1. Electronic Health Records Is Now Finally the Time?

2. A Little Bit About Me UCLA Chicago Medical School Georgetown-Providence Hospital Medical Informatics Fellowship Joined SCPMG in 2001

3. Why I'm Here Tonight? Share my personal experience of implementing, using and now optimizing an Electronic Health Record for the last 4 years Share the experiences of other physicians, nurses, staff and patients Going electronic can be challenging, but nobody would go back to paper

4. Why go Electronic? Immediate and remote access to clinical information E-prescribing Decision support with physician order entry (CPOE) Redeploy existing resources in different ways Integration with other services (i.e. Labs, Radiology, Pharmacy, Inpatient, Emergency Dept) After Visit Summary Personal Health Record Secure Messaging (Encrypted Patient Email)

5. Why not to go Electronic? Some initial pain Cost Time Decreased productivity (period of time) IT Support Poor typing or computer skills

6. Critical Success Factors You need to go all in Invest up front Change Management Make time to meet Inout from your Team

7. Potential Pitfalls The EHR is a Tool, but you have to use it correctly to benefit Bloated progress notes Poor office workflows on paper will become poor office workflows electronically Don't Assume - spend time up front talking about what's working and what isn't Invest time before you go-live or after?

8. Change Management Communicate, Communicate, Communicate Don't make special deals Create a Positive Vision Fast Change is easier than Slow Change Things get worse before they get better

10. An EHR won't fix everything The EHR is a Tool, but you have to use it correctly to benefit Bloated progress notes Poor office workflows on paper will become poor office workflows electronically Don't Assume - spend time up front talking about what's working and what isn't Invest time before you go-live or after?

11. Typical KP Setup Appointments can be made online at KP.org Paperless Check in via Receptionist or Kiosk Medical Assistant rooms & preps patient Every physician office and exam room with a wired Desktop Computer mostly on carts Clinical Documentation & Computerized Physician Order Entry (CPOE) Patient given After Visit Summary with list of diagnoses, orders, medication list, and patient instructions Prescriptions, Lab or Radiology orders submitted electronically

13. Training 24 hours of initial training Currently done in 16 hours of training All providers went though a class on Interacting with Patients and a Computer in an Exam Room 4 weeks of reduced patient schedules

14. What Makes Kaiser Permanente Different? It's the Care Delivery Model Integration, Integration, Integration More than an Electronic Health Record More than a Personal Health Record

15. Productivity 50% reduction in schedule for 2 weeks 25% reduction in schedule for 1 weeks 10% reduction in schedule for 1 weeks Physicians took 6-12 months to regain previous productivity

16. Productivity 50% reduction in schedule for 2 weeks 25% reduction in schedule for 1 weeks 10% reduction in schedule for 1 weeks Physicians took 6-12 months to regain previous productivity

17. Methods of Data Entry Typing Macros or Shortcuts Point and Click interface Voice recognition

18. Decision Support Medication interactions Allergy checking Quality Reminders

19. EMR Sustainability Is it doable?

20. Just a bit about me. Pacific Union College Loma Linda University Bachelor of Science in Nursing Worked in L&D, ER, Trauma, Critical care transport and ambulatory care. Joined SCPMG in 2005.

21. Why AM I here tonight? Because Stephen asked me... Seriously, to share a nursing, administrative and provider view on EMR sustainability. Share what I learned from my failures, epiphanies and successes. Help avoid some of the pitfalls. Help you become a CSI agent.

22. We bought it, rolled it out and now we are committed. Now what??

23. The Plan That's about right!

24. What are the challenges to sustainability? Spread of information Multiple and varied stakeholder's with different needs that interface. Various training groups may have different messages. Amount of information vs time to train. Low priority.

25. What happens if there is no oversight and sustainability...

26. Then... Urban legends abound "I thought that's what they told me to do." "Someone else told me" "Isn't that what they said?" "I'm just saying" "That's how we've always done it."

27. Finally... Inefficiency and confusion, declining quality and frustration now abound.

28. Essential pillars to success Active Senior leader sponsorship. Multidisciplinary group interaction-operational, technical, front-line and administrative. Ability to engage, influence and build trust at all levels. Test labs for RIM Willingness to try new methods, challenge the status quo.

29. First Steps What are your biggest areas of opportunity or risk? Ask the right questions. Facilitate communication with everyone affected. Test with 1-2 people then spread.

30. Widen the view Will you need more resources to spread and sustain? Were there any other entities that need the information? Are there any other venues that can be utilized to communicate and train? Develop experts Train 3 deep Have coverage and contingency agreements.

31. Include everyone at every opportunity. Spread the learning curve over time and venue. Communicate a new tip, Q&A, upcoming change, at every meeting, via email, Webshare, presentation, websites.

32. Make it the culture Give a clear goal Set expectations Train to the goal Variation, while expected, should be initiated by the other party. It should not be due to lack of knowledge or skill on our behalf. It should be known and if granted, within our variation plan.

33. Some outcomes from our journey Presence at every administrative meeting. 2 week intensive at every medical office. Standardization of practice in many areas. Resource website developed to support the staff Consistent message for new hires to yearly competency for all staff, including float staff. Message support center for Adult Primary Care.

34. Good luck! Success is yours!