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What to Consider Before Implementing Health  Information Technology Jerri Hiniker, RN, BSN, CPEHR Program Manager
Stratis Health <ul><li>Stratis Health is a non-profit organization that leads collaboration and innovation in health care ...
Regional Extension and Assistance Center for HIT (REACH) <ul><li>Project of Key Health Alliance: Stratis Health, National ...
Today’s Goals <ul><li>Learn how to access, modify and apply HIT tools for your organization </li></ul><ul><li>Identify opp...
HIT TOOLKITS:  BACKGROUND
HIT vs. EHR <ul><li>Health Information Technology   (HIT):  a general concept that describes the technology that supports ...
EHR vs. EMR <ul><li>Electronic Medical Record (EMR) sometimes refers to: </li></ul><ul><ul><li>Physician office EHR </li><...
EHR <ul><li>Encompasses broader view of a health record   moving from notion of a location for keeping track of patient c...
EHR and Health Care Reform <ul><li>Includes patient demographic and clinical health information </li></ul><ul><li>Has capa...
Key HIT Priorities <ul><li>Coordination </li></ul><ul><ul><li>Exchange key clinical information among providers and patien...
Health Information Exchange (HIE) <ul><li>Very strong interest in accessing and exchanging health information in all healt...
THE HIT TOOLKITS:  TOOLS YOU CAN USE
HIT Toolkits  <ul><li>Purpose of the toolkits </li></ul><ul><li>Instructions for use </li></ul><ul><li>Types of tools </li...
Purpose of Toolkits <ul><li>Kick start your HIT and EHR planning </li></ul><ul><li>Formalize the process </li></ul><ul><li...
Instructions for Use: Your Dashboard
Types of Tools <ul><li>Recorded Webinar sessions </li></ul><ul><ul><li>Short (15-20 minute) educational tools </li></ul></...
Tool Structure <ul><li>Purpose  </li></ul><ul><ul><li>Each tool begins with a brief statement of purpose </li></ul></ul><u...
Purpose and Instructions for Use Statement of Purpose
Resources and References
Examples and Illustrations
Tools in Excel
 
THE HIT TOOLKITS:  USING THE TOOLS
Model for Adopting Interoperable Electronic Health Records (Source: Minnesota E-Health Initiative) Assess Plan Interoperat...
Parts of the Toolkit: Adopt <ul><li>Tools to help you assess, plan for, and select HIT and EHR </li></ul><ul><ul><li>readi...
Adopt - Assess <ul><li>How to use the toolkit (Handout, PPT, Webinar) </li></ul><ul><li>HIT Governance </li></ul><ul><li>V...
Communication <ul><li>Communicate  </li></ul><ul><ul><li>Early </li></ul></ul><ul><ul><li>Often </li></ul></ul><ul><ul><li...
Communication Plan EHR Progress
Reviewing Your Readiness <ul><li>Readiness Assessment report </li></ul><ul><li>Attitudes and Skills Survey </li></ul><ul><...
Readiness Assessment Report <ul><li>Interviews with facility leaders and physicians </li></ul><ul><li>Assesses readiness i...
Attitudes Survey * * Risk Area: Where Red + Yellow > 40% Risk Area: Where Red + Yellow > 40%
Computer Skills Survey
Financial Assessment
Adopt - Plan <ul><li>HIT Steering Committee </li></ul><ul><li>Meetings, Agendas, and Minutes </li></ul><ul><li>Clinical IT...
HIT/EHR Steering Committee <ul><li>Physician leader </li></ul><ul><li>Other physician representatives, including </li></ul...
Project Management <ul><li>Ensure readiness </li></ul><ul><ul><li>Provide for EHR education </li></ul></ul><ul><ul><li>Ass...
Job Description
Project Plan <ul><li>Start early to manage tasks </li></ul><ul><li>Manage scope and timeline </li></ul><ul><li>Control “im...
EHR Goals <ul><li>Access data </li></ul><ul><li>Improve quality of care </li></ul><ul><li>Enhance patient safety </li></ul...
Getting Specific (Patient Safety) <ul><li>“ We want to improve patient safety” </li></ul><ul><ul><li>Great, but will physi...
Goal Analysis <ul><li>Are these goals? </li></ul><ul><li>Are they sufficiently measurable? </li></ul><ul><li>What will it ...
Achieving the Goal <ul><li>Step 1. Gain consensus on guideline to help achieve better outcomes </li></ul><ul><li>Step 2. I...
 
Workflow and Process Redesign <ul><li>Process mapping is the task of describing the nature of the tasks associated with ea...
Process Mapping Steps <ul><li>Identify processes to map; define process boundaries </li></ul><ul><li>Define process elemen...
Identify Processes and Boundaries <ul><li>Process mapping should get to a very specific level of detail </li></ul><ul><li>...
Define Process Elements <ul><li>Map information flows </li></ul><ul><li>Ensure all inputs and outputs are identified </li>...
Brainstorm to Refine Tasks <ul><li>Are these all the tasks? </li></ul><ul><li>Are some tasks performed only occasionally? ...
Collect Forms and Reports <ul><li>Identify all forms, their versions, where used, by whom, under what circumstances </li><...
Analyze and Describe Revisions <ul><li>Bottlenecks </li></ul><ul><li>Sources of delay </li></ul><ul><li>Rework due to erro...
Process Improvement <ul><li>Build cohesive teams of individuals who actually perform the process and orient team members o...
Process Improvement <ul><li>Determine the root cause(s) of problems needing improvement </li></ul><ul><li>Identify changes...
Improve/Automate Process <ul><li>Why is it done – is it necessary? </li></ul><ul><li>Why is it done at this location? </li...
For Clinical Transformation <ul><li>Always ask, does it always happen this way? Does it always have to happen this way? </...
Model for Adopting Interoperable Electronic Health Records (Source: Minnesota E-Health Initiative) Assess Plan Interoperat...
Adopt - Select <ul><li>HIT Code of Conduct </li></ul><ul><li>Vendor Selection (Handouts, PPT, Webinar) </li></ul><ul><li>R...
Utilize - Implement <ul><li>Project Planning – Word version </li></ul><ul><li>Project Planning – Excel version </li></ul><...
Utilize – Effective Use <ul><li>Quality Measurement, Reporting, and Improvement Resources </li></ul><ul><li>HIT Adoption M...
Exchange – Readiness <ul><li>HIE Readiness </li></ul><ul><li>HIE Goals and Governance Models </li></ul><ul><li>HIE Technol...
Exchange – Interoperate <ul><li>HIE Data Stewardship </li></ul><ul><li>HIE Interoperability (PPT) </li></ul><ul><li>Policy...
Opportunities for Improvement <ul><li>EHR adoption and implementation should be part of an overall strategic plan </li></u...
Visit Stratis Health TODAY <ul><li>www.stratishealth.org/HIT_Toolkit </li></ul>
Stratis Health: Types of HIT Services <ul><li>Readiness Assessments </li></ul><ul><li>Comprehensive EHR Roadmap </li></ul>...
Stratis Health: Types of Assistance <ul><li>Educational sessions </li></ul><ul><ul><li>Conference presentations </li></ul>...
Resources <ul><li>HIMSS,  http://www.himss.org   </li></ul><ul><ul><li>Technology, resources, tools </li></ul></ul><ul><li...
Thank You! Contact Information: Jerri Hiniker, RN, BSN, CPEHR  Email:  [email_address] Ph:  952-853-8540 To register or fi...
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What to consider before implementing hit final 052710_nn

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What to consider before implementing hit final 052710_nn

  1. 1. What to Consider Before Implementing Health Information Technology Jerri Hiniker, RN, BSN, CPEHR Program Manager
  2. 2. Stratis Health <ul><li>Stratis Health is a non-profit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facility improvement for people and communities. </li></ul><ul><li>Under federal contract, Stratis Health serves as Minnesota’s Medicare Quality Improvement Organization (QIO). </li></ul><ul><li>Stratis Health is also involved in other state and national projects funded through government contracts, foundation and corporate grants, and health systems. </li></ul><ul><li>www.stratishealth.org </li></ul>
  3. 3. Regional Extension and Assistance Center for HIT (REACH) <ul><li>Project of Key Health Alliance: Stratis Health, National Rural Health Resource Center, and The College of St. Scholastica </li></ul><ul><ul><li>Strong track record of success in HIT and EHR technical assistance and support </li></ul></ul><ul><li>Working in close cooperation with: </li></ul><ul><ul><li>North Dakota Health Care Review, Inc. (NDHCRI) </li></ul></ul><ul><ul><li>University of ND, Center for Rural Health </li></ul></ul>
  4. 4. Today’s Goals <ul><li>Learn how to access, modify and apply HIT tools for your organization </li></ul><ul><li>Identify opportunities to utilize the HIT toolkit resources to improve care </li></ul><ul><li>Formalize a process for adopting technology in your organization </li></ul>
  5. 5. HIT TOOLKITS: BACKGROUND
  6. 6. HIT vs. EHR <ul><li>Health Information Technology (HIT): a general concept that describes the technology that supports management of health information for many purposes </li></ul><ul><li>Electronic Health Record (EHR): a specific system of applications and other elements that capture data from multiple sources for clinical decision support at the point of care  wherever that may occur  including promotion of health and wellness </li></ul>Software that directs computer devices People to support and use systems Policy that drives adoption of systems Hardware that enables system use Process that helps achieve results Copyright © 2009, MargretA Consulting, LLC. Used with permission of author.
  7. 7. EHR vs. EMR <ul><li>Electronic Medical Record (EMR) sometimes refers to: </li></ul><ul><ul><li>Physician office EHR </li></ul></ul><ul><ul><li>Hospital document imaging system </li></ul></ul><ul><ul><li>Non-interoperable record of health-related information </li></ul></ul><ul><li>EHR is term used by: </li></ul><ul><ul><li>Federal government </li></ul></ul><ul><ul><li>Institute of Medicine (IOM) </li></ul></ul><ul><ul><li>Health Level Seven (HL7) </li></ul></ul><ul><ul><ul><li>Primary organization to develop interoperability in health care information systems; adopts the term EHR system </li></ul></ul></ul><ul><ul><li>Certification Commission for Healthcare Information Technology </li></ul></ul>
  8. 8. EHR <ul><li>Encompasses broader view of a health record  moving from notion of a location for keeping track of patient care events to a resource with enhanced utility </li></ul><ul><li>Provides longitudinal (i.e., lifelong) access to events that may have influenced a person’s health. Virtual core of a health care delivery system information infrastructure </li></ul><ul><li>Merely automating the form, content, and procedures of current resident/patient records will perpetuate their deficiencies and will be insufficient to meet emerging user needs </li></ul><ul><li>Institute of Medicine, Computer-based Patient Record: An Essential Technology for Health Care, 1991, 1997 </li></ul>
  9. 9. EHR and Health Care Reform <ul><li>Includes patient demographic and clinical health information </li></ul><ul><li>Has capacity to: </li></ul><ul><ul><li>Exchange electronic health information with and integrate such information from other sources </li></ul></ul><ul><ul><li>Capture and query information relevant to health care quality </li></ul></ul><ul><ul><li>Provide clinical decision support </li></ul></ul><ul><ul><li>Support physician order entry </li></ul></ul>
  10. 10. Key HIT Priorities <ul><li>Coordination </li></ul><ul><ul><li>Exchange key clinical information among providers and patient-authorized entities electronically (HIE) </li></ul></ul><ul><ul><li>Summary care record for every transition in care </li></ul></ul><ul><ul><li>Medication reconciliation </li></ul></ul><ul><ul><li>Rx fill status notification </li></ul></ul><ul><li>Population </li></ul><ul><ul><li>Electronically submit/received data to/from immunization registry </li></ul></ul><ul><ul><li>Electronic syndromic surveillance data/reportable lab results to public health; receive public health alerts </li></ul></ul><ul><li>Privacy </li></ul><ul><ul><li>Compliance with HIPAA Privacy and Security Rules </li></ul></ul><ul><ul><ul><li>Conduct or update a security risk assessment </li></ul></ul></ul><ul><ul><li>Compliance with fair data sharing practices (Nationwide Privacy and Security Framework) </li></ul></ul><ul><ul><li>Provide summarized or de-identified data for population/public health reporting and research were appropriate </li></ul></ul>
  11. 11. Health Information Exchange (HIE) <ul><li>Very strong interest in accessing and exchanging health information in all health care settings </li></ul><ul><li>Specific areas of need: </li></ul><ul><ul><li>Medication reconciliation and organization </li></ul></ul><ul><ul><li>Health history and information organization and access </li></ul></ul><ul><ul><li>EHR connections </li></ul></ul><ul><ul><li>Cross-setting connections (e.g., clinic to nursing home) </li></ul></ul><ul><li>Potential barriers to HIE success: </li></ul><ul><ul><li>Lack of capital resources, specifically in some settings </li></ul></ul><ul><ul><li>Lack of knowledge/understanding about HIE </li></ul></ul>
  12. 12. THE HIT TOOLKITS: TOOLS YOU CAN USE
  13. 13. HIT Toolkits <ul><li>Purpose of the toolkits </li></ul><ul><li>Instructions for use </li></ul><ul><li>Types of tools </li></ul><ul><li>Tool structure </li></ul><ul><li>Parts of the toolkits </li></ul>
  14. 14. Purpose of Toolkits <ul><li>Kick start your HIT and EHR planning </li></ul><ul><li>Formalize the process </li></ul><ul><li>Reduce your cost </li></ul><ul><li>Serves as surrogate staff </li></ul><ul><li>Achieve your HIT and EHR goals </li></ul>
  15. 15. Instructions for Use: Your Dashboard
  16. 16. Types of Tools <ul><li>Recorded Webinar sessions </li></ul><ul><ul><li>Short (15-20 minute) educational tools </li></ul></ul><ul><ul><ul><li>Walk through use of key tools </li></ul></ul></ul><ul><ul><ul><li>Introduce key topics for your HIT team, EHR steering committee, staff </li></ul></ul></ul><ul><ul><ul><li>Stimulate team discussion </li></ul></ul></ul><ul><li>Survey forms, checklists, comparisons, charts, tip sheets, interview tools, rating forms, other tools </li></ul><ul><li>Sample job descriptions, policies and procedures, request for proposal, other model documents </li></ul>
  17. 17. Tool Structure <ul><li>Purpose </li></ul><ul><ul><li>Each tool begins with a brief statement of purpose </li></ul></ul><ul><li>Instructions for Use </li></ul><ul><ul><li>Many tools include specific instructions for use </li></ul></ul><ul><ul><li>Some tools are more informative than interactive and may not need instructions for use </li></ul></ul><ul><li>Notes and illustrations </li></ul><ul><ul><li>Some tools include notes to define terms, diagram a concept, or provide references </li></ul></ul><ul><li>Tool </li></ul><ul><ul><li>Microsoft Word, PowerPoint, or Excel </li></ul></ul><ul><ul><li>Modifiable </li></ul></ul>
  18. 18. Purpose and Instructions for Use Statement of Purpose
  19. 19. Resources and References
  20. 20. Examples and Illustrations
  21. 21. Tools in Excel
  22. 23. THE HIT TOOLKITS: USING THE TOOLS
  23. 24. Model for Adopting Interoperable Electronic Health Records (Source: Minnesota E-Health Initiative) Assess Plan Interoperate Readiness Effective Use Implement Select Achievement of 2015 Mandate Continuum of EHR Adoption Adopt Exchange Utilize
  24. 25. Parts of the Toolkit: Adopt <ul><li>Tools to help you assess, plan for, and select HIT and EHR </li></ul><ul><ul><li>readiness assessments </li></ul></ul><ul><ul><li>project management aids </li></ul></ul><ul><ul><li>goal setting tools </li></ul></ul><ul><ul><li>instructions on current workflow and process mapping </li></ul></ul><ul><ul><li>support for understanding the HIT marketplace, issuing a request for proposal, and conducting due diligence for selection and contract negotiation </li></ul></ul>
  25. 26. Adopt - Assess <ul><li>How to use the toolkit (Handout, PPT, Webinar) </li></ul><ul><li>HIT Governance </li></ul><ul><li>Vision and Strategic Planning for HIT (Handout, PPT, Webinar) </li></ul><ul><li>Communication Plan </li></ul><ul><li>HIT Attitudes Assessment </li></ul><ul><li>Computer Skills Survey </li></ul><ul><li>Total Cost of Ownership/Return on Investment Analysis </li></ul><ul><li>IT Staffing Inventory </li></ul><ul><li>IT System Inventory </li></ul><ul><li>HIT Security Risk Analysis and Controls Assessment </li></ul><ul><li>Contingency Plan Assessment </li></ul><ul><li>Application Interface Inventory </li></ul><ul><li>Financing Resources </li></ul>
  26. 27. Communication <ul><li>Communicate </li></ul><ul><ul><li>Early </li></ul></ul><ul><ul><li>Often </li></ul></ul><ul><ul><li>To all </li></ul></ul><ul><ul><li>In many ways </li></ul></ul><ul><li>Communication </li></ul><ul><ul><li>Removes fear factor </li></ul></ul><ul><ul><li>Generates ideas </li></ul></ul><ul><ul><li>Gains buy-in </li></ul></ul><ul><ul><li>Achieves results </li></ul></ul><ul><li>Plan for Communication </li></ul><ul><ul><li>Or it will be forgotten </li></ul></ul><ul><li>Stakeholders: </li></ul><ul><li>Board of Directors </li></ul><ul><li>Physicians </li></ul><ul><li>Administrators </li></ul><ul><li>Clinical leads </li></ul><ul><li>All staff </li></ul><ul><li>Patients </li></ul><ul><li>Payers </li></ul><ul><li>Insurers </li></ul><ul><li>Employers </li></ul><ul><li>Others </li></ul>
  27. 28. Communication Plan EHR Progress
  28. 29. Reviewing Your Readiness <ul><li>Readiness Assessment report </li></ul><ul><li>Attitudes and Skills Survey </li></ul><ul><li>IT inventory and IT staffing </li></ul><ul><li>Financial assessment </li></ul><ul><li>Interpret results and assess your specific needs </li></ul>
  29. 30. Readiness Assessment Report <ul><li>Interviews with facility leaders and physicians </li></ul><ul><li>Assesses readiness in 8 different areas </li></ul><ul><ul><li>  Pre-work in selecting an EHR </li></ul></ul><ul><ul><li>Understanding of associated costs </li></ul></ul><ul><ul><li>  EHR expenditures and benefits (finances and </li></ul></ul><ul><ul><li>financing) </li></ul></ul><ul><ul><li>  Commitment of administration leadership </li></ul></ul><ul><ul><li>Physician support </li></ul></ul><ul><ul><li>Use of technology </li></ul></ul><ul><ul><li>IT infrastructure and support </li></ul></ul><ul><ul><li>Benefits/expectations </li></ul></ul>
  30. 31. Attitudes Survey * * Risk Area: Where Red + Yellow > 40% Risk Area: Where Red + Yellow > 40%
  31. 32. Computer Skills Survey
  32. 33. Financial Assessment
  33. 34. Adopt - Plan <ul><li>HIT Steering Committee </li></ul><ul><li>Meetings, Agendas, and Minutes </li></ul><ul><li>Clinical IT Leadership </li></ul><ul><li>Project Management </li></ul><ul><li>Project Manager Job Description </li></ul><ul><li>Goal Setting </li></ul><ul><li>Change Management </li></ul><ul><li>Workflow and Process Redesign (Handouts, PPT, Webinar) </li></ul><ul><li>Chart Conversion Planning </li></ul>
  34. 35. HIT/EHR Steering Committee <ul><li>Physician leader </li></ul><ul><li>Other physician representatives, including </li></ul><ul><ul><li>Champions </li></ul></ul><ul><ul><li>Curmudgeons </li></ul></ul><ul><li>Representatives from: </li></ul><ul><ul><li>Nursing </li></ul></ul><ul><ul><li>Administration </li></ul></ul><ul><ul><li>Business office </li></ul></ul><ul><ul><li>IT </li></ul></ul><ul><li>Project manager </li></ul><ul><li>Use as applicable: </li></ul><ul><li>Board liaison </li></ul><ul><li>CFO </li></ul><ul><li>Procurement specialist </li></ul><ul><li>Legal counsel </li></ul><ul><li>EHR consultant </li></ul><ul><li>External contract </li></ul><ul><li>negotiator </li></ul>
  35. 36. Project Management <ul><li>Ensure readiness </li></ul><ul><ul><li>Provide for EHR education </li></ul></ul><ul><ul><li>Assess readiness </li></ul></ul><ul><ul><li>Facilitate identifying goals, critical success factors, assumptions, risks, & obstacles </li></ul></ul><ul><li>Organize the effort </li></ul><ul><ul><li>Facilitate formation of EHR steering committee </li></ul></ul><ul><ul><li>Develop job descriptions for new & changed positions </li></ul></ul><ul><ul><li>Plan communications </li></ul></ul><ul><ul><li>Document project tasks </li></ul></ul><ul><li>Initiate change management </li></ul><ul><ul><li>Oversee process mapping </li></ul></ul><ul><ul><li>Identify EHR functional requirements </li></ul></ul><ul><ul><li>Coordinate technical requirements </li></ul></ul><ul><ul><li>Plan chart conversion </li></ul></ul><ul><li>Coordinate vendor selection </li></ul><ul><ul><li>Support code of conduct </li></ul></ul><ul><ul><li>Aid in surveying marketplace & narrowing field of candidates </li></ul></ul><ul><ul><li>Coordinate RFI/RFP issuance, response, & evaluation </li></ul></ul><ul><ul><li>Coordinate due diligence activities </li></ul></ul><ul><ul><li>Assist in identifying financing/ROI </li></ul></ul><ul><li>Coordinate implementation </li></ul><ul><ul><li>Establish progress reporting system </li></ul></ul><ul><ul><li>Maintain issues log problem-escalation </li></ul></ul><ul><ul><li>Install change control process </li></ul></ul><ul><ul><li>Harmonize project plan w/vendor’s </li></ul></ul><ul><ul><li>Develop turnover strategy </li></ul></ul><ul><ul><li>Monitor task completion </li></ul></ul><ul><ul><li>Develop & oversee training plan </li></ul></ul><ul><ul><li>Develop & oversee test plan </li></ul></ul><ul><ul><li>Support system build </li></ul></ul><ul><ul><li>Plan & manage go live </li></ul></ul><ul><li>Coordinate ongoing maintenance & benefits realization </li></ul>
  36. 37. Job Description
  37. 38. Project Plan <ul><li>Start early to manage tasks </li></ul><ul><li>Manage scope and timeline </li></ul><ul><li>Control “implementation” </li></ul><ul><li>Harmonize “installation” component with vendor </li></ul>
  38. 39. EHR Goals <ul><li>Access data </li></ul><ul><li>Improve quality of care </li></ul><ul><li>Enhance patient safety </li></ul><ul><li>Support health maintenance, preventive care, and wellness </li></ul><ul><li>Increase productivity </li></ul><ul><li>Reduce hassle factors/improve satisfaction for clinicians, consumers, and caregivers </li></ul><ul><li>Support revenue enhancement </li></ul><ul><li>Support predictive modeling and contribute to development of evidence-based health care guidance </li></ul><ul><li>Maintain patient confidentiality and exchange data securely among all key stakeholders </li></ul>
  39. 40. Getting Specific (Patient Safety) <ul><li>“ We want to improve patient safety” </li></ul><ul><ul><li>Great, but will physicians? </li></ul></ul><ul><ul><li>Use EHR at point of care? </li></ul></ul><ul><ul><li>To reduce potential medication errors as evidenced by no reportable ADEs, and fewer than 2 anecdotes of near misses per month? </li></ul></ul><ul><ul><li>Using a drug reference tool or comprehensive e-prescribing system? </li></ul></ul><ul><ul><li>Within 12 months of EHR implementation? </li></ul></ul>Who What Why How When
  40. 41. Goal Analysis <ul><li>Are these goals? </li></ul><ul><li>Are they sufficiently measurable? </li></ul><ul><li>What will it take to achieve such access? </li></ul><ul><li>Does the timeline seem appropriate? </li></ul>
  41. 42. Achieving the Goal <ul><li>Step 1. Gain consensus on guideline to help achieve better outcomes </li></ul><ul><li>Step 2. Identify data needed: last procedure/test date, where performed, results; document performance, results, & provider ID, or referral, or instructions to patient </li></ul><ul><li>Step 3. Test data collection using a structured paper form, if desired/applicable </li></ul><ul><li>Step 4. Incorporate into EHR as an alert, prompt, &/or template </li></ul><ul><li>Step 5. Establish measurement scheme (e.g., query database monthly, report by provider, report by results, monitor progress via quarterly QA) </li></ul>
  42. 44. Workflow and Process Redesign <ul><li>Process mapping is the task of describing the nature of the tasks associated with each process </li></ul><ul><ul><li>Processes are tasks performed </li></ul></ul><ul><ul><ul><li>For EHR, processes are how data is collected and processed into information and how knowledge is applied to the information </li></ul></ul></ul><ul><ul><li>Workflow is the sequence in which the tasks are performed </li></ul></ul><ul><li>Process mapping should identify all the detailed steps, in sequence, as well as the supporting forms and/or reports that are currently used or generated in order to ensure all current data collection and information generation processes are identified </li></ul>
  43. 45. Process Mapping Steps <ul><li>Identify processes to map; define process boundaries </li></ul><ul><li>Define process elements: inputs, outputs, tasks, participants – focus on information flow and use </li></ul><ul><li>Brainstorm to ensure all tasks are identified, identify critical tasks, those that don’t belong </li></ul><ul><li>Arrange tasks in sequence, alternative paths </li></ul><ul><li>Identify at what points errors, delays, communication breakdowns, or repetition or rework occurs </li></ul><ul><li>Use process mapping to collect all forms and reports to be automated </li></ul><ul><li>Once current process is mapped, analyze and describe revised processes </li></ul>
  44. 46. Identify Processes and Boundaries <ul><li>Process mapping should get to a very specific level of detail </li></ul><ul><li>Too big a process becomes tedious, and usually involves too many people </li></ul><ul><li>Map processes that are typically separate from one another; e.g., medication ordering may or may not always follow medical history taking </li></ul>
  45. 47. Define Process Elements <ul><li>Map information flows </li></ul><ul><li>Ensure all inputs and outputs are identified </li></ul><ul><ul><li>Paper: sources of data, forms, reports </li></ul></ul><ul><ul><li>Electronic: systems, templates, displays </li></ul></ul><ul><li>Identify all tasks, including those performed mentally (e.g., “Have I checked whether the patient is allergic to the active ingredient in this drug?” is a process that can’t be seen, but is critical to medication ordering process) </li></ul><ul><li>Even though processes on data and flow of information are being mapped, capture who is responsible for each process </li></ul>
  46. 48. Brainstorm to Refine Tasks <ul><li>Are these all the tasks? </li></ul><ul><li>Are some tasks performed only occasionally? Are they included? What triggers their performance? </li></ul><ul><li>Are some tasks performed by others, but part of this process? Include them. </li></ul><ul><li>Are there some tasks identified that really are not a part of this process, but a part of another process? Exclude them. </li></ul><ul><li>What tasks are critical? That is, if not performed, the process is meaningless. </li></ul>
  47. 49. Collect Forms and Reports <ul><li>Identify all forms, their versions, where used, by whom, under what circumstances </li></ul><ul><ul><li>Evaluate whether forms are currently entirely completed and accurate </li></ul></ul><ul><ul><li>Compare similar forms for differences, understand the differences, and map them </li></ul></ul><ul><li>Identify all reports, their versions, who generates them, when, under what circumstances, who uses them </li></ul><ul><ul><li>Determine whether all reports are actually needed and used </li></ul></ul>
  48. 50. Analyze and Describe Revisions <ul><li>Bottlenecks </li></ul><ul><li>Sources of delay </li></ul><ul><li>Rework due to errors </li></ul><ul><li>Role ambiguity </li></ul><ul><li>Duplications </li></ul><ul><li>Unnecessary steps </li></ul><ul><li>Cycle time </li></ul><ul><li>Lack of adherence to standards </li></ul><ul><li>Lack of information </li></ul><ul><li>Lack of quality controls </li></ul>Send politics & personal preferences out the door Always get to root cause
  49. 51. Process Improvement <ul><li>Build cohesive teams of individuals who actually perform the process and orient team members on purpose of process improvement </li></ul><ul><li>Select tools and instruct team members on process improvement methodology </li></ul><ul><li>Map current processes that are impacted by EHR, commonly performed, critical to clinical care </li></ul><ul><li>Leave bias and blame at the door, you want to identify workarounds and issues </li></ul><ul><li>Avoid identifying opportunities for improvement prior to completely mapping current processes </li></ul><ul><li>Obtain benchmark data, using statistical charts, to define expectations for change and for use in benefits realization studies </li></ul>
  50. 52. Process Improvement <ul><li>Determine the root cause(s) of problems needing improvement </li></ul><ul><li>Identify changes that address the root cause(s), not just symptoms </li></ul><ul><li>Document changes by creating an “improved” process map </li></ul><ul><li>Use new processes to identify: </li></ul><ul><ul><li>EHR functional specifications </li></ul></ul><ul><ul><li>Write scenarios for performance requirements </li></ul></ul><ul><ul><li>Build out the EHR system, test, and train to achieve improvements </li></ul></ul><ul><li>Incorporate changes into policy and procedure </li></ul><ul><li>Test new workflows and processes </li></ul><ul><li>Train all on new workflows and processes </li></ul><ul><li>Conduct benefits realization and celebrate successful change/correct course as necessary </li></ul>
  51. 53. Improve/Automate Process <ul><li>Why is it done – is it necessary? </li></ul><ul><li>Why is it done at this location? </li></ul><ul><li>Why is it done at this time? </li></ul><ul><li>Why is it done by this person? </li></ul><ul><li>Why is it done this way? </li></ul><ul><li>What is impact of automation? </li></ul>
  52. 54. For Clinical Transformation <ul><li>Always ask, does it always happen this way? Does it always have to happen this way? </li></ul><ul><ul><li>Why not have as much patient data entered as possible in advance of the hospitalization, then validate it </li></ul></ul><ul><li>Anticipate push back when flows start to differ from today: </li></ul><ul><ul><li>Look closely at multiple forms for one purpose </li></ul></ul><ul><ul><li>Anticipate “downstream” time savings </li></ul></ul><ul><ul><li>Introduce quality checks that improve patient safety, quality of care </li></ul></ul><ul><ul><li>Communication changes must be anticipated and managed </li></ul></ul>
  53. 55. Model for Adopting Interoperable Electronic Health Records (Source: Minnesota E-Health Initiative) Assess Plan Interoperate Readiness Effective Use Implement Select Achievement of 2015 Mandate Continuum of EHR Adoption Adopt Exchange Utilize
  54. 56. Adopt - Select <ul><li>HIT Code of Conduct </li></ul><ul><li>Vendor Selection (Handouts, PPT, Webinar) </li></ul><ul><li>Requirements Analysis </li></ul><ul><li>Request for Proposal </li></ul><ul><li>RFP Analysis </li></ul><ul><li>Key Differentiators </li></ul><ul><li>Due Diligence: Demonstration Plan </li></ul><ul><li>Due Diligence: Site Visit Plan </li></ul><ul><li>Due Diligence: Reference Check Plan </li></ul><ul><li>Vendor of Choice </li></ul><ul><li>Contract Checklist </li></ul>
  55. 57. Utilize - Implement <ul><li>Project Planning – Word version </li></ul><ul><li>Project Planning – Excel version </li></ul><ul><li>Issues Management </li></ul><ul><li>Workflow and Process Improvement </li></ul><ul><li>Policy and Procedure Checklist </li></ul><ul><li>Forms and Reports Analysis </li></ul><ul><li>Input Device Planning </li></ul><ul><li>System Build </li></ul><ul><li>Change Control </li></ul><ul><li>Clinical Decision Support </li></ul><ul><li>Training Plan </li></ul><ul><li>Testing Plan </li></ul><ul><li>Roll Out Strategies </li></ul><ul><li>Space Planning </li></ul><ul><li>Go-live checklist </li></ul><ul><li>HIT Technical Security Controls </li></ul><ul><li>Implementation Strategies for Assessment Documentation </li></ul><ul><li>Implementation Strategies for EDMS and Hybrid Record Risk Management </li></ul><ul><li>Implementation Strategies for Physician Documentation </li></ul><ul><li>Implementation Strategies for Electronic Medical Administration (E-MAR) </li></ul><ul><li>Ongoing System Maintenance, Administration, and Data Quality </li></ul>
  56. 58. Utilize – Effective Use <ul><li>Quality Measurement, Reporting, and Improvement Resources </li></ul><ul><li>HIT Adoption Milestone Results </li></ul><ul><li>Monitoring SMART Goal Achievement </li></ul><ul><li>Benefits Realization </li></ul><ul><li>User Satisfaction </li></ul><ul><li>TCO and ROI Assessment </li></ul>
  57. 59. Exchange – Readiness <ul><li>HIE Readiness </li></ul><ul><li>HIE Goals and Governance Models </li></ul><ul><li>HIE Technology </li></ul>
  58. 60. Exchange – Interoperate <ul><li>HIE Data Stewardship </li></ul><ul><li>HIE Interoperability (PPT) </li></ul><ul><li>Policy and Procedure for Personal Health Records (PHR) </li></ul>
  59. 61. Opportunities for Improvement <ul><li>EHR adoption and implementation should be part of an overall strategic plan </li></ul><ul><li>Infrastructure needs to be well functioning </li></ul><ul><ul><li>Leadership </li></ul></ul><ul><ul><li>Governance </li></ul></ul><ul><ul><li>Project Management </li></ul></ul><ul><ul><li>Staff buy-in </li></ul></ul><ul><li>Goal setting and measuring benefits throughout the process is vital </li></ul><ul><li>Process map and re-design are essential to successful use </li></ul><ul><li>Effective change management is the cornerstone </li></ul>
  60. 62. Visit Stratis Health TODAY <ul><li>www.stratishealth.org/HIT_Toolkit </li></ul>
  61. 63. Stratis Health: Types of HIT Services <ul><li>Readiness Assessments </li></ul><ul><li>Comprehensive EHR Roadmap </li></ul><ul><ul><li>Assess, Plan and Select </li></ul></ul><ul><ul><li>Implement and Optimize </li></ul></ul><ul><li>Workflow redesign </li></ul><ul><li>Cultural adoption </li></ul>
  62. 64. Stratis Health: Types of Assistance <ul><li>Educational sessions </li></ul><ul><ul><li>Conference presentations </li></ul></ul><ul><ul><li>Toolkit tutorials </li></ul></ul><ul><li>Formal Learning Collaboratives </li></ul><ul><ul><li>Three-four learning sessions </li></ul></ul><ul><ul><li>Monthly group or individual consultation </li></ul></ul><ul><li>One-on-one consultations </li></ul><ul><ul><li>Monthly consultation </li></ul></ul>
  63. 65. Resources <ul><li>HIMSS, http://www.himss.org </li></ul><ul><ul><li>Technology, resources, tools </li></ul></ul><ul><li>AHIMA, http://www.ahima.org/ </li></ul><ul><ul><li>Job descriptions, EHR content, legal issues </li></ul></ul><ul><li>Federal Government Health Information Technology Website, http://healthit.hhs.gov </li></ul>
  64. 66. Thank You! Contact Information: Jerri Hiniker, RN, BSN, CPEHR Email: [email_address] Ph: 952-853-8540 To register or find out more information about REACH http://khaREACH.org 877-331-8783, ext. 222

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