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Multnomah County Health Department EMR project

Multnomah County Health Department EMR project. Topics covered :-Strategies for planning an EMR projectChallenges and issues in implementationIntegrating EMR with existing Reporting Systems- Improvements in outcomes in patient Flow, closure of encounters and encounter life cycle after EMR.. Multnomah County Health Department EMR project.

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Multnomah County Health Department EMR project

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    1. Multnomah County Health Department EMR project Presentation for NAPHIT Webinars – April 19th, 2006 by Pramod Jacob, Clinical Systems Project Manager, Multnomah County Health Department

    2. Multnomah County Health Department EMR project Topics covered :- Strategies for planning an EMR project Challenges and issues in implementation Integrating EMR with existing Reporting Systems - Improvements in outcomes in patient Flow, closure of encounters and encounter life cycle after EMR.

    3. Multnomah County Health Department EMR project Multnomah County Health Department (MCHD) has provided a combination of population-based public health services and direct access to primary care services for underserved populations since 1860.

    4. Multnomah County Health Department EMR project MCHD services support County citizens, as well as other FQHC and Safety Net providers in the community EMR to be rolled out in :- 6 Primary care clinics 12 School based clinics Specialty clinics TB, HIV,STD Field Services like Early Childhood Services

    5. Multnomah County Health Department EMR project Went live on the EMR with the first test pilot clinic on Oct 25 , 2006. The clinic was the North Portland clinic. Next clinic going live end of this month on April 25th, 2006 Will be followed by a clinic every two months or so.

    6. Multnomah County Health Department EMR project How EMR implemented in MCHD OCHIN was the service provider who house the Epic applications and pipeline it out to MCHD Epic Practice Management has been rolled out for the last three years Now implementing the Epic EMR on top of the Epic Practice Management System.

    7. Multnomah County Health Department EMR project Strategies for planning the implementation of the EMR Formed a Clinical Design Team who designed core EMR The core EMR was then “localized” and configured to fit the local clinic’s workflows Started implementation on the most “vanilla” clinic and then will progress to increasingly more complex clinics

    8. Multnomah County Health Department EMR project Strategies for planning the implementation of the EMR Built a Clinical Systems Team for MCHD Laid out the project plan for the entire roll out across the clinic in MS Projects Then did the detailed project plan for the local clinic on MS Projects

    9. Multnomah County Health Department EMR project Strategies for planning the implementation of the EMR - Held joint meetings with all the stake holders including facilities, hardware, networking etc and carried out walkthroughs of the clinic. Made the providers of the clinic give their input about placement of arms and exam room arrangements.

    10. Multnomah County Health Department EMR project Strategies for planning the implementation of the EMR Took stakeholders input for tasks duration and dates and put it into the project plan. Stakeholders participated in building the project plan Kept a tight track of the EMR implementation progress using project tracking in MS Projects Proactively worked on issues before they could become critical or delay the project.

    12. Multnomah County Health Department EMR project Challenges and Issues in Implementation 1. Inter-organizational 2. Intra-organizational 3. Intra departmental

    13. Multnomah County Health Department EMR project Inter-organizational challenges and issues - The EMR was a joint effort between different organizations needing very close collaboration between the EMR vendor , OCHIN and MCHD. The different organizations may have different perceptions and agendas for the implementation. Need for close collaboration and work on people-people interaction besides the task driven project progress.

    14. Multnomah County Health Department EMR project Intra-organizational challenges and issues - Within Multnomah county the Facilities dept separate from IT dept separate from Health dept. - IT dept has various wings- desktop separate from network separate from LAN etc Getting a task done like putting terminals on arms needed a lot of “herding of cats” Facilities puts up arms then Desktop put up the terminals on the arms and then LAN connects the terminals Reality of working in a county public health department

    15. Multnomah County Health Department EMR project Intra-departmental challenges and issues Being a public health department, decision making is a democratic inclusive process Need to get policies and procedures in place and well documented Getting the providers and clinic support staff buy in is crucial. Got to do hand holding for the technologically challenged. Connecting up with State and Federal Health systems

    16. Multnomah County Health Department EMR project Integration of Existing Reporting Systems:- DEMS and Depression Registry will be phased out and EMR will take over these functionalities. Difficulty in importing over past labs, medications and problem list Working on interfacing with State and Federal health systems like IRIS Integration into existing reporting systems is a challenge and being taken up at the level of the state health dept, Ahlers etc

    17. Multnomah County Health Department EMR project Outcome improvements after EMR There is a trend of significant improvement in outcomes like:- - Cycle time – time for a patient to go through a clinic visit Closure of encounters by providers Encounter life cycle – time between the encounter and billing out a claim for the encounter

    18. Multnomah County Health Department EMR project W.R. E.R. C.O. E to CO Tot AC Provider A Before EMR 03/05 22.1 113.5 136.9 09/05 30.8 106.9 135.5 After EMR 12/05 19.2 35.1 21.5 55.6 77.6 02/06 28.9 34.7 24.3 57.1 86.1

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    20. Multnomah County Health Department EMR project W.R. E.R. C.O. E to CO Tot AC Provider B Before EMR 09/05 48.4 93.1 135.8 10/05 34.8 149.7 166.4 After EMR 12/05 26.9 24.2 12.4 36.6 65.0 02/06 19.1 25.9 22.3 47.9 67.9

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    22. Multnomah County Health Department EMR project W.R. E.R. C.O. E to CO Tot AC Lab Tech Before EMR 03/05 58.7 108.7 111.3 09/05 83.2 126.7 168.7 After EMR 12/05 5.8 46.0 57.6 02/06 19.4 38.2 58.3

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    27. Multnomah County Health Department EMR project In conclusion : There are strong indicators and trends that show the EMR brings about positive changes. The EMR is well worth the expense and effort of implementation.

    28. Multnomah County Health Department EMR project Contact:- Pramod Jacob, Clinical Systems Project Manager, Multnomah County Health Department, Tel: (503) 988-3674 extn : 24381 Email: pramod.d.jacob@co.multnomah.or.us

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