Implementing an EMR Implications for Clinicians, IT and Management

Implementing an EMRImplications for Clinicians, ITand Management David Bolt COO and Director of Planning and Business Development Lewis County Primary Care System Vanceburg – Tollesboro – Flemingsburg - Maysville

Maysville Tollesboro Garrison Vanceburg Mason County LewisCounty Laurel Flemingsburg Fleming County

Lewis County Family Health Center Eleanor Johnson Women’s Center Lewis County Family Dental Center Fitness First and Rehab Center Lewis County Primary Care Center Pharmacy Tollesboro Family Health Center Tollesboro Clinic Pharmacy Fleming County Family Health Center Maysville OB/GYN and Family Health Center Garrison Elementary School Clinic Laurel Elementary School Clinic Central Elementary School Clinic Tollesboro Elementary School Clinic Lewis County Middle School Clinic Lewis County High School Clinic

Frame Relay Cloud EMR/MIS and TELEHEALTH CONNECTIVITY TeleRadiologyOffice EMR TeleHealth Connectivity Internet Circa: 2005 Flemingsburg Family Health Center Tollesboro FHC & Pharmacy Comprehend Maysville T-1s Data and Video TeleRad, MRI and Internet Connection 384 PVC Data Connection Fiber Optic Connectivity Data Only Vanceburg Campus Comprehend Vanceburg Lewis Co. Middle School Clinic Rehab Center FCH Laurel Elementary School Clinic Vanceburg FHC Women, Children & MH/SA Sxs. T-1 Video Only Dental Clinic T-1 Video Only Tollesboro Elementary School Clinic T-1s Data and Video Eastern State Hospital University of Kentucky Video T-1 Video Only Kentucky TeleHealth Network Maysville OB/GYN and Family Health Center Video Garrison Elementary School Clinic University of Louisville

1. The amount of success in implementing an EMR is directly proportional to the amount of work you do on the front end. 2. If you are still asking “how much will an EMR cost?”, you are not ready to make the leap. 3. Implementing an EMR is not a 50 yard dash, it is an “iron person” marathon. 4. If you have preconceived ideas about what system you are going to purchase, or if you let a vendor dictate what you do, your chances of creating more problems than you solve increase exponentially. Bolt’s Laws on EMRs

5. Education on use of the system is an ongoing effort. 6. People will create short cuts and when they do it will cause problems. There must be standards of use and everyone must follow the standards. 7. Your utility providers (electric and phone) will become your best friends or your worst nightmare. 8. Printers, batteries and computers have a life expectancy. Most don’t last that long. 9. Someone who says it won’t work, will find the truth is, it won’t work for them. Attitude is everything. Bolt’s Laws on EMRs

Look at an EMR as an investment. Bill Gates in his book Business @ the Speed of Thought cited an article from Windows in Healthcare stating that a 5 physician clinic in Hammond, Louisiana invested $50,000 and saved $60,000 the first year in transcription costs alone. Gates points out that 20 to 30 percent of the cost of healthcare is in paperwork. That amounts to 200 to 300 billion dollars per year, which is more than the gross national product of many countries.

First Steps Develop a Plan on How to Proceed Target “Points of Pain” for Amelioration and Gain Consensus Pick Clinical and Clerical Champions Share it in the Practice Create a Vision

Vision Receiving more timely and accurate payments from carriers Saving time and money in operations Seeing more patients per day Working more productively in practice Improving and consistently tracking intra-practice communications (0rders, phone notes, scripts) Improving the quality of care provided to patients and being able to track the care given Scalability and expandability of new system to accommodate planned growth

Share the Vision Use the “Wouldn’t it be nice if”…. we didn’t loose charts, …you didn’t have to spend evenings finishing the charts, etc. approach Simple approach in staff meetings and individual discussions. Build the concept that it is an investment, not an expense.

Pick Champions • Remember – Other people will use the systems • You need a cross section • They need to be respected in the clinic

The Team Approach Include your champions in key decisions along the way Keep other staff informed

Target the Points of Pain Poor Documentation Lack of continuity between buildings Low Coding Lost Charts Poor Workflow

When there is agreement, you are ready to go.... Develop a Plan

The Plan Must use a team approach - (make sure you understand the difference in users) Establish how success will be measured Develop a realistic timeframe for decision making and implementation Consider the challenges Research what is available Develop a list of features Outline an RFP based on the needs of the practice – not what someone has to sell you Be realistic Be flexible Research the vendor

Among Clinical Providers, CIOs and IT professionals major barriers to implementing an EMR include: Lack of adequate funding or resources Lack of support by medical staff Difficulty in creating a migration plan from paper to electronic health records - from Medical Records Institute “Fifth Annual Survey of EHR Trends and Usage” Challenges in Implementing EMRs

Other crucial barriers to implementing an EMR include: Organization’s Commitment to IT Staffing Lack of Understanding Product Categories, Choice and what is really needed to improve systems of service Challenges in Implementing EMRs

Fear of Change Lack of Buy-In Among Key Physicians, Staff, and especially Management Perceived High Cost of EMR Systems Implementation Timeline Perceived as Too Long Organization Still Not Completely Paperless Immediately Challenges in Implementing EMRs

Management Realize in the beginning that you are making an investment of time and dollars. If you haven’t been a champion in the process up to now, employees may not see the importance of the project. Make sure the system will generate the reports and data you need to manage the practice. Understand that some jobs will change and be prepared to take advantage of the efficiencies created. Don’t stifle creativity, but only implement changes to the system that are reached by consensus among medical staff and other user groups. Set-up a team, maybe the one you used during decision making, to take and evaluate changes in the system and to educate and re-educate users. (should include your vendor) (PDSA approach) Implications

Clinicians To avoid major problems, make sure templates or decision trees, flow charts, etc. fit the needs of the practice and the standards of care before you begin implementation. Phase in implementation- scheduling and other components of practice management system first, then the clinical side. (PDSA approach) In the first few weeks, or even the first couple of months, productivity will drop. Don’t’ be afraid to ask for help or say you don’t know how to do something. Monitor and review charts Re-educate Implications

IT Realize that someone needs to be available/accessible 24/7 (employee or contract service) Be responsive to needs – if it’s broke, then fix it! Participate in the “internal user team”. After all, you speak the language that the rest of us don’t know. The network, the software and the hardware must be maintained. In larger organizations this may be three separate jobs. Implications

Are There Problems? • Sure, but most are manageable and present fewer points of pain than a paper system • Data is more accessible in a real time fashion • Continuity of care among PCPs and work with pharmacists, etc. has improved • We are ready to participate in our State’s Medicaid Modernization Program

David Bolt E-mail: dbolt@lcpcc.org Phone: 606.845.0280 Contact Information

Implementing an EMR Implications for Clinicians, IT and Management