Building Consensus for Electronic Health Records for Information Management in Health Care NUR353 Jacksonville University online School of Nursing

1. Andrew Collins, Joy Culberson, Veronica George,
Jane Glick and Steven Gumbs

2. What is EMR?
 Digital
paper chart
 Medical & treatment history
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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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
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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
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16. Building Consensus-Steps to
gaining consensus
 Step
5: Select a vendor for EHR
 Form a focus group
 Written request
 Demonstrations
 Rank vendors
 Contract
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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
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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
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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
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20. Timeline for EHR
implementation
 Six to nine months before go-live
 Name a project team and define roles and
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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
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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
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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
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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.
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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
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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
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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
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