1. EHR Implementation by Clinch River Health Services, Inc. Clinch River Health Services, Inc. A Community Health Center in Dungannon, Virginia; population 400, with 3500 active users serviced by three Providers. Gary E. Michael, MD Family Medicine Physician Medical Director for 17 years National Health Service Corp Alumni

2. EHR Implementation Plan Phase 1 – Strategic Planning Phase 2 – Partnerships Phase 3 – Staff Evaluation & Education Phase 4 – Define Measurable Outcomes Phase 5 – Review Vendors,Select & Purchase Phase 6 – EHR Implementation Phase 7 – Revisit Outcome Measures

3. Phase 1 – Strategic Planning Board of Directors Accurate and timely data is essential to quality, data-driven health care. Performance Improvement – 5 year plan EHR implementation as an organization wide effort to enhance efficiency, increase productivity, but mostly as an innovation to introduce quality tools for better health service delivery with accurate, real-time data collection and reporting. Financial Review Loss of Revenue due to initial loss of productivity Funding, Grants

4. Phase 2 - Partnerships EHealth Committee Developed by the Community Care Network of Virginia focused on the planning for Virginia CHCs to acquire EHR CareSpark A RHIO located in northeastern Tennessee – southwestern Virginia A Champion

5. Phase 3 – Staff Evaluation & Education Vendor Presentations Staff to evaluate the systems for Flexibility Presentation Layer Attributes to complete the work we do Melt away staff fears Examples of how EHR enhances work performance or the work day. Hunting down paper charts Completing Tracking Logs

6. Phase 3 – Staff Evaluation & Education DOQ-IT Evaluate staff skills, organization readiness Process Analysis Document: office management, patient/visit specific tasks Working well, poorly, not at all Barriers to Improvement: workflow, data entry, integration/interfacing, personnel PDCA cycles, CQI techniques

7. Phase 3 – Staff Evaluation & Education Patient Flow Analysis Visit Re-engineering Process Conversion Paper process converted to EHR process an ongoing effort as staff learns more, processes can be converted Aligning Personnel, skills, needs Staff for scanning

8. Phase 4 – Define Measurable Outcomes Categories: Cost, Efficiency, Productivity, Satisfaction Interview all staff for job functions, concerns, work flow, goals of EHR Promotes Staff Buy-in Provides valuable information of present status of the system/organization

9. Phase 5 – Review Vendors, Select & Purchase EHealth Committee Work 25 page EMR Functional Requirements Standards Vendor Presentation with selected Scenario On-site Visits Grants – Rural Development IT support TechSoup – for non-profits

10. Phase 6 – EHR Implementation Designate a Superuser Works closely with the Vendor before “go-live” date Or have an on-site IT person and train the person in daily activities Schedule Preparation Increase load of RMC before “go-live” date NO patients during training Clinical Template Building 25% scheduling & increase every 2 weeks

11. Phase 6 – EHR Implementation Policy Development Chart Messaging Chart Population Pre-loading Post-loading First visit responsibilities Second visit responsibilities Desk Top Responsibilities

12. Phase 6 – EHR Implementation Policy Development (continued) Front Desk Intake Medical Records Request Orders Management Password Protected Routine Charting System Down System Upkeep

13. Phase 6 – EHR Implementation Staff exposure to the EHR prior to “go- live” Weekly team meetings Share Lessons Learned Skills development Convert OLD processes to EHR processes

14. Phase 7 – Revisit Outcome Measures Outcome Measures being collected and analyzed now after 1 year of “go-live” General Comments after looking back: Completed the PI project 2 years early EHR captures more information and documents more work than ever before Lessons Learned Checklist developed and given to other centers to improve their implementation process

15. Were We Successful? Productivity 2007 Total Encounters > 2006 Encounters 2007 Diabetes Metrics = 2006 Results Subpopulation data vs Total Population data Efficiency Number of daily recorded telephone messages increased by 25% Rx refill turnaround time reduced by 50% X-ray report turnaround >90% within 48Hours