and Family Health
Center
Bolt’s Laws on EMRs
1. The amount of success in implementing an EMR is directly proportional to the amount of work you do on the front end.
2. If you are still asking “how much will an EMR cost?”, you are not ready to make the leap.
3. Implementing an EMR is not a 50 yard dash, it is an “iron person” marathon.
4. If you have preconceived ideas about what system you are going to purchase, or if you let a vendor
dictate what you do, your chances of creating more problems than you solve increase exponentially.
Bolt’s Laws on EMRs
5. Education on use of the system is an ongoing effort.
6. People will create short cuts and when they do it will cause problems. There must be standards of use and everyone must follow the standards.
7. Your utility providers (electric and phone) will become your best friends or your worst nightmare.
8. Printers, batteries and computers have a life expectancy. Most don’t last that long.
9. Someone who says it won’t work, will find the truth is, it won’t work for them. Attitude is everything.
Look at an EMR as an investment. Bill Gates in his Look at an EMR as an investment. Bill Gates in his book book Business @ the Speed of Thought Business @ the Speed of Thought cited an cited an article from article from Windows in HealthcareWindows in Healthcare stating that a 5 stating that a 5 physician clinic in Hammond, Louisiana invested physician clinic in Hammond, Louisiana invested $50,000 and saved $60,000 the first year in $50,000 and saved $60,000 the first year in transcription costs alone.transcription costs alone.
Gates points out that 20 to 30 percent of the cost Gates points out that 20 to 30 percent of the cost of healthcare is in paperwork. That amounts to of healthcare is in paperwork. That amounts to 200 to 300 billion dollars per year, which is more 200 to 300 billion dollars per year, which is more than the gross national product of many countries.than the gross national product of many countries.
Create a Vision
Share it in the Practice
Target “Points of Pain” for Amelioration and Gain Consensus
Develop a Plan on How to Proceed
Pick Clinical and Clerical Champions
Receiving more timely and accurate payments from carriers
Saving time and money in operations
Seeing more patients per day
Working more productively in practice
Improving and consistently tracking intra-practice communications (0rders, phone notes, scripts)
Improving the quality of care provided to patients and being able to track the care given
Scalability and expandability of new system to accommodate planned growth
Simple approach in staff meetings and
individual discussions.
Build the concept that it is an
investment, not an expense.
Use the “Wouldn’t it be nice if”…. we didn’t loose
charts, …you didn’t have to spend evenings finishing
the charts, etc. approach
• You need a cross sectionYou need a cross section
• Remember – Other people will use the Remember – Other people will use the systemssystems
• They need to be respected in the clinicThey need to be respected in the clinic
Include your Include your champions in key champions in key decisions along the decisions along the waywayKeep other staff Keep other staff informedinformed
Lost Chart
s
Poor Workflo
w
Low Codin
g
Poor Documentat
ion
Lack of continuity between buildings
Must use a team approach - (make sure you understand the
difference in users)
Be flexible
Develop a realistic timeframe for decision making and implementation
Be realistic
Research what is available
Consider the challenges
Outline an RFP based on the needs of the practice – not what someone has to sell you
Research the vendor
Develop a list of features
Establish how success will be measured
Among Clinical Providers, CIOs and IT professionals major barriers to implementing an EMR include:
Lack of adequate funding or resources
Lack of support by medical staff
Difficulty in creating a migration plan from paper to electronic health records
- from Medical Records Institute “Fifth Annual Survey of EHR Trends and Usage”
Other crucial barriers to implementing an EMR include:
Organization’s Commitment to IT Staffing
Lack of Understanding Product Categories, Choice and what is really needed to
improve systems of service
Fear of Change
Lack of Buy-In Among Key Physicians, Staff, and especially Management
Perceived High Cost of EMR Systems
Implementation Timeline Perceived as Too Long
Organization Still Not Completely Paperless Immediately
ImplicationsManagement• Realize in the beginning that you are making an investment of
time and dollars.• If you haven’t been a champion in the process up to now,
employees may not see the importance of the project.• Make sure the system will generate the reports and data you
need to manage the practice.• Understand that some jobs will change and be prepared to take
advantage of the efficiencies created.• Don’t stifle creativity, but only implement changes to the
system that are reached by consensus among medical staff and other user groups.
• Set-up a team, maybe the one you used during decision making, to take and evaluate changes in the system and to educate and re-educate users. (should include your vendor) (PDSA approach)
ImplicationsClinicians• To avoid major problems, make sure templates or
decision trees, flow charts, etc. fit the needs of the practice and the standards of care before you begin implementation.
• Phase in implementation- scheduling and other components of practice management system first, then the clinical side. (PDSA approach)
• In the first few weeks, or even the first couple of months, productivity will drop.
• Don’t’ be afraid to ask for help or say you don’t know how to do something.
• Monitor and review charts• Re-educate
Implications
IT• Realize that someone needs to be
available/accessible 24/7 (employee or contract service)
• Be responsive to needs – if it’s broke, then fix it!• Participate in the “internal user team”. After all, you
speak the language that the rest of us don’t know.• The network, the software and the hardware must be
maintained. In larger organizations this may be three separate jobs.
• Sure, but most are manageable and Sure, but most are manageable and present fewer points of pain than a present fewer points of pain than a paper systempaper system
• Data is more accessible in a real time Data is more accessible in a real time fashionfashion
• Continuity of care among PCPs and Continuity of care among PCPs and work with pharmacists, etc. has work with pharmacists, etc. has improvedimproved
• We are ready to participate in our We are ready to participate in our State’s Medicaid Modernization State’s Medicaid Modernization ProgramProgram
