Planning for Your EHR: Answering the Tough Questions

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Adopting an EHR isn’t easy. If things go badly, your medical practice’s productivity could drop like a stone, your staff may have trouble performing basic functions and even patient care could suffer. But if you plan well, your EHR launch can be nearly painless – and you’ll dramatically increase your chances of earning Meaningful Use payouts from the federal government.

If you’re determined to make your EHR rollout a success, check out this presentation.

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Planning for Your EHR: Answering the Tough Questions

  1. 1. Planning for Your EHR:Answering The Tough QuestionsMartin SizemoreDirector, Healthcare StrategyPerficient, Inc. EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any form or medium without express written permission of Access Intelligence, LLC is prohibited.
  2. 2. Agenda• Introduction and Background• People – Are we “do it yourselfers” or do we need outside help? – Is the project leader committed to success? – What is the level of staff readiness for an EHR? – Can we get outside help?• Process – Will an EHR impact our regular workflow? – What is the impact on our billing – faster or slower?• Technology – What about the total cost of ownership? – Can’t we just do all of this stuff over the web? – What about security and privacy management? EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any8/17/2011 form or medium without express written permission of Access Intelligence, LLC is prohibited.
  3. 3. Ten Key Issues in Healthcare Systems1. How to create a patient’s health record2. How to build a lifelong health history for a patient from information stored in multiple, diverse systems3. How to manage identity and authorities4. How to identity a patient (or a healthcare professional) uniquely and reliably5. How to “join up” different systems on different platforms6. How to interconnect diverse systems and how to make them interoperate7. How to communicate with remote systems8. How to reuse legacy systems9. How to achieve flexibility and agility10. How to achieve performance and scalability EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any form or medium without express written permission of Access Intelligence, LLC is prohibited.
  4. 4. Our view of the EHR evolution• Connected systems – Software networks that span applications, devices, services, and healthcare organizations to help streamline processes, improve knowledge sharing and reduce costs• Information-driven software – New applications that dramatically improve the way healthcare workers find, organize and act on information, facilitating better collaboration and quality of care• Collaborative environments – Rich interfaces and new experiences that help improve collaboration and consultation for healthcare workers and patients using high-quality audio, video and natural language EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any form or medium without express written permission of Access Intelligence, LLC is prohibited.
  5. 5. Current State Assessment• Ambulatory Care - Doctor’s Office Visit – Customer satisfaction is low but volumes of activity remain high, building pent-up frustration – Processes that are non-value-added to the patient are relatively high cost to the provider • Tasks are highly repetitive and clerical in nature • Routine tasks are medium to high in complexity • Manual hand-offs between processes create a high probability of failure and rework EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any form or medium without express written permission of Access Intelligence, LLC is prohibited.
  6. 6. Current State Assessment– Quality problems appear at the outset of the process and get worse as activities unfold • Simple, routine manual tasks are most susceptible to error • Standard patient data, manually input across disparate systems is error prone – at risk for improper coding EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any form or medium without express written permission of Access Intelligence, LLC is prohibited.
  7. 7. Typical Practice Workflow– Processes are not standardized. Each office institutes its own procedures • Standardization appears to stem from outside influences only – insurance carriers, regulators • There are disparate systems, inconsistent policy interpretation, duplication of effort, user confusion– Critical processes are not documented, providing few controls and little discipline • Critical tasks require specific expertise, but are typically mastered by only one or two staff members • Consistent quality assurance cannot be monitored or maintained • Utilization of staff managed via the “Walking Around” method– Each process, if done correctly, would significantly differentiate a provider’s service offerings EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any form or medium without express written permission of Access Intelligence, LLC is prohibited.
  8. 8. Technology Used Inconsistently – Practices lose efficiency by inconsistent or inefficient use of technology • Generic out-of-the-box Electronic Health Record (EHR) applications are set up to meet unique office policies • Technology is used for record keeping only. Work processes remain manual in nature EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any form or medium without express written permission of Access Intelligence, LLC is prohibited.
  9. 9. Know Your Technology Style Is A Key Starting Point“Do It Yourself” types Outside Help• Install your own PCs and • Want to avoid managing servers my own servers, but• Don’t mind the weekly willing to manage local Microsoft Windows updates PCs• Back-up the computers on a regular basis and know how • Need to focus on what we to do a system restore do best, not managing• Like to train office staff on our own IT Windows and new applications • Don’t want to manage the constant updates from anyone EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any8/17/2011 form or medium without express written permission of Access Intelligence, LLC is prohibited.
  10. 10. Is the project leader committed to success?• Patience, patience, patience (especially around patients)• It will take time to master – by each of us• Continuous improvement – can I accept making mistakes and learning from them?• It will take a plan for when things don’t work exactly right – power out, Internet connection down, staff illness or vacation EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any8/17/2011 form or medium without express written permission of Access Intelligence, LLC is prohibited.
  11. 11. What is the level of staff readiness for an EHR?• Make an honest healthcare IT skills assessment of each staff member – Level of Microsoft Windows knowledge – Ability to learn the EHR software application – navigate the screens, print the reports, etc. – Understanding of key data elements and importance of data accuracy – Confidence in working with computers EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any8/17/2011 form or medium without express written permission of Access Intelligence, LLC is prohibited.
  12. 12. Can we get outside help?• Funding – Can we get funding help at the local level? – Can we get funding help at the Federal level?• Consulting – Do we need help to get the EHR implemented? – Do we need to evaluate or update our workflows?• IT Help – Can we just hire temporary IT help to get the software going? – Do we need periodic or annual maintenance help? EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any8/17/2011 form or medium without express written permission of Access Intelligence, LLC is prohibited.
  13. 13. How will an EHR impact our regular workflow?• Is our current workflow documented and well understood by the staff?• Can the software be changed easily to meet our current process?• Should we change our process to follow the software? How hard will it be to adapt?• When do we need to create and maintain hard copies of information? EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any8/17/2011 form or medium without express written permission of Access Intelligence, LLC is prohibited.
  14. 14. EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in anyform or medium without express written permission of Access Intelligence, LLC is prohibited.
  15. 15. What is the impact on our billing – faster or slower?• Does the billing portion of the application support both ICD-9 and ICD-10?• Can we send 4010 and 5010 transactions to health plans and insurance companies?• Can we send or receive electronic Continuity of Care documents to participate in a Health Information Exchange (HIE)?• Can we check insurance eligibility quickly and easily? EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any8/17/2011 form or medium without express written permission of Access Intelligence, LLC is prohibited.
  16. 16. Technology• Technology – What about the total cost of ownership? • Assess the hidden costs – administration and oversight of the system, project planning, annual maintenance, archiving of old records – Can’t we just do all of this stuff over the web? • Good choice – with the right vendor and understanding of the pros and cons • What happens with the internet connection is down? – What about security and privacy management? • Must be planned, reviewed and tested – frequently EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any8/17/2011 form or medium without express written permission of Access Intelligence, LLC is prohibited.
  17. 17. Set goals for your EHR implementation• People – Experienced staff elevated from clerical tasks and routine, rules-based decision making – User held responsible for basic data integrity – Workflow activity levels monitored to better balance staff workload – Time available for cross training and knowledge transfer• Process – Standardized, measurable, repeatable processes that work across a broad range of ambulatory services – Once and done processing – touch data once, QA once, set appointment once, etc. – Straight through processing – eliminate bottlenecks, rework, clerical, duplicate and repetitive tasks EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any form or medium without express written permission of Access Intelligence, LLC is prohibited.
  18. 18. Where do you want to go in the future?• ePrescribing – may be a necessity• Online physician referrals• Portable medical records• Patient data entry of personal details and interfaces to home monitoring devices• Online reporting, email notifications and medical reminders• Security enabled, multi-tiered online access to patient records• Rules based automation of scheduling, insurance eligibility verification, data capture, diagnostic and procedural coding, and billing• Centralized recordkeeping for improved security, system-wide access and business continuity• Practitioner access to affiliated facilities and professionals regardless of location EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any form or medium without express written permission of Access Intelligence, LLC is prohibited.
  19. 19. Q&A• How much time do you plan to spend on implementing your EHR?• What is your budget for training?• How will you decide if the implementation is a success? (Determine this answer before you start) EHRoutlook is a division of Access Intelligence, LLC. Reproduction in whole or in part in any form or medium without express written permission of Access Intelligence, LLC is prohibited.

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