Thayer County Health Services Hebron, Nebraska Joyce Beck CEO

 Background of implementation of EHR at Thayer County Health Services (TCHS)  Discuss decision process to establish interoperability  Nationwide interoperability demonstration  How quality measures were affected at TCHS through implementation of EHR  Discuss lessons learned, challenges and rewards

Build Bridge with EMS Improve effectiveness and efficiency of Critical Access Hospital Connect with tertiary hospital Improve communication with satellite clinics Improve communication with pharmacy Improve communication with long term care and assisted living Address safety and security of clinical information: compliance with State and Federal Regulations

 Two choices for interoperability in Nebraska- NeHII or use CONNECT to reach the Nationwide Health Information Network (NHIN)  Pros and Cons of each explored and choice was made to use open-source connectivity available using CONNECT software  Connection made with Redwood MedNet in Healdsburg, California

 Information Technology said it would work  Test data had only been sent on the NHIN between facilities  There were doubts from other HIE’s in Nebraska about NHIN  If NHIN was to be endorsed I had to see it myself  If our actions do not help a patient than all is for nothing

 Dr. Bryan Hubl ordered lab test in Hebron for wellness check  Lab results obtained and placed in EHR in Hebron  Lab results then made available to Redwood MedNet in California for actual wellness exam  Information also available on USB to fulfill meaningful use

 Results of labs and x-ray of left hip taken in Healdsburg placed in Alliance Medical Center EHR  Results could be placed on USB bracelet or card at patient request  This product available through 911 Medical ID or Zaptag

 Wellness exam completed by Dr. Jeff Meckler at Alliance Medical Center, Healdsburg, California  Lab results from Thayer County retrieved by Redwood MedNet via CONNECT gateway

 Returned to Thayer County Health Services to be seen by Dr. Hubl  Wellness exam as well as results of lab work was available to Dr. Hubl via the NHIN therefore no duplication of testing necessary  Dr. Hubl was able to recommend treatment based on information gathered in both Hebron, Nebraska and Healdsburg, California

 Information flowed from one facility to another without difficulty  Duplication of testing was avoided due to availability of information via the NHIN and patient USB device  Ease of availability of medical information provided better patient care  The NHIN as functioning, provides patients with information needed

Quality indicators in medication reconciliation were directly related to implementation of EHR In the area of medication reconciliation, those physicians using e-prescription had 100% medication reconciliation compared to 33%, 17%, 25%,20% and 33% for physicians not using e-prescribing

 While the EHR is a useful tool it must be accompanied with a culture of safety  Development of employee leadership and accountability are necessary for patient safety  Tools such as Hardwiring Excellence also need to be in place to ensure quality of patient care  Leaders need to hold people accountable, they must ask them to “get off the bus” if necessary

 Technology is improving compared to former implementation and therefore results are improved  Results were realized in early stages of implementation however results improved as implementation progressed  Success of implementation of EHR is directly related to the buy-in of end users  Success of EHR and how it affects quality indicators is directly related to the culture of safety in a facility

 A physician champion is necessary for the success of the EHR implementation  A team approach is necessary for the success of the EHR implementation  The results of the implementation of EHR on quality indicators was very positive  As a result of project not only was there a positive affect on quality indicators there is also facility pride

 EMS units in Nebraska were not allowed to apply 12-lead EKG required TCHS staff to request EMS in Thayer County be allowed to place the 12-lead  Verizon coverage limited in areas therefore transmission of data interrupted  Use of T1 line was restricted to non-profit entities limiting the use of the T1 line  Limitations of software available

 Quality indicators were positively affected by implementation of the EHR at TCHS  The positive affects were especially true when the measurement was only on the affects of EHR eliminating variables such as patient compliance  Tests were ordered timely, allowing for close monitoring of chronic conditions, when templates were used

 Medication reconciliation was greatly affected by e-prescribing  Medication errors were greatly reduced using EHR as a tool in combination with a culture of safety  Medication error reduction as well as medication reconciliation would impact the cost of healthcare greatly in the nation

Joyce Beck QUESTIONS? QUESTIONS?