Laurie A. Huryk RN, BSN

VNACJ Community Health Center

Family Medicine Residency Program at CentraState

Enhancing EHR Acceptance Through End User/IT

Partnership

Cell phones: Please turn them off or set them to vibrate

Questions: Please reserve your questions until the end of the presentation

House Keeping

Determine the level of involvement end users should have in an IT project.

Determine an acceptable level of decreased productivity throughout the development and implementation process.

Provide appropriate support for end users post implementation.

Learning Objectives

Modernize our nation’s infrastructure

Enhance energy independenceExpand educational opportunities

Provide tax reliefPreserve and improve affordable health care.

The American Recovery and Reinvestment Act of 2009

Goal: Improve quality and value of American health care

Method: Expanded use of health information technology (HIT) *2008 only 4% physician offices and 2% hospitals fully utilize Electronic Health Records (EHR)

Plan: Accelerate the adoption of HIT

HOW......?

Health Information Technology for Economic and Clinical Health Act (HITECH)

Money

Eligible Providers and Hospitals who are Meaningful Users of certified HIT.

Beginning with financial year 2011 and ending with financial year 2015.

Penalties of reduced payments will begin in financial year 2015.

How and When to Distribute the Money

Must use certified EHR technology in a meaningful manner

Must be able to electronically exchange information from the certified EHR.

Must submit clinical quality measures to the Secretary of the US Department of Health and Human Services.

Meaningful Use

Implementation of EHR

Systems that are fully functional but inadequate for meeting meaningful use requirements

Systems that are not being used to their full potential

Upgrades and core functionality modifications from the vendor

Alteration of existing EHR

Change for everyone

Perceive problem with current process and believe that an improved process exists.

The individual or group must be willing to learn the new process, and must feel safe in the learning environment.

New process must be congruent with individual’s other tasks and responsibilities.

Lewin’s Theory

User must be aware that an innovation exists and persuaded that the idea is beneficial.

A conscious decision must be made to use the innovation.

The user must be provided with feedback to verify that the new innovation is beneficial in order to sustain change.

Rogers’ Theory

Innovators Early AdoptersEarly MajorityLate MajorityLaggards

Rogers’ Theory continued

Retrieved from http://en.wikipedia.org/wiki/File:Diffusionofideas.PNG

Technology is EssentialReduction in medical errors Expert support for clinical decisionsReduction in re-hospitalizationAbility to reach rural patientsAccess to experts around the clockConsistency in documentationPortability and redundancy of medical recordsAbility to create and maintain a complete patient

centered health recordEnhanced reporting capabilitiesImproved patient follow-up

Where is the evidence?

Longhurst, C. A., Parast, L., Sandborg, C. I., Widen, E., Sullivan, J., Hahn, J. S., … Sharek, P. J. (2010). Decrease in hospital-wide mortality rate after implementation of a commercially sold computerized physician order entry system. Pediatrics. Advance online publication. doi: 10.1542/peds.2009-3271

Poon, E. G., Keohane, C. A., Yoon, C. E., Ditmore, M., Bane, A., Levtzion-Korach, O., … Gandhi, T. K. (2010). Effect of bar-coded technology on the safety of medication administration. New England Journal of Medicine, 362(18), 1698-1707.

Chumbler, N. R., Haggstrom, D. A., & Saleem, J. (2010). Implementation of health information technology in veterans health administration to support transformational change: Telehealth and personal health records. Medical Care 48(12), Advance online publication.

Evidence Supporting Technology

Evidence-based practiceDiligent healthcare providersImproved quality through focusing on chronic conditions and other factors

The potential is unimaginable with paper processes.

Current Care is of High Quality

How to develop the partnership

Identify innovatorsDesignate specific meeting times

Develop timeline for project

Develop IT Committee

Purpose: Allow IT staff the opportunity to understand the workflow requirements of clinical operations.

Methods: Individual key IT personnel observe patient encounter through entire visit

cyclecurrent documentation processes of

clinical staffcurrent system report usage

Observe Workflow

Purpose: To familiarize IT staff with current forms so that new system may be analyzed for congruency with documentation requirements and formatting may be customized to be similar to current forms whenever possible.

Method: IT staff members will analyzeclinical documentation formsexternal forms (i.e. referral forms for particular

programs)reports compiled under current system

Review Current Forms

InterviewsPurpose: Allow clinical staff the opportunity

to further explain and clarify workflow and documentation needs and to offer suggestions for process improvement that may be incorporated into the new system.

Method: IT Analyst will interviewclinical staff membersadministratorsclerical staff

Careful Design

Thorough testing done in stagesInvolve all staff, not just committee members

Be prepared to rework some components of system

Encourage constructive criticism

Testing Phase

Training Phase

Onsite vendor supportOnsite super–user supportMethod depends upon comfort level of provider

Plan on decreased productivity

Go-Live/Implementation Support

Rates of Adoption

Post Implementation Support

Emergencies onlySix month ruleUtilize the IT CommitteeThoroughly test all changesTrain all users on changes

Immediate Changes

Super-usersContinuing educationIT departmentVendor supportIT Committee

Continued Support

Required changes to systemStandards of careMedicationsVaccinesPatient education documentsElectronic featuresElectronic standards

New Standards and Requirements

New Employees

Enhancement Requests

ENHANCEMENT REQUEST FORM

NAME: ______________________________ PHONE: ___________________________ DATE: _______________

DETAILED DESCRIPTION OF ENHANCEMENT REQUEST ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

TEMPLATE REQUEST

REPORT REQUEST

DOCUMENT REQUEST

Implementing an EHR is a big investment. Including your staff and physicians throughout the planning, development, and implementation processes and providing adequate support post “go-live” enhances the probability of success.

Big Investment

Questions

Leiber, H. S. (2009). Overview of the American Recovery and Reinvestment Act of 2009. Powerpoint presentation from a virtual conference of the Health Information Management Systems Society. Retrieved May 1, 2009 from http://www.himss.org/ .

Lewin, Kurt (1997). Resolving social conflict/ Field theory in social science. Washington, D.C.: American Psychological Association.

McGonigle, D., & Mastrian, K. (2009). Nursing Informatics and the Foundation of Knowledge. Sudbury, MA: Jones and Bartlett Publishers.

Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule, 75 Fed. Reg . (proposed Jan. 13, 2010) (to be codified at 45 C.F.R. pt. 412, 413, 422, and 495).

Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Simon & Schuster. Schein, E. H. (1996). Kurt Lewin’s change theory in the field and in the classroom:

Notes toward a model of managed learning. Systemic Practice and Action Research 9(1), 27-47.

Shelly, G. B., & Rosenblatt, H. J. (2010). Systems analysis and Design (8th Ed.). Boston, MA: Course Technology, Cengage Learning.

U.S. Department of Health and Human Services. Health IT Adoption Initiative. Retrieved June 11, 2009 fromhttp://healthit.hhs.gov/portal/server.pt?open=512&objID=1152&parentname=CommunityPage&parentid=11&mode=2&in_hi_userid=10741&cached=true

References

To be published in the Journal of Nursing Management within the next 6 months.

Factors Influencing Nurses’ Attitudes Toward Healthcare

Information Technology