1. EHR Adoption – Barriers & Solutions
John Weir
Illumisys – A Division of Lumetra

2. Illumisys Established in 2005
Mission: to assist healthcare organizations and their providers transform their patient environments through the adoption of technology.
Core Competencies:
HIT Adoption Programs
Systems Implementation
Systems Integration
Operations Strategy
HIT Project Management

3. Presentation Outline
Provide an outline of the state of systems adoption, common barriers & solutions.
Offer proven considerations for addressing barriers and implementation suggestions targeted on success.

4. Ambulatory System Adoption
CDC's 2006 National Ambulatory Medical Care Survey of 3,350 office-based physicians
Health Affairs, How Common Are EHRs in the US?
Modern Healthcare 10/30/2008

5. HIT Adoption in Physician Offices
Source: HIT Adoption in Physician Offices – A Summary of Findings in Iowa; August 2007, Iowa Foundation for Medical Care

6. Why is Adoption So Difficult?
Training &
Education
Patient
Safety & Compliance
Initiatives
HIT
Implementation
Data
Analysis
Change
Process
Running the Business
Patient Care
Quality
Reporting
& P4P Requirements

7. Perspectives of EHR… What we want… What we often get…
Complexity of configuration and user base needs.
No one size fits all products.
Lack of trained professionals.
Too much going on in the office to focus.

8. EHR Adoption Barriers

9. Major Adoption Barriers
Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record Keeping among Physicians & Group Practices in the US, Preliminary Data, November 2007

10. SO WHAT DOES THIS MEAN AT THE PHYSICIAN OFFICE LEVEL?
WHAT CONSIDERATIONS SHOULD BE MADE?

11. Financial Barriers

12. Financial Solutions Smart Contracting: Go live and milestone clauses.
Consider group purchasing where feasible.
Lease purchasing and deferrals on initial billing.
Upfront Costs
Ongoing
Costs
Consider an hosted environment server (ASP) that can be paid for monthly.
Consider hardware depreciation, support fees, upgrade costs & miscellaneous expenses such as new staff training.
Negotiate longer term Interface costs upfront.
Services
Ensure implementation, training and go live support is covered.
Consider having a source for vendor management and hand holding.
Build in-house product expertise within staff.
Purposefully schedule for less patients during initial go live.
Look at who can be reassigned for assuming certain project responsibilities.
Create goals that balances lost time against high impact automation and decreased data entry.
Lost Time
Integration Costs
Create an ROI process to track the benefits of the system. E.g. value of eRx, reduced transcription against system costs.
Improvements in timeliness of claims submission.
Include consumers by incorporating and online visit protocols.

13. Key Areas of Financial Focus
High impact cost savings:
Elimination of paper charts & encounter form
Decrease in data entry and transcription
Increase physicians’ ability to submit new and refill prescriptions directly to the pharmacy
Improvement in claims capture – billing revenue
Decrease patient & administrative staff time
Further time/cost savings:
Enhanced clinical processes & practice workflow efficiency
Provide decision support
Decrease documentation & improve legibility - Safety
Increase timeliness patient tracking & follow-up
Reduce time of administrative staff filing, finding and pulling records
Use messaging

14. Technology Barriers

15. Technology Solutions
Technical
Support
Create performance guarantees associated with vendor support & uptime.
Have a maintenance plan that is tested and works.
Plan for, implement and transition upgrades with care.
Complex System Customization
Establish system review process before enhancing templates & workflow.
If it works don’t customize it.
Plan out the system workflow with feedback from all staff.
Standards bodies have emerged and working with certification programs.
Ask your vendor about terminologies and vocabulary sets used.
Established interface needs early and have a clear set of specifications that can be shared between vendors.
Broker vendor communications to eliminate any he said/she said scenarios
Fragmented Standards & Data Exchange
If you’re not clear on functionality vs. your needs prior to purchasing - ASK.
Make sure you have people who understand how the system will work for your office.
Hire experts where you need to.
Product Expectations/
Resources
Privacy &
Security
All systems must comply with HIPAA
Ensure data is encrypted where transmission is involved.
Create levels of security for users where data access should be limited.

16. Organizational Barriers

17. Organizational Solutions
Infrastructure
Establish change management processes.
Create a process for decision making.
Develop a process for issue escalation.
Technical Capacity
IT Network has bandwidth and capability for new system.
IT Support protocols established.
Communications created for implementation process through the business.
Operational Capacity
Staff appropriately with internal, vendor and where necessary consultants.
Review and establish appropriate workflows focused on improvement.
Understand training needs and have vendor work to that need.
Create paper migration plan with vendor input.
Goal Alignment
Build consensus across the organization with management and providers.
Build commitment from staff to meet timelines and USE the system.
Create a focus on quality from system performance/capability to outcomes.
Leadership
Identify physician champion who will remain committed to the project.
Entrust authority with implementation lead and physician champion.
Maintain project ‘VISION’ throughout the implementation and Go Live.
Establish management reporting and staff updates.
Address legal issues upfront.

18. Cultural Considerations

19. Leadership & Accountability
Cultural Solutions
Technical
Competency
Ready staff for what may be new technology. E.g. MS Windows, browsers.
Have staff involved in requirements development and system planning feedback.
Address the change process in a proactive and benefits oriented manner.
Leadership & Accountability
Establish good project management practices; maintain a plan and timeline.
Manage the vendor and seek clear recommendations.
Proactively communication progress and goals achieved within the organization.
Consumers
Integrate access to relevant components. E.g. PHR, , scheduling.
Inform patients of the transition; make the benefits apparent and set expectations.
Involve the patient in their care and look at improved outreach methods.
Stem privacy and security concerns.
Change Management
Address resistance to change by illustrating system capabilities.
Incorporate staff in the entire process including goal setting, build & testing.
Match roles and functions to staff skills and fill the gaps with training.
Conduct team meetings and communicate project outwards.

20. HOW DOES THIS GET ACTED UPON?

21. Solutions – Readiness & Preparation
Build practical understanding of:
Barriers & risks;
Current state workflow;
Future state workflow that create improvements;
Gaps associated with the project.
Determine financial capacity.
Create ground rules for moving forward.
Establish and prioritize needs.
There are no secrets to success. It is the result of preparation, hard work, and learning from failure. - Colin Powell

22. Solutions - Planning Establish a team with goals.
Set framework for measurable success.
Provide vendor with clear objectives.
Keeps the project focused and on track.
Creates leadership and confidence.
Outlook on go live reductions in productivity.
He who every morning plans the transaction of the day and follows out that plan, carries a thread that will guide him through the maze of the most busy life. But where no plan is laid……chaos will soon reign. – Victor Hugo

23. Solutions - Implementation
Phase I Incorporate basics & workflow:
Registration & scheduling (assuming integrated system)
Patient eligibility and check-in process
ePrescribing fundamentals
Commence paper migration (scanning & data entry)
Phase II Building core functionality
Nursing documentation
Patient histories, vitals, chief complaints
Lab orders (where applicable to staff)
Slide 1 of 2

24. Solutions - Implementation
Phase III Incorporate Physician
Full exam recorded in EMR (voice / template driven)
Charge coding
Lab order and results
Cross-staff tasking & messaging
Reporting
Interoperability components (electronic referrals)
Phase IV Other
Integrate device interfaces
Claim management within an integrated system
Slide 2 of 2

25. Solutions - Implementation
Training
Entire staff needs to be trained: EHR in changes how the practice does everything.
During training, plan to minimize business interruption and monitor organizational progress.
Hands-on EHR training may incorporate basic terminology, workflow, security, usability, communications, and interoperability.
Paper Migration
Avoid parallel paper and electronic data entry
Enter information in advance OR as you go
Scan key recent reports and transfer past information
Maximize electronic data exchange
Set up efficient data exchanges between systems
Redesign work processes to eliminate paper-based clinical processes

26. Success Principles Build user based acceptance & diffusion.
Balance goal setting across staff.
Identify high impact issues that can be solved relatively quickly and painlessly.
Keep it simple: Initiatives must be in ‘chewable’ pieces.
Wins create momentum.

27. Legislative Landscape
Can the next 5 years get us beyond the tipping point?
Financial Assistance:
Loans
Grants
Incentives
Technical Assistance:
Regional Resource Centers
Workforce training
Demonstration projects

28. Keep The End In Mind Improvements in quality care.
Increased decision support & patient safety.
Increased provider – patient communication.
Improved revenue management.
Increased information access & interoperability.
Reductions in medical errors.
Improved staff efficiency.

29. Questions/Discussion

30. Contact Information
John Weir
President
Illumisys
1 Sansome Street
San Francisco, CA 94104 P: C: E: W: