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7 Symptoms of a Troubled Implementation andWhat to Do About ItCarolyn P. Hartley, MLAPresident, CEO Physicians EHR, Inc Former VP, Media RelationsPresented to MGMA, October 7, 2013
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Carolyn P Hartley, MLA
• Consultant • Share Best Practices • Stabilize EHR Installs
• Author • EHRs, HIPAA, ICD-10, MU
• HIM Strategist for • Multi-specialty practices • Specialty practices • Small-midsize hospitals
• Speaker, Facilitator • Founder, Physicians EHR, Inc
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1
•Signs of Trouble
2
•Stabilize Process
3
•Replace (Scrap) Process
4
•Decision Points/ Next Steps
5
•Questions, situations Today’s Overview
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Why I love my EHR – a good starting point• Complete snapshot of practice • Better scheduling, better patient planning • Improved patient preventive care • Efficient refills • Supports mobile access • Access to other clinical protocols from MD leaders • Data drives decisions • More thorough documentation; justified billing • Hands-free dictation (voice recognition / natural language • Supports disciplined workflows
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Why I Dislike My EHR* • Definition of productivity has changed dramatically• Templates don’t work for some specialties• Templates are too easy to create, not centralized • Enterprise system better to manage than interfaced EHR /PMS• Network Issues • Cannot trust details in record – big fear of patient safety • Upgrades are very disruptive • Alert fatigue • System is clunky, not user friendly • Not enough space for dictation; rolls to another screen • Outdated programming language – cannot move to mobile*Source: Data extracted from www.empEHRical.com
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Weariness • Sleep deprived• Quality Improvement over done • Too much focus on data entry & consistency• Documentation not meaningful• Physicians not experiencing the benefits of an EHR • Accountable Care Act
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Ambulatory Discovery ProcessEHR 7 Most Troublesome Workflows
• New patient registration • Rooming the patient • Charting, Documentation capture • Computerized Provider Order Entry • Messaging / Incoming calls • Night clinics and walk ins • Patient portals /patient engagement
*Source: Data lifted from www.empEHRical.com
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Decision: Keep it or Scrap It
Keep It
Small Midsize LargeMulti-specialty
Small
Midsize
Large
Multi-specialty
Stabilize or Scrap: Trigger Points Vendor• Pieces of charts
missing – chart “falls apart”
• Notes not formatting or incomplete
• Insufficient ongoing technical support from the vendor
• Productivity report
Provider Leadership • Compromising practice
event:• –financial surprise, key
departure, breach, audit
• Patient Safety event • Leadership frustration• Is divided; lots of finger-
pointing • One or two are heavy handed• Is focused on multiple new
endeavors • Staff mutiny • Weary of the process
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Switching: Find Out Why?
EHR Vendor (Hostile)
• Interfaces, Interoperability • Customer Service, training• M&A• Specialty – specific issues • Charting / Documentation • Mobility compatibility • Privacy, Security, Audit
controls
Internal (Healing)
• Fear of Patient Safety Event• Governance• Strategy • Process Redesign• Provider issues • Productivity • Critical information (free
text or coded)
Triage
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Reasons To Stabilize First
• Vendors know they need to stabilize clients to stay in business. • Meaningful Use Stage 2 allows for: • Greater data standardization • More time for vendors to customize software
• System must be ICD-10 test-ready
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First, Try to Stabilize
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How to Stabilize EHRStep 1 Discovery 1. Follow the money
a) Track provider / billing codes / reimbursement b) Analyze patient load vs. reimbursementsc) Analyze productivity drops
2. Follow the patient a) Observe transition of data from front to clinic to back officeb) Observe templates compared to patient visit / specialty c) Ask patients
3. Follow clinical documentation processesa) Need a scribe? b) Look for sudden / disruptive system reaction / lockouts c) Look for consistencies / inconsistencies
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Step 2: Analyze Data Current State
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Step 3: Identify Barriers• What is the problem? • Have we documented it? • Does the vendor know about this problem and capable of fixing? • Are other users having same issue?
• Is it solvable in current state? • Is it a process, people, or system problem? Or all three? • Is there a short term and a long term fix? • Can portions of the EHR be rebuilt?
• Analyze investments• Current investment – actual and soft costs • Costs to continue present course• Costs / penalties per contract
• What can we do better if we switch / save? • What is happening in our practice to derail the fix?
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Some Tools for Goal Setting, Managing Barriers • SMART® Standardized Monitoring and Assessment of
Relief and Transitions• PDSA – Plan Do Study Act • Six Sigma, LEAN Methodology
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Step 4: Establish a Plan
• How will our practice stay in business? • If we switch?• If we don’t’ switch?
• What needs to be fixed now; what can wait for 3, 6 months? • How will we roll out the fix? • How will we change attitudes?
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Step 5: Achieve Consensus, Act
• Leadership makes decision • Put a plan in place • Ensure revenue stability • If possible, schedule roll out by
Department, Specialty• Expect resistance • Communicate with the vendor
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Introductory callwith Leadership team
to ask baselinequestions
Phase 1: Discovery - 3-5 Day On-Site Visit
Submit3-prongedproposal
Pre-site visit call:What's happening?What have you done so far?What do you think we will find?
PEHR Team: EHR System Knowledge, Financial, Clinical/Data Workflow
Day 1:Leadership
team meeting
Observe 25+workflows
1-on-1meetings, if
possible
End-of-daydebrief
Connect with EHRtechnical support
or sales rep, ifpossible
Debrief with leadershipteam, including department
heads, at end of site visit
EHR Stabilization Approach
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Phase II: Repair & Stabilize
Phase III: Optimize and Grow
Createprioritized
report
Identifyresponsibilities
and createtimeline
How client typically uses findings:Build clinical SOPSFacilitate EHR workgroup meetingsFacilitate clinical customization meetingsPut team member in place for period of time
Handoff to EHRtechnical supportand maintenance
Weekly ormonthly
transition calls
Offer participationin webinars,empEHRicalexchange
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5 key questions prior to replacing 1. Are we willing to evaluate our part of the problem /
solution? 2. What is the length of our contract, and what will it cost for us
to get out of our contract? 3. What does current data look like? 4. What processes need to be in place to support the
transition? 5. How much will it cost to transition?
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Reasons to Switch
• Vendor cannot meet MU Stage 2• Vendor puts patient safety at risk• Vendor cannot meets its promises from 3-4 years ago• Data is dropped, missing, interfaces continue to not work.
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Scrap: Migration Process
Planning Technology Migration Validation
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Migration Process: Planning• Stabilization Report • Assess As-Is data; perform QA. • Current and future contracts • Measure impact: risks clinical and business criticalities for
downtime. • Evaluate transition effect on federal incentives • Transition plan? Big bang, incremental • Create a strategic plan• Engage everyone
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Migration: Technology Migration
• Select operating systems • Third party software and interfaces? • Install and configure database• Database versions • Evaluate hardware from multivendor environments• Network speeds• Communicate plans
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Migration: Testing and Validation • Build checklists: assign areas of responsibility• Check performance • Copy and transfer rate• Ensure governance in place• Document what you did. • Preserve clear, traceable audit trail.
Questions, Comments
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Thank you!
Carolyn Hartley, CHP, MLAwww.physiciansehr.comPH: 919-859-9907 x103
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Taking Data to Decisions
