Performance Improvement within an  EHR (Electronic Health Record)       (El t   i H lth R      d)             Launch  WCBF...
Purpose and Learning Objectives   p               g   jPurpose: Introduce basic principles of an EHR  launch and how Lean-...
Key Q  y Questions/Issues• The HITECH Act mandate that health care  entities must implement EHRs by 2015 or face  monetary...
Lou Rhodes, MBA, MBB          ,    ,• Administrator, New York University (Department of Obstetrics and  Gynecology)• Gradu...
Agenda, Ground Rules, andExpectationsE    t ti• Agenda:    g  • HITECH Act provisions  • EHR implementation considerations...
HITECH Act Provisions                        6
HITECH Act Provisions           Provisions*• Health Information Technology for Economic and  Clinical Health Act• Part of ...
Incentives and Penalties*               Penalties• Physician:           Medicare (per            Medicaid (per  Implementa...
Certified EHR Systems              Systems*• Assures purchasers and users that EHR system will meet            p          ...
Meaningful Use*           Use• EHR must be adopted, implemented, or upgraded.• Show use of certified EHR technology that c...
Security Provisions         Provisions*• Strengthens civil and criminal enforcement of HIPAA:   • Four categories of viola...
Impact on EHR Implementation• Restricts selection to approved vendors• Offers incentives for early adopters (and  p  penal...
EHR ImplementationConsiderations                     13
EHR Advantages andDisadvantagesDi d    t        Advantages                    Disadvantages• Reduction of errors          ...
EHR Promoters and Inhibitors          Promoters                     Inhibitors• Change readiness             • Lack of inc...
Transition Friction and Inefficiency                                    1.Slow acceptance and                             ...
Integration                         • EHR enters as an                           technology initiative                    ...
Leveraging Patient Data                                    • Patient EHR:   Patient                           • Continuity...
EHR Implementation at USF Health                                   19
USF Health Overview• Mission: To improve life by improving health through                 p          y p       g          ...
USF Health: EHR Timeline   2006             2007               2008            2009• Vendor        • Initial go-live   • C...
Workflow Design: Deployment ofNew T h lN   Technology or Facility                  F ilitCreate Future          Identify  ...
Design Principles• Fully e-enabled scheduling and check-in:     • Ability to schedule appointments, check-in, pay co-pay (...
Workflow Evaluation: InitialIdentificationId tifi tiProcesses:                        Processes (continued):• Pre-Appointm...
Standardized Workflow: PatientVisitVi it  CCS monitors IDX forarrived Patients specific to                                ...
Clinical Floor Design and Flow                                                                         7                  ...
USF Health: EHR Timeline   2006             2007                    2008            2009• Vendor        • Initial go-live ...
Form: Past Medical History                             28
Change Aid: Provider InstructionTrifoldT if ld                                   29
After Action Review: Issue andAction PlA ti Plan                                 30
Data Entry OptimizationOther staff enters    • Good use of staff data into EHR        • Limited potential for transfer of ...
Key Learnings: USF HealthTransition to EHRT    iti t• Purchasing:   • Select system based on reasonable expectation of nee...
The 4C’s of the EHR*        4C s        EHR    • Completion: All entries finished in total at      time of service    • Co...
Thank you for your time.Questions?                           34
Upcoming SlideShare
Loading in …5
×

Performance Improvement Within An EHR (Electronic Health Record) Launch

682 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
682
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
11
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Performance Improvement Within An EHR (Electronic Health Record) Launch

  1. 1. Performance Improvement within an EHR (Electronic Health Record) (El t i H lth R d) Launch WCBF Lean Six Sigma Healthcare Summit May 2011 Louis C. Rhodes
  2. 2. Purpose and Learning Objectives p g jPurpose: Introduce basic principles of an EHR launch and how Lean-Six Sigma experts can contribute to its successLearning objectives: p• Describe HITECH Act and EHR related impact• Identify key concepts associated with EHR implementation• Describe points at which Lean-Six Sigma experts can support EHR design and launch 2
  3. 3. Key Q y Questions/Issues• The HITECH Act mandate that health care entities must implement EHRs by 2015 or face monetary penalties in the form of reductions in Medicare reimbursements.• What is “meaningful use of electronic health records”?• The role of Lean Six Sigma in the EHR deployment process d l t• Crucial decisions that result in successful EHR adoption and a oidance of e pensi e EHR avoidance expensive mistakes 3
  4. 4. Lou Rhodes, MBA, MBB , ,• Administrator, New York University (Department of Obstetrics and Gynecology)• Graduate of United States Military Academy (BS Management – Engineering) and Xavier University (MBA)• General Electric Certified Black Belt and Master Black Belt in Six Sigma and Lean• Eleven years experience in Six Sigma Lean and Change Sigma, Lean, Management roles: • Two years chemical industry (Millennium Chemicals) • Four years in healthcare equipment and service delivery (GE Healthcare) • Five years academic healthcare (USF Health and NYU School of Medicine)• Expertise in curriculum development and skills transfer to clients 4
  5. 5. Agenda, Ground Rules, andExpectationsE t ti• Agenda: g • HITECH Act provisions • EHR implementation considerations • EHR implementation at USF Health• Ground rules: • Informal environment • Maintain speed • Limit cell phone use • Anything else?• As a group describe expectations for this session group, session. 5
  6. 6. HITECH Act Provisions 6
  7. 7. HITECH Act Provisions Provisions*• Health Information Technology for Economic and Clinical Health Act• Part of the American Recovery and y Reinvestment Act of 2009• $17B allocated for incentives for EHR implementation• Major provisions: • Incentives and penalties • “Certified” EHR Systems • “Meaningful use” of EHR 7* - From HHS.gov
  8. 8. Incentives and Penalties* Penalties• Physician: Medicare (per Medicaid (per Implementation in: eligible professional) eligible professional) • ≤2012 $44K (5 year payout) $64K (6 year payout) • 2013 $39K (4 year payout) $64K (6 year payout) • 2014 $24K (3 year payout) $64K (6 year payout) • 2015 - $64K (6 year payout) • 2016 Payment adjustment $64K (6 year payout) • ≥2017 Payment adjustment -• Hospital: Medicare (base Medicaid (base Implementation in: incentive) incentive) • ≤2013 $2M $2M • 2014 ≤$2M $2M • 2015 ≤$2M; Payment adj. $ ; y j $ $2M • 2016 Payment adjustment $2M • ≥2017 Payment adjustment - 8* - From HHS.gov
  9. 9. Certified EHR Systems Systems*• Assures purchasers and users that EHR system will meet p y requirements for: • Technological capability • Functionality • Security• For certification, EHR s stem m st be tested and certified certification system must by an Office of the National Coordinator (ONC) Authorized Testing and Certification Body (ATCB). 9* - From HHS.gov
  10. 10. Meaningful Use* Use• EHR must be adopted, implemented, or upgraded.• Show use of certified EHR technology that can be measured significantly in quality and in quantity: • Use of certified EHR in meaningful manner (i.e. - e-prescribing) e prescribing) • Electronic exchange of health information to improve quality of health care • Submit clinical quality and other measures• Demonstrating “meaningful use”: • Professional: • 3 core and 3 additional clinical quality measures • 15 core and 5 of 10 meaningful use objectives • Hospital: • 15 clinical quality measures • 14 core and 5 of 10 meaningful use objectives 10* - From HHS.gov
  11. 11. Security Provisions Provisions*• Strengthens civil and criminal enforcement of HIPAA: • Four categories of violations that reflect increasing levels of culpability; • Four corresponding tiers of penalty amounts that significantly increase the minimum penalty amount for each violation; and • A maximum penalty amount of $1.5 million for all violations of an identical provision provision.• Also: • Strikes the previous bar on the imposition of penalties if the covered entity did not know and with the exercise of reasonable diligence would not have known of the violation (such violations are now punishable under the lowest tier of penalties); and • Pro ides a prohibition on the imposition of penalties for an violation Provides any iolation that is corrected within a 30-day time period, as long as the violation was not due to willful neglect. 11* - From HHS.gov
  12. 12. Impact on EHR Implementation• Restricts selection to approved vendors• Offers incentives for early adopters (and p penalties for late adopters) p )• Increases penalties associated with security breaches and data management risks g• Requires investment in quality information collection processes and security protocols 12
  13. 13. EHR ImplementationConsiderations 13
  14. 14. EHR Advantages andDisadvantagesDi d t Advantages Disadvantages• Reduction of errors • Initial investment (software, (information transfer, hardware, internal staff, cross-checks) consultants)• Data mining capacity • Ongoing support costs• D i i support f Decision t for (internal staff, hardware, staff hardware streamlined workflows upgrades)• Immediate information • Transition friction availability • Data entry time• Single record (for hospital or practice)• Potential mobility (?) 14
  15. 15. EHR Promoters and Inhibitors Promoters Inhibitors• Change readiness • Lack of incentives• Physician engagement y g g • Impact on p p productivity and y• Regulatory requirements efficiency• Planning and preparation • Lack of standardization• Adequate support • Cost of transition availability • Changes to workflow Interactions and Trade-offs 15
  16. 16. Transition Friction and Inefficiency 1.Slow acceptance and efficiency improvement 2.Fast acceptance and efficiency improvement 3 • Physician engagement ency 2 • Workflow development 20-30% 1Efficie • Support mechanisms 3.Efficiency improvement Implementation and leverage • Template set-up Time • Tablet use • Dictation software • Further workflow improvements 16
  17. 17. Integration • EHR enters as an technology initiative • Leverage of the EHR People Process occurs ththroughh improved processes • Adoption and utilization of the EHR Technology occurs through people EHR • All are needed for successful implementation and return on investment 17
  18. 18. Leveraging Patient Data • Patient EHR: Patient • Continuity and Electronic Data Hospital availability of Health Workflows information Record • Hospital workflows: • Application of clinical rule-sets rule sets • Triggers for orders Data Mining and actions (Education and • Data Mining: Research) • Ease of case review and comparison • Discrete data availability 18
  19. 19. EHR Implementation at USF Health 19
  20. 20. USF Health Overview• Mission: To improve life by improving health through p y p g g partnership, research, education and healthcare• 3,500 team members of educators, staff, physicians, researchers h• Over 420 physicians, 135 allied health, and 70 nurse practitioners• 2 new out-patient buildings with imaging and an ambulatory surgery center• 500,000 outpatient visits• 33% of Best Doctors in Tampa Bay• $350 million enterprise illi t i 20
  21. 21. USF Health: EHR Timeline 2006 2007 2008 2009• Vendor • Initial go-live • Continued • Workflow selection l ti • Rolling department d t t improvements i t• Planning department go-lives • Tablet roll-out• Workflow go-lives • v11 upgrade development• IT platform upgrades pg Initialinvestment 21
  22. 22. Workflow Design: Deployment ofNew T h lN Technology or Facility F ilitCreate Future Identify Develop Build State Workflow Organization Specifications• Collect voice of • Map current • Identify tasks • Map layout customer c stomer process and assign to • Identify• Describe future • Build future positions technology state process maps • Create requirements• Identify design • Identify gaps/ organizational • Develop principles constraints and structure protocols/ needed actions • Build job policies • Conduct walk- descriptions through Operational Mechanisms: Interdisciplinary Executive Team and22 Workflow Design Teams with change management skills 22
  23. 23. Design Principles• Fully e-enabled scheduling and check-in: • Ability to schedule appointments, check-in, pay co-pay (or balances), and input health status information • Check-in ticket print-out and streamlined on-site process Check in print out on site• All patient care occurs in exam rooms: • Triage, assessment, treatment, and scheduling of appointments occur in the exam room • Phones and computers in each exam room• One-stop shopping: • Referrals and procedures routinely go to USF Health • System and service level supports high availability of appointments ( pp (immediate, space available, scheduled) , p , ) • Additional services (x-ray, lab, ancillary) are completed at time of23 appointment they were identified as a need 23
  24. 24. Workflow Evaluation: InitialIdentificationId tifi tiProcesses: Processes (continued):• Pre-Appointment • No-Shows/Same Day Cancellations• Arrival/Check-in • Nurse/Tech Visit• Paper Scanning • Correspondence • Provider Pro ider Actions• Provider Actions• Other Media Routing• Patient Visit Standardization opportunities: • Positions and abbreviations• Protocol Driven Test • Greenie Construction• CCS Post-Visit • Exam Room Flags• Academic Secretary Post-Visit • Orders and Routing Options g p• Point-of-Service Test • Provider/Designee Delivery• PSR Check-out • Test Classification• CCC check-out • Internal Referral Appointment Needs• Messaging and Tasking• Results Verification24 24
  25. 25. Standardized Workflow: PatientVisitVi it CCS monitors IDX forarrived Patients specific to CCS confirms Examsupported Provider (CCC CCS observes arrival Room availability acts as back-up monitor) CCS moves to appropriateCCS identifies appropriate Patient moves to Clinical Clinical Entry Point, greetsPager number of arrived Entry Point Patient, and confirmsPatient and trips Pager identity CCS collects Pager and CCS collects Greenie and drops into Pager CCS flags Exam Room escorts Patient to Exam Collection Point inside “CCS Intake CCS Intake” Room Clinical Entry Point CCS identifies brief Chief Complaint/Reason for Visit CCS takes Vitals andCCS starts AllScripts note and enters data into enters data into AllScripts25 AllScripts 25
  26. 26. Clinical Floor Design and Flow 7 8 6 3 5 4 3 Floor Guide greets Patient and fast pass checks in, or directs to kiosk or PSR 4 PSR checks-in Patient, receives co-pay, and receives history and releases 5 Patient selects waiting area 6 MA accompanies Patient to exam room 7 MA completes vitals and history; Physician provides care; MA schedules follow-on appointments 8 MA escorts Patient to clinic exit and farewells26 26
  27. 27. USF Health: EHR Timeline 2006 2007 2008 2009• Vendor • Initial go-live • Continued • Workflow selection l ti • Rolling department d t t improvements i t• Planning department go-lives • Tablet roll-out• Workflow go-lives • v11 upgrade development• IT platform IT Train Design Support upgrades pg Upgrade • Install • Provide • Identify • On-site computers/ basic specific support printers training needs • Transition • Check • Set up Set-up to phone platforms templates support Implementation 27
  28. 28. Form: Past Medical History 28
  29. 29. Change Aid: Provider InstructionTrifoldT if ld 29
  30. 30. After Action Review: Issue andAction PlA ti Plan 30
  31. 31. Data Entry OptimizationOther staff enters • Good use of staff data into EHR • Limited potential for transfer of workloadPhysician types • Control into i t EHR • Familiarity with process • Poor use of Physician timePhysician uses • Quick data entrydictation service • Dictation cost • Requirement to check dictationPhysician enters • Quick data entrydata into discrete • Supports ease of researchfields in template • Requires template set-up and some standardizationPhysician utilizes y • Quick data entryvoice recognition • Immediate check of dictation software • Initial cost and training
  32. 32. Key Learnings: USF HealthTransition to EHRT iti t• Purchasing: • Select system based on reasonable expectation of need• Planning: • Create roll out plan for technology training and process actions roll-out technology, training, • Expect transition friction and temporarily reduce scheduled patient load• Physicians: • E Engage early and often l d ft • Consider a physician champion• Workflow: • Plan on changes where technology, people, and process intersect • Consider standardization based on best practices before transition• Communication: • Provide updates often through multiple channels 32
  33. 33. The 4C’s of the EHR* 4C s EHR • Completion: All entries finished in total at time of service • Communication: Ease of access to information and appropriately routed •CCompliance: M t all regulatory li Meets ll l t requirements • Quality: Information is of value* - Dr. Lennox Hoyte, USF Health CMIO 33
  34. 34. Thank you for your time.Questions? 34

×