AmericanEHR Webinar - Chart Conversion in the Small Practice


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One of the biggest roadblocks practices face with electronic health record (EHR) adoption is the conversion of their existing paper charts to their new EHR system. During this webinar Dr. Jacqueline Fincher and Pam Shivers of McDuffie Medical Associates, a four-physician practice in rural GA, will give an overview of how they successfully managed the conversion from both a clinical and administrative viewpoint. Their presentation will touch on some of the unexpected challenges they encountered, how they overcame these challenges, and their hindsight advice to practices preparing for chart conversion.

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AmericanEHR Webinar - Chart Conversion in the Small Practice

  1. 1. Funding to support this Webinar has been provided by Hewlett-Packard Coping with Chart Conversion, Experiences and Techniques from a Small Practice June 30, 2011
  2. 2. Funding to support this Webinar has been provided by Hewlett-Packard Coping with Chart Conversion, Experiences and Techniques from a Small Practice June 30, 2011
  3. 3. Disclosure of Financial Relationships <ul><li>Dr. Fincher and Mrs. Shivers have a relationship with the following proprietary entity producing health care goods or services. </li></ul><ul><li>Owner – GE Centricity EHR System </li></ul><ul><li>Research Grants/Contracts - none </li></ul><ul><li>Speakers Bureau - none </li></ul>
  4. 4. COPING WITH CHART CONVERSION: EXPERIENCES AND TECHNIQUES FROM A SMALL PRACTICE JUNE 30, 2011 Jacqueline W. Fincher, MD, MACP Managing Partner Governor, Georgia Chapter American College of Physicians And Pam Shivers, CPC Practice Administrator McDuffie Medical Associates Thomson, GA
  5. 5. McDuffie Medical Associates 4 Physicians - 2 Internal Medicine, 2 Family Practice 5 LPNS, 3 CMAs, 4 Administrative staff, 1 Practice Administrator
  6. 6. After You Have Selected the EHR, Where Do You Begin? <ul><li>Make a timeline - start 5-6 months before the “Go Live” date – and stick to it </li></ul><ul><ul><li>Complete administrative steps </li></ul></ul><ul><ul><li>Make PM / EHR interface </li></ul></ul><ul><ul><li>Talk to primary labs & hospitals about interfaces </li></ul></ul><ul><ul><li>Set up fax server </li></ul></ul><ul><ul><li>Convert work flows </li></ul></ul><ul><ul><li>Communicate </li></ul></ul>
  7. 7. Timeline for MMA Implementation of EHR <ul><li>Start Training: </li></ul><ul><li>All users train off site for 1 day </li></ul><ul><li>Superusers train for 3 days and given task to complete (i.e. setting up custom lists for referrals, pharmacies, labs,etc) </li></ul><ul><li>Start documenting phone messages in the EHR. </li></ul><ul><li>Start preloading charts </li></ul>&quot;Go Live&quot; (Everything from here out will only be documented in the EHR.) <ul><li>Install EHR and Hardware </li></ul><ul><li>Reduce schedule for Go Live date </li></ul><ul><li>Perform Administrative Functions: </li></ul><ul><li>Set up locations </li></ul><ul><li>Set up providers </li></ul><ul><li>Set up users </li></ul><ul><li>Plan weekly meetings with staff and physicians </li></ul>                                                                                                                                                                                                                                                  1-Jan-05 15-Feb-05 1-Mar-05 11-Apr-05     5-May-05                                                                                                                                                                                                                                                                                                                                                                      
  8. 8. Work Flows <ul><li>Convert your paper chart work flows to electronic work flows </li></ul><ul><li>Examples: </li></ul><ul><ul><ul><ul><li>Office Visits </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Blood draws/Lab work </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Prothrombin times/ INRs </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Allergy/Therapeutic injections </li></ul></ul></ul></ul>
  9. 9. Lab Draw Workflow When the pt comes in the nurse verifies the orders. She hands the pt a form to pick a lab, and/or an ABN to sign (if needed.) The blood is drawn and the nurse documents in the EMR and on the superbill. The chart is sent to the lab queen under an “Admin Hold” status. Once the lab queen prepares the specimen to go out, she changes the status to “In Process” which prints an order to accompany the specimen. The results are sent to the physician’s desktop and the status is “Completed” once the physician signs. The lab queen checks a daily report to verify that all labs have been received.
  10. 10. <ul><li>Work as a team and communicate daily on how it is going </li></ul><ul><li>Ask the Vendor if there are tools to help the preload process </li></ul><ul><li>Preloading should start as soon as possible </li></ul><ul><li>Everyone should preload to learn the system (this is a must) </li></ul>Preloading Charts
  11. 11. What will you need to convert Paper to Electronic? <ul><li>Excellent staff and physician communication </li></ul><ul><li>Fax server – helpful even with paper charts </li></ul><ul><li>Checklist of key items & documents to preload </li></ul><ul><li>Electronic preload option/form to help guide staff when preloading charts </li></ul><ul><li>TIME to do the preloading </li></ul><ul><li>Reduced appointment schedule starting at “Go Live” date </li></ul>
  12. 12. Work Flow for Preloading Charts <ul><li>Start with phone messages 2 or 3 months out </li></ul><ul><ul><li>Office staff documents the phone message in the EHR and preloads the chart. The paper chart is placed in the stack for the physician to view and he/she answers the phone message using the EHR. </li></ul></ul><ul><li>Preload frequent flyer patients </li></ul><ul><ul><li>Doctors about 5-10 charts a day </li></ul></ul><ul><ul><li>Each staff member is to do as many as they can do throughout the day – you can set goals </li></ul></ul><ul><li>Start preloading upcoming scheduled patients beginning with “Go Live” date </li></ul>
  13. 13. List of Items to Preload
  14. 14. Find Ways to Make Preloading Easier Our Vendor was able to send the patients most recently used ICD-9 codes on claims in our PM product to our EHR. All of the ICD-9 codes for each patient were down loaded into the chart and sitting on hold until the patient came in. At that point the provider could pick the appropriate diagnoses.
  16. 16. Work Flow for the Chart Conversion <ul><li>We used a Stop Light System. </li></ul><ul><ul><li>The charts were pulled for the next day and a GREEN dot was placed on the chart. It moved with the patient around the office as usual. The paper chart was for read only – everything was documented in the EHR. </li></ul></ul><ul><ul><li>The nurses preloaded any additional information. </li></ul></ul><ul><ul><li>The doctors flagged anything in the chart they wanted preloaded or scanned in </li></ul></ul><ul><ul><li>The next time the patient came in, the chart got a YELLOW dot, and finally a RED dot on the third visit. </li></ul></ul>
  17. 17. <ul><li>The fourth time the patient </li></ul><ul><li>came in, the chart was not pulled because of the RED dot. </li></ul><ul><li>YAY!!! </li></ul><ul><li>Is what your staff will say when </li></ul><ul><li>they do not have to pull or file charts! </li></ul><ul><li>The Goal of the </li></ul><ul><li>Stop Light System </li></ul><ul><li>is to have everything in the </li></ul><ul><li>EHR that the physician and office </li></ul><ul><li>needs after the third visit. </li></ul>
  18. 18. <ul><li>What did not work: </li></ul><ul><li>Patient history tool </li></ul><ul><li>Picking the correct observation terms (“Obs term”) </li></ul><ul><li>the first time </li></ul><ul><li>Too much time spent on customizing EHR templates up </li></ul><ul><li>front. </li></ul><ul><li>What was hard: </li></ul><ul><ul><li>Reducing the schedule for three months </li></ul></ul><ul><li>Same day appointments </li></ul><ul><li>Keeping everyone from pulling </li></ul><ul><li>their hair out!! </li></ul>
  19. 19. What are we doing 5 years later? <ul><li>Archiving patients’ paper charts that have not been in our office in three years – these will go to storage </li></ul><ul><li>Scanning the paper charts of established patients into a PDF documents </li></ul><ul><ul><ul><li>To make it easy to find we are dating the document the “Go Live” date </li></ul></ul></ul><ul><ul><ul><li>Scanning all into one document as a PDF file, but you could separate the lab and X-ray from the office visits </li></ul></ul></ul><ul><li>Attaining Stage 1 Meaningful Use </li></ul><ul><li>Becoming a Patient Centered Medical Home </li></ul>
  20. 20. Our Advice to You <ul><li>Communicate </li></ul><ul><li>Stay on task </li></ul><ul><li>Work as a Team </li></ul><ul><li>Never go back to paper </li></ul>
  21. 21. QUESTIONS?
  22. 22. QUESTIONS?
  23. 23. QUESTIONS?
  24. 24. Funding to support this Webinar has been provided by Hewlett-Packard Coping with Chart Conversion, Experiences and Techniques from a Small Practice June 30, 2011