1. WELCOME Attendees and telehealth participants to the National EHR Incentive Program Event

2. WELCOME Rita Luongo, Marketing Director Attendees and telehealth participants to the National EHR Incentive Program Event

3. Thayer County Health Services Presentation for National EHR Incentive Program Registration Event The Road to Successful EHR Implementation Joyce Beck, LPN, MHA January 13, 2011

4. Objective of Presentation Illustrate TCHS commitment to quality of care through the use of health information technology Support national efforts promote EHR adoption Outline step by step methods used for EHR implementation and obtaining meaningful use

5. Background of TCHS EHR implementation As a result of CAH-HIT $1.5M grant TCHS implemented EHR in 2008 Communication was established with long term care, pharmacy, assisted living, EMTs and tertiary hospital As a result, Southeast Nebraska Health Information Exchange was formed Nationwide interoperability obtained through NHIN

6. The Road to Successful EHR Implementation Have a commitment to patient safety-you have to want it Examine culture and address issues Determine the vision Evaluation of financial options Formation of EHR project team Vendor selection process Develop timeline with accountability for deadlines

7. Commitment to Patient Safety There has to be a driving force in the facility to create a safe environment for the patient-you have to want it In everything you do patient safety has to come first What are your commitments to patient safety?

8. Commitment to Patient Safety Through Education Hardwiring Excellence Practicing Excellence The 7 Habits of Highly Effective People If Disney Ran Your Hospital How Full is Your Bucket Customer Service in Health Care Flight of the Buffalo

9. Commitment to Patient Safety Through Process Improvement Tools TeamSTEPPS Lean Balanced Scorecard

10. Results of Patient Safety Commitment

11. Examine Culture and Address Issues Culture must be a just culture: 1.Culture in facility must be open and fair 2.Culture must be one of learning 3.Culture must design safe systems 4.Culture must manage behavior choices

12. Behavior Standards Based off the book Hardwiring Excellence Developed by employees They are part of annual review and count equally with job performance Scores are calculated from peer review A score of 80 or below requires employee to be on probation If, in 90 days a repeat peer review does not score higher than 80 they are terminated

13. Culture is by far the most important aspect of successful implementation of EHR

14. Determine the Vision US EMR Adoption Model SM StageCumulative Capabilities 2010 Q2 2010 Q3 Stage 7 Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 0.8%1.0% Stage 6 Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS 2.6%2.8% Stage 5 Closed loop medication administration 3.2%3.7% Stage 4 CPOE, Clinical Decision Support (clinical protocols) 9.7%10.3% Stage 3 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 50.2%49.7% Stage 2 CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable 15.5%15.4% Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 6.8%6.7% Stage 0 All Three Ancillaries Not Installed 11.2%10.5% Data from HIMSS Analytics TM Database © 2010N = 5,217N = 5,233

15. Once vision determined-next step Perform a gap analysis 1.What do you currently have in place and is it working for you? 2.What systems do we need to meet MU? 3.What other systems do you want in place for patient safety? 4.What resources do you need to meet goal?

16. Evaluation of Financial Options Michael Pracheil CFO What capital is needed? 1.Considerations should include software, hardware, training, travel, data migration 2.Disaster recovery costs 3.Fire suppression and data protection

17. Financing Is there enough cash on hand for project? Lease options? Donations and grant available? What resources are available through Medicare and Medicaid?

18. Medicare Share Reasonable cost is based on cost incurred for purchase of certified EHR system during the cost reporting period and similarly incurred cost from previous cost reporting period Includes acquisition costs for the purchase of depreciated assets such as computers and hardware and software

19. Example CAH A incurred reasonable cost of $500,000 for purchase of certified EHR during previous cost reporting period. The CAH depreciates $100,000 in previous cost report leaving $400,000 of undepreciated costs

20. Calculation for Medicare Reimbursement Formula for calculating Medicare Share: __ #IP Part A Days + #IP Part C Days___ + 20% Total IP Days x Total Charges - Charity Care Total Charges

21. CAH A Information CAH A had 300 Part A IP days and 400 Part C IP days, total inpatient days were 1,000, total charges excluding charity care were $2.0M, total charges were $2.2M

22. Results for CAH A _____700_______ 1,000 x _$2.0 M__ +20% $2.2 M Equals 97% Preliminary Incentive Payment of $388,000

23. Incentive Payment The best advice concerning incentive payment is: KEEP UP Changes can occur all the time. What you learn today may not apply tomorrow!

24. Formulation of EHR Implementation Team Team should have representation from all departments Open communication vital for success of team All members of the team do not need to agree Set goals and meet those goals Total team commitment to get project completed Regular meetings are important

25. Vendor selection process Desired ServiceVendor 1Vendor 2Vendor 3 eRXyes Robust CDSSnoyes Facility-wide integration yesnoyes Ability to enter future orders noyes Hospital Templates yes Fax patients information yes cost$1.8M$1.011M$2.1M

26. Develop Timeline for Project Numerous methods available to use for timeline Identify tasks and mark the tasks that are mission critical Set start and stop dates Identify people in charge of tasks Hold people accountable for tasks and deadlines

27. Timeline example

28. Accountability for project Strong leadership must be in place to ensure timelines are met Accountability can be obtained through the use of just culture and behavior standards

29. Success of Project Success can be judged by employees and physicians who are satisfied with the system and patients see a positive outcome from implementation

30. An Interoperability Option Dan Engle CIO

31. Nationwide Health Information Exchange The Nationwide Health Information Network (NHIN) is being developed to provide a secure, nationwide, interoperable health information infrastructure that will connect providers, consumers, and others involved in supporting health and healthcare. This critical part of the national health IT agenda will enable health information to follow the consumer, be available for clinical decision making, and support appropriate use of healthcare information beyond direct patient care so as to improve health.

32. Challenges Few rural existing examples Lack of information about options Broadband cost and availabilities Legal barriers

33. TCHS demonstration!

34. Thayer County Chose Mirth MUX option MUX ( Meaningful Use eXchange ) National or Global vs. Statewide Cost Minimal bandwidth requirements Non-EHR specific

35. CONNECT CONNECT gateway ( open source ) 2 step request for information Health Care facilities that have an agreement Patients data that is requested displays

36. Information Technology said it would work Test data had only been sent on the NHIN between facilities There were doubts from other HIEs 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 Joyce Beck CEO

37. 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

38. 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

42. 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

43. 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

47. Interoperability is a part of MU Ask questions Talk to vendors Dont accept one solution options Dan Engle CIO

48. Dont Worry about Interoperability, Until you are Operable!

49. References http://www.csm.gov/EHRIncentivePrograms Seim Johnson Accounting Firm CUSP Consultants

50. Questions?

51. Contact Information Joyce Beck, CEO ceo@tchsne.orgceo@tchsne.org Rita Luongo, Marketing Director rluongo@tchsne.orgrluongo@tchsne.org Michael Pracheil, CFO cfo@tchsne.orgcfo@tchsne.org Daniel Engle, CIO cio@tchsne.orgcio@tchsne.org www.thayercountyhealth.com