1. IHS EHR Indian Health Service Electronic Health Record Michele Miller Warm Springs Health & Wellness Center

2. Preparation, Implementation and Lessons Learned  Preparing for Installation Implementation Team Implementation Team CAC CAC OIT Requirements OIT Requirements  Setup EHR CAC & Implementation Training (ABQ) EHR CAC & Implementation Training (ABQ) OIT On-site RPMS-EHR setup OIT On-site RPMS-EHR setup  Go Live  Looking Ahead

4. Where to Start?

5. Implementation Team Clinical Application Coordinator (CAC) Clinical Application Coordinator (CAC) Clinical Application Coordinator (CAC) Clinical Application Coordinator (CAC) Medical Staff (Clinician) Medical Staff (Clinician) Nursing Nursing Pharmacy Pharmacy Lab and Radiology Lab and Radiology Medical Records Medical Records Billing/Coding Billing/Coding Information Technology staff Information Technology staff *Administrator/Executive Leadership* *Administrator/Executive Leadership*

6. Implementation Team Roles  Monitor and Execute Implementation Plan  Identify and define Policies and Procedures  Address staffing and scheduling during transition  Peer Training & Marketing  Design and Approve EHR Menus, templates,etc

7. What’s Next?

8. Hardware/Infrastructure upgrade  RPMS server  Backup/Training server  Thin Clients, laptops, pcs?  Network  Lab Interface Upgrade  Workstation Access-Everywhere  Backup Power

9. Costs Associated with EHR  Workstations Laptops, tablets, pc, thin clients Laptops, tablets, pc, thin clients  Ergonomic workstations  Backup Server  Backup Generator  Clinical Applications Coordinator GS 12  Training / Travel Costs  Software-$0.00

10. OIT Requirements http://www.ihs.gov/CIO/EHR/index.cfm

12. Step 1-Site Survey http://www.ihs.gov/CIO/EHR/index.cfm

13. Step 2: EHR Site Tracking http://www.ihs.gov/CIO/EHR/index.cfm

14. Elapsed time (in months) Decision to implement EHRReview EHR Website 0 Complete EHR Site Survey Begin EHR Site Tracking Record Begin hiring process for CAC Establish EHR Implementation Team Attend Lessons Learned classRPMS current, CACHE Begin pharmacy drug file cleanup for Pharm 5/7 * Begin procurement process for hardware Install PIMS Optimize “Point-of-Service” RPMS Packages Optimize PCC Error Reports Install/configure Radiology 5.0, Lab 5.2 Install Pharmacy 5/7 and EHR GUI Implement Paperless Refill Attend CAC training On-site Setup with Nat’l EHR Team EHR Super User training EHR Go-Live with Nat’l EHR Team Full rollout 123581061112 24 Please note that this is just a general timeline of how long it might take for your site to implement EHR. Every site will be different, and the amount of time it takes to implement EHR depends upon many factors, including size of the facility, services offered at the facility, current state of RPMS and packages installed and utilized. EHR Planning & Implementation * Most sites contract for external resources to complete pharmacy file preparation. Implement Adverse Reaction Tracking package

15. 6 Months of Setup? After Pharmacy 5/7 installation

16. National EHR Training and Deployment Program recommends at least 6months  Three months of Pharmacy 7.0 utilization before "Paperless Refill"  Three months of "Paperless Refill" and "Coding Queue" before beginning Provider Order Entry (POE) with EHR.

17. Medical Clinic Preparations  Formed Teams  Practiced EHR Walk-Through(on paper)  Defined Roles  Computers everywhere

18. Lab All Labs need to be entered in RPMS On-site Labs On-site Labs Reference Labs Reference Labs State Labs State Labs  Computer Access Points Change from Esig to EHR after Go-Live

19. EHR Setup

20. OIT Help / Training  EHR CAC & Implementation Team (Set Up) Training in ABQ  EHR Onsite Set-Up Team  Onsite Go Live Team  EHR for Techies, EHR for Inpatient, EHR for HIM and Business Office

21.  Customize order menus Lab, Pharmacy, Radiology Lab, Pharmacy, Radiology  Setup Referrals/Consults  Progress Note Templates Design your own Design your own Share with other sites Share with other sites  User Setup  ICD/ CPT Pick Lists Setup by CAC

22. EHR beforeConfiguration EHR before Configuration

23. EHR after Configuration

24. Preparation-Customizing Orders

25. Preparation-Customizing Templates Templates can be shared with other IHS and VHA facilities More Complete Documentation

26. Training/Marketing  EHR Demo Movie  VA Training Modules ftp://intranetftp.ihs.gov/pub/EHR/ ftp://intranetftp.ihs.gov/pub/EHR/ Pharmacy Pharmacy CPRS CPRS  WebEx Demos  Show and Tell Newsletters Newsletters Web Updates Web Updates Meeting Updates Meeting Updates Email Quizzes Email Quizzes

27. Implementation Strategy Implementation-Who and When  Everyone at once  Lab ordering, then radiology ordering, then pharmacy ordering, then notes  Bring up one team/dept at a time

28. Going Live

29. Go Live Week  Intense CAC and IT Support  Make Appropriate Scheduling Adjustments  Daily Debriefings…. Procedural Questions Procedural Questions Technical Issues Technical Issues How did it work before EHR? How did it work before EHR? More Training-Email training More Training-Email training

30. How the Week First Goes Growling at CAC’s Crying, gnashing of teeth Excited TGIF Excited

31. Change is Good

32. Medical Records  Filing notes in chart during the transition?  Print And File Chart Copies? Batch Print?  Release Of Information?  Outside Consults? Scanning?  When to stop pulling the chart  When to stop pulling the chart

33. Medical Records Supervisory  Daily Report: Unsigned Orders  Daily Report: Unsigned Notes  Retracting /Correcting Incorrect Entries  Paper P&P changed to Electronic P&P  Sensitive Pt Tracking  Medical Records Supervisor: Business rules/HIPAA Who can view which parts of EHR Who can view which parts of EHR Works cooperatively with RPMS Site Manager Works cooperatively with RPMS Site Manager

34. Business Office  No Hard Copy to Wait for  No more missing E&M Codes  EHR Notes Are Legible  Great Opportunity For Improved Provider Documentation & Increase Billing/Collections

35. Medical Clinic  Using templates/graphs instead of flow sheets  Using the Scheduling GUI for visual routing of pt flow  Selecting ICD/CPT codes  Reminders  Voice Recognition Dragon NaturallySpeaking Dragon NaturallySpeaking  Vista Imaging

36. Staff Changes at Warm Springs  More Nurse Aids after EHR From 2 to 7 From 2 to 7  Medical Records Staff PCC Data Entry (temporarily reassigned) PCC Data Entry (temporarily reassigned) Benefits Coordinator (temporarily reassigned) Benefits Coordinator (temporarily reassigned) Medical Department (temporarily reassigned) Medical Department (temporarily reassigned) Nurse aidsNurse aids Medical ReceptionistMedical Receptionist Shifted to scanning documents into VistA Imaging Shifted to scanning documents into VistA Imaging

37. Next Steps  EHR v1.1  CPHAD (Public Health Activity Reporting System)  Electronic Dental Record (EDR)  Visual PHN System (VPS)  VistARAD

38. Questions?

39. Clinical Applications Coordinator (CAC) Coordinates EHR Implementation New Position / Role New Position / Role Works cooperatively with Site Manager and Medical Records Works cooperatively with Site Manager and Medical Records EHR User Support EHR User Support Training Training Customizes EHR Customizes EHR Workflow Workflow back