Information Management for Health Care

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Information Management for Health Care Group E Presentation
Building Consensus for Electronic Health Records
Jacksonville University Online School Nursing NUR353

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Information Management for Health Care

  1. 1. Andrew Collins, Joy Culberson, Veronica George, Jane Glick and Steven Gumbs
  2. 2. What is EMR?  Digital paper chart  Medical & treatment history     Track data over time Determine when due for check up Check parameters such BP & vac. Monitor quality of care within practice  Difficult to transfer out of facility  Little improvement over paper charting Garrett & Seidman, 2011 2
  3. 3. What is EHR?  Total health of patient  Reach beyond initial health organization  Share health information  Other providers  Laboratories  Specialists   Moves with the patient Accessed by all involved in patient care including patients Garrett & Seidman, 2011 3
  4. 4. Advantages of EHR  Contain and share patient information from all providers  Reduce medical error  Improves accuracy  Clarity of medical records  Available information  Reduce  Duplicate tests  Delay in treatment  Patient well informed  Better decisions about care CMS.gov, 2012 4
  5. 5. Drawbacks to EHR  Acquisition costs  Hardware and software  Loss of revenue due to decreased productivity  One study involving several internal medicine clinics estimated a productivity loss of 20% in the first month, 10% in the second month, and 5% in the third month, with productivity subsequently returning to its original levels.  Full-time salaries for employees hired to input existing patient data  Ongoing maintenance costs 5
  6. 6. Drawbacks to EHR  Patient privacy  Liability concerns by physician/hospitals with respect to protecting electronic data  Inability to do a thorough “look back” in a patient’s record without piling through volumes of data Wang, Middleton, & Prosser et al., 2003 6
  7. 7. Building consensus- Steps to gaining consensus  Step 1: Assess readiness  Where is the facility now in terms of automation? Is anything currently automated? What stage is the facility at in terms of the HIMSS Analytics Adoption Model?  Stage 0: Automation exists but not all systems are operating  Stage 1: Laboratory, pharmacy, and radiology departments       installed Stage 2: Clinical documentation automated, EMR present and integrated with clinical data repository Stage 3: Nursing documentation/flow sheets are in place and physicians can retrieve/view basic documentation Stage 4: Computerized provider order entry in place (CPOE) Stage 5: Barcode medication administration (BCMA) or radio frequency identification (RFID) implemented Stage 6: Physician documentation, full clinical decision support system and picture archiving and communication system in place Stage 7: Completely paperless 7
  8. 8. Building consensus-Steps to gaining consensus  Step 1: Assess readiness (continued)  Is there commitment from administration to implement EHR?  Support from administration imperative for implementation to occur  Are funds available to implement EHR?  Cost  Size, location, system  Well designed and correct implementation of EHR will reduce errors, improve quality of care, increase physician and patient satisfaction which will lead to lower costs Haugen & Sebelius, 2008 8
  9. 9. Building Consensus- Steps to gaining consensus  Step 1: Assess readiness (continued)  How much experience does the current staff have with technology?  For success in implementing EHR, clinician involvement and acceptance of changes is imperative  Resistance to change from medical staff  Consider technical proficiency of staff when selecting a system 9
  10. 10. Building consensus- Steps to gaining consensus  Step 2: Conduct focus groups  Have representation from all stakeholders affected by the change involved in the focus groups  Members of the focus group(s) identify needs form a clinical and administrative perspective.  Members discuss impact of workflow  Appoint a leadership team to oversee implementation Hebda & Czar (2013) 10
  11. 11. Building Consensus- Steps to gaining consensus  Step 3: Set goals for the EHR system  Goals should be “SMART”  Specific  Measurable  Attainable  Relevant  Time bound HealthIT.gov, 2012 11
  12. 12. Building Consensus- Steps to gaining consensus  Step 3: Set goals for the EHR system (continued)  Examples of goals  Establishment of a focus group  Selection of EHR system  Creating a time line  Allocating resources  Training hospital staff  Launching the system 12
  13. 13. Building Consensus- Steps to gaining consensus  Step 3: Set goals for the EHR system (continued)  Goals should coincide with meaningful use. What is meaningful use?  Discrete structured data available through other healthcare facilities  Meaningful use Stage 1 criteria         Computer provider medication orders Medication list Allergies Problem list Discharge instructions Decision support tools Growth charts for children Providing patient electronic health information Patrick, 2013 13
  14. 14. Building Consensus- Steps to gaining consensus  Step 3: Set goals for the EHR system (continued)  Meaningful use Stage 2 criteria  Tracking medication from order to administration  Secure electronic messaging  Outpatient lab reporting  Discharge prescriptions  Recording clinical notes  Patient family history  Exchange of health information McCartney, 2013 14
  15. 15. Building Consensus-Steps to gaining consensus  Step 4: Prioritize goals  Short-term goals  Focus groups  Time line  Selecting vendor  Long-term goals  Installing EHR  Training staff  Launching system 15
  16. 16. Building Consensus-Steps to gaining consensus  Step 5: Select a vendor for EHR  Form a focus group  Written request  Demonstrations  Rank vendors  Contract 16
  17. 17. Building Consensus- Steps to gaining consensus  Step 6: Create a plan/timeline for implementation  Request input from clinical and support staff  Perform workflow analysis  Arrange for workflow redesign  Create an abstraction plan  Create a timeline for implementation 17
  18. 18. Building Consensus-Steps to gain consensus  Step 7: Communicate  Communication should happen often and to all employees of the facility throughout the entire transition to EHR  When “go-live” is ready to occur, a meeting should occur whereby the leadership committee/team assigned by presents the plan for the entire facility 18
  19. 19. Timeline for EHR implementation  Nine to 12 months before go-live  Obtain support from facility leadership  Submit request for proposals  Choose vender and make a shortlist  Plan training and implementation  Evaluate current project management 19
  20. 20. Timeline for EHR implementation  Six to nine months before go-live  Name a project team and define roles and      responsibilities Develop workflows Plan abstraction for transferring paper information to system Examine templates and data elements Evaluate data elements for billing and patient encounters Define necessary hardware/software needs 20
  21. 21. Timeline for EHR implementation  Three to six months before go-live  Install hardware  Assess readiness of staff  Plan for training of staff and super users  Compare installation timeline with vender’s timeline  Notify patients of new system, explain benefits and ask for feedback 21
  22. 22. Timeline for EHR implementation  One to three months before go-live  Build and test interfaces  Test readiness system  Fill in patient records  Adjust schedules for patients  Arrange staff schedules 22
  23. 23. Timeline for EHR implementation  About 30 days before go-live  Customize templates  Decrease patient load for going live  Test and recheck system, workflows, etc. 23
  24. 24. Timeline for EHR implementation  From 30 to 120 days after go-live  Examine provider’s templates in system  Share protocols among staff  Create a network with other facilities for support and feedback  Discuss with vendor about concerns or questions Ehrintelligence, 2012 24
  25. 25. Summary  Learned what an EMR/EHR are and their differences  Benefits and challenges of EHR  Steps to building a consensus  Assessment of readiness in a facility  Process to conduct focus groups  Importance of setting SMART goals that coincide with meaningful use  How to choose a vendor  Created a plan for implementation 25
  26. 26. References Benefits of ehr's. (n.d.). Definition and benefits of electronic medical records . Retrieved from http://www.healthit.gov/providers-professionals/electronic-medical-records-emr EHR implementation timeline for hospitals. (2012, June 14). EHRintelligencecom. Retrieved from http://ehrintelligence.com/2012/06/14/ehr-implementation-timeline-for-hospitals/ Electronic Health Records. (2012, March 26). - Centers for medicare & medicaid services. Retrieved from http://www.cms.gov/Medicare/E-Health/EHealthRecords/index.html Garrett, P., & Seidman, J. (2011, January 4). Health it buzz emr vs ehr what is the difference Retrieved from http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/ HealthIT.gov. (n.d.). Selecting an ehr system or upgrading an ehr system. Retrieved from http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-2-plan-your-approach Hebda, T., & Czar, P. (2013). Handbook of informatics for nurses & healthcare professionals (5th ed.). Boston: Pearson. McCartney, P. (2013). Meaningful use stages 1 and 2. Health information technology, 38(January/February), 1st ser., 56. Mooney, B. L., & Boyle, A. M. (2011, May 10). 10 steps to successful her implementation | medical economics. Medical Economics. Retrieved from http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modernmedicine-feature-articles/10-steps-successful-ehr-imple Patrick, K. (2013, November 7). How to convert paper charting to electronic charting [Personal interview) Wang, S. (2003). A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine, 114(5), 397-403. doi: 10.1016/S0002-9343(03)00057-3 Zandieh, S. O., Yoon-Flannery, K., & Kuperman, G. J., et al.(2008). Challenges to ehr implementation in electronic. Journal of General Internal Medicine, 23(6), 755-761. doi: 10.1007/s11606-008-0573-5 26

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