1EHR Adoption – Barriers & Solutions John WeirIllumisys – A Division of Lumetra
2Illumisys Established in 2005 Mission: to assist healthcare organizations and their providers transform their patient environments through the adoption of technology.Core Competencies:HIT Adoption ProgramsSystems ImplementationSystems IntegrationOperations StrategyHIT Project Management
3Presentation OutlineProvide an outline of the state of systems adoption, common barriers & solutions.Offer proven considerations for addressing barriers and implementation suggestions targeted on success.
4Ambulatory System Adoption CDC's 2006 National Ambulatory Medical Care Survey of 3,350 office-based physiciansHealth Affairs, How Common Are EHRs in the US?Modern Healthcare 10/30/2008
5HIT Adoption in Physician Offices Source: HIT Adoption in Physician Offices – A Summary of Findings in Iowa; August 2007, Iowa Foundation for Medical Care
6Why is Adoption So Difficult? Training &EducationPatientSafety & ComplianceInitiativesHITImplementationDataAnalysisChangeProcessRunning the BusinessPatient CareQualityReporting& P4P Requirements
7Perspectives 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.
9Major 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
10SO WHAT DOES THIS MEAN AT THE PHYSICIAN OFFICE LEVEL? WHAT CONSIDERATIONS SHOULD BE MADE?
12Financial Solutions Smart Contracting: Go live and milestone clauses. Consider group purchasing where feasible.Lease purchasing and deferrals on initial billing.Upfront CostsOngoingCostsConsider 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.ServicesEnsure 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 TimeIntegration CostsCreate 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.
13Key Areas of Financial Focus High impact cost savings:Elimination of paper charts & encounter formDecrease in data entry and transcriptionIncrease physicians’ ability to submit new and refill prescriptions directly to the pharmacyImprovement in claims capture – billing revenueDecrease patient & administrative staff timeFurther time/cost savings:Enhanced clinical processes & practice workflow efficiencyProvide decision supportDecrease documentation & improve legibility - SafetyIncrease timeliness patient tracking & follow-upReduce time of administrative staff filing, finding and pulling recordsUse messaging
15Technology SolutionsTechnicalSupportCreate 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 CustomizationEstablish 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 scenariosFragmented Standards & Data ExchangeIf 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/ResourcesPrivacy &SecurityAll systems must comply with HIPAAEnsure data is encrypted where transmission is involved.Create levels of security for users where data access should be limited.
17Organizational Solutions InfrastructureEstablish change management processes.Create a process for decision making.Develop a process for issue escalation.Technical CapacityIT Network has bandwidth and capability for new system.IT Support protocols established.Communications created for implementation process through the business.Operational CapacityStaff 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 AlignmentBuild 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.LeadershipIdentify 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.
19Leadership & Accountability Cultural SolutionsTechnicalCompetencyReady 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 & AccountabilityEstablish 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.ConsumersIntegrate 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 ManagementAddress 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.
21Solutions – 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
22Solutions - 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
23Solutions - Implementation Phase I Incorporate basics & workflow:Registration & scheduling (assuming integrated system)Patient eligibility and check-in processePrescribing fundamentalsCommence paper migration (scanning & data entry)Phase II Building core functionalityNursing documentationPatient histories, vitals, chief complaintsLab orders (where applicable to staff)Slide 1 of 2
24Solutions - Implementation Phase III Incorporate PhysicianFull exam recorded in EMR (voice / template driven)Charge codingLab order and resultsCross-staff tasking & messagingReportingInteroperability components (electronic referrals)Phase IV OtherIntegrate device interfacesClaim management within an integrated systemSlide 2 of 2
25Solutions - Implementation TrainingEntire 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 MigrationAvoid parallel paper and electronic data entryEnter information in advance OR as you goScan key recent reports and transfer past informationMaximize electronic data exchangeSet up efficient data exchanges between systemsRedesign work processes to eliminate paper-based clinical processes
26Success 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.
27Legislative Landscape Can the next 5 years get us beyond the tipping point?Financial Assistance:LoansGrantsIncentivesTechnical Assistance:Regional Resource CentersWorkforce trainingDemonstration projects
28Keep 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.