integrating it and clinical practice for implementation and support of electronic health records at...
TRANSCRIPT
Integrating IT and Clinical Practice
for
Implementation and Support of
Electronic Health Records
at
The University of Texas at Austin
May 30, 2013
Presenters:
Theresa Spalding, MD Medical Director
Robert Reed Assistant Director, Health Information Management Services
Sherry Guyton, FNP Advanced Practice Clinician & Informaticist
Objectives:
Identify obstacles to the efficient support and implementation of an electronic health record (EHR)
Discuss the strategies UT employed to address some of these obstacles from an IT standpoint
Explain the benefits of having a clinical provider in the IT department
Overview
Background on UT and University Health Services History of IT at UHS Problems with a traditional IT model Finding a solution Informaticist’s experience
Time for Q&A
UT info
350-acre main campus 17 colleges and schools more than 50,000 students and about 24,000 faculty and staff,
UHS Info Funding
Student Activity Fee —• lump sum divided among all Student Services
Billing and Insurance revenue
Student Services Building UHS
Counseling and Mental Health Center
Services for Students with Disabilities
Dean of Students
Financial Aid
Pharmacy
UHS Info
Medical Provider Staff17 MDs = 11.7 FTE 6 FNP/PA = 3.9 FTE 4 WH NP = 2.9 FTE 27 18.5 FTEs
Nursing staff = 40RNsLVNsMAs
UHS Clinics 3 General Medicine Clinics
Medical providers Integrated Health counselors
Women’s Health Clinic Colposcopy
Sports Medicine Clinic 2 fellowship trained SM MDs Orthopedic consultant
Urgent Care Open til 5:30 weekdays and 11-3 on Saturdays
UHS Ancillary Services
Allergy and Immunizations Registered Dietitian Physical Therapy
Laboratory Digital radiology Pharmacy
A Little History…
The Beginning• Mainframe Terminals
• HCSCHED• Scheduling
• HCBILL• Billing
• Email• Web Browsing
First Attempt (1998-2009) In 1997, UHS went out on bid for a Practice
Management System. Scheduling Billing
The product was installed in 1998.
ITS in UHS begins to change… So we were slinging computers like any other ITS shop
on campus, but then….
Could somebody figure out a way to request a paper chart based on a phone message, have the chart arrive in the clinic with an explanation, and track all patient contact?
HITS was “born”! Now we were directly supporting the mission of UHS and not just the computers.
How can we securely message our patients so that their protected health data was not sent in a plain email? E-Messaging was born
Further Implementation of an EHR Step-wise approach to implementation of
Laboratory and radiology orders, Documenting medications and allergies Laboratory results viewed on computer
Vendor evolving into a full Electronic Medical Record (EMR), with the ability to edit templates But who is going to create and edit all of the templates we
needed?
Technology Evolves…
• Lack understanding of clinical processes
• Lack a common language with clinicians
• Different priorities
• Lack understanding of complexities of IT
• Lack the time to clearly explain what they need
• Clinical staff even busier due to new technology
Result = Frustration for both IT and Clinical staff
Brainstorming the Solution
Initially discussed using an RN but went with FNP. (No particular reason at the time).
Funding Joint appointment with Medical Staff and HITS Joint supervision
Creating job description
Results
Building understanding
IT begins to understand clinical priorities and workflows
Clinicians understand that not all processes can be replicated electronically and why!
Debate reshaped Initially had been EHR makes things faster
(obviously not true) Now EHR makes patient data more available
Results for IT Clinician has more time to work with IT and understand the information
Clinician can then take time to distill (translate?) this to peers.
Clinician brings understanding of the clinical process
Clinician can better communicate issues to our vendors.
Better communication between IT and clinical staff
Increased satisfaction with the process
Clinicians know that somebody in IT is using the solution and not just
pushing it out.
EHR-2 With experience gained by Clinical Informaticist (CI) coupled
with staff frustration, we decided to seek out new vendor for EHR
Implemented EHR-2 on Aug 4, 2009
CI was crucial in working with vendor implementation team to develop and adapt EHR to our needs
HITS added support for CMHC in May 2010.
CLINICIAN / INFORMATICIST
Typical EHR Development/Training responsibilities
include:
• acting as a liaison between providers/users and Health Information Technology Services (HITS);
• communicating with associate medical director and HITS manager as needed for priorities related to EHR issues;
• collaborating closely with HITS staff in the development, testing, training and/or implementation of technologies related to the EHR;
• training new providers on the use of the EHR and other technologies that may facilitate its use;
• collaborating with other departments within UHS that are impacted by EHR changes and use (Pharmacy, Lab, Radiology, Cashier/Insurance, Health Information Management).
Experience for the Clinician/Informaticist Role
Experience No formal IT experience had background in training & education UHS medical staff member
Training for the Clinician/Informaticist Role
On-the-Job Training workshop by original EHR vendor on
template building structures,
linking codes, and
building coding dictionaries.
webinars by EHR-2 vendor on set up of all dictionaries,
designing templates,
creating links between clinical templates and coding and billing,
secure messaging,
patient portal.
Training for the Clinician/Informaticist Role
HIT-Pro Certification Program
Training as Clinician Practitioner Consultant
In-depth education on basic IT history, IT terminology, IT security related to healthcare Implementation strategies
Clinical duties
Set schedule during long semesters (3-4 sessions/week)
Fill in during unexpected provider absences or increased pt volume
Identify things that need to be corrected or added into the EHR
UHS Acceptance of CI
Both sides seeing her as representing their best interests
Broader exposure--- member of Clinic Management Team, member of Coding and Charges Committee Member of EHR Committee ad hoc committees on clinic flow
Accomplishments Building templates Triage Guidelines Editing process Clinical flow brainstorming
Prescription refills PVNs Setting up flow sheets for such recurrent visits as INH
treatments, EDAST, concussions…. Trainer of all new employees on the EHR One-on-one training of new providers
Kudos from new staff member I also wanted to say a special thanks to
Sherry for spending so much time and effort training me on the EHR and for helping to develop all of my templates. You are directly responsible for helping make my job so much easier, not to mention assuring effective communication between disciplines, accuracy, and compliance, etc.
Customer Satisfaction
It’s very helpful having someone with clinical experience
representing our needs and creating templates and reports that
maximize clinic efficiency. In a few minutes or less I can explain to
Sherry what tool I need in PnC, whereas it often takes multiple
conversations with an IT staff member (even one who works in a
healthcare setting) to convey the same information. It also makes it
very easy to brainstorm solutions to challenges when the person
you are working with understands the clinic perspective. • Mary Ann Dolph, RN
• Nurse Triage Manager
Presenters:
Theresa Spalding, MD [email protected]
Robert Reed [email protected]
Sherry Guyton, FNP [email protected]
