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Thayer County Health ServicesHebron, Nebraska
Joyce Beck CEO
Background of implementation of EHR at Thayer County Health Services (TCHS)
Discuss decision process to establish interoperability
Nationwide interoperability demonstration How quality measures were affected at
TCHS through implementation of EHR Discuss lessons learned, challenges and
rewards
Build Bridge with EMS Improve effectiveness and efficiency of Critical
Access Hospital Connect with tertiary hospital Improve communication with satellite clinics Improve communication with pharmacy Improve communication with long term care and
assisted living Address safety and security of clinical
information: compliance with State and Federal Regulations
Two choices for interoperability in Nebraska-NeHII or use CONNECT to reach the Nationwide Health Information Network (NHIN)
Pros and Cons of each explored and choice was made to use open-source connectivity available using CONNECT software
Connection made with Redwood MedNet in Healdsburg, California
Information Technology said it would work Test data had only been sent on the NHIN
between facilities There were doubts from other HIE’s in
Nebraska about NHIN If NHIN was to be endorsed I had to see it
myself If our actions do not help a patient than all
is for nothing
Dr. Bryan Hubl ordered lab test in Hebron for wellness check
Lab results obtained and placed in EHR in Hebron
Lab results then made available to Redwood MedNet in California for actual wellness exam
Information also available on USB to fulfill meaningful use
Results of labs and x-ray of left hip taken in Healdsburg placed in Alliance Medical Center EHR
Results could be placed on USB bracelet or card at patient request
This product available through 911 Medical ID or Zaptag
Wellness exam completed by Dr. Jeff Meckler at Alliance Medical Center, Healdsburg, California
Lab results from Thayer County retrieved by Redwood MedNet via CONNECT gateway
Returned to Thayer County Health Services to be seen by Dr. Hubl
Wellness exam as well as results of lab work was available to Dr. Hubl via the NHIN therefore no duplication of testing necessary
Dr. Hubl was able to recommend treatment based on information gathered in both Hebron, Nebraska and Healdsburg, California
Information flowed from one facility to another without difficulty
Duplication of testing was avoided due to availability of information via the NHIN and patient USB device
Ease of availability of medical information provided better patient care
The NHIN as functioning, provides patients with information needed
Quality indicators in medication reconciliation were directly related to implementation of EHR
In the area of medication reconciliation, those physicians using e-prescription had 100% medication reconciliation compared to 33%, 17%, 25%,20% and 33% for physicians not using e-prescribing
Thayer County Health Services Medication Errors by Severity
from Q1 2004 to Q4 2008
0
10
20
30
40
50
60
70
80
90
Qtr 12004
Qtr 22004
Qtr 32004
Qtr 42004
Qtr 12005
Qtr 22005
Qtr 32005
Qtr 42005
Qtr 12006
Qtr 22006
Qtr 32006
Qtr 42006
Qtr 12007
Qtr 22007
Qtr 32007
Qtr 42007
Qtr 12008
Qtr 22008
Qtr 32008
Qtr 42008
Quarter
# of
Erro
rs
A B C D E Total Linear (Total)
Pyxis Implemented
Pyxis Cubies E-MARE-MAR
47% of Acute/skilled care personnel agree "Our proceudres and systems are good at preventing errors."
66% of Acute/skilled care personnel agree "Our proceudres and systems are good at preventing errors."
Hardw iring forExcellence
Hardw iring forExcellence
Leadership Leadershi
p CustomerServiceBalanced
ScorecardRoot CauseAnalysis
CPOETeamSTEPP S
While the EHR is a useful tool it must be accompanied with a culture of safety
Development of employee leadership and accountability are necessary for patient safety
Tools such as Hardwiring Excellence also need to be in place to ensure quality of patient care
Leaders need to hold people accountable, they must ask them to “get off the bus” if necessary
Technology is improving compared to former implementation and therefore results are improved
Results were realized in early stages of implementation however results improved as implementation progressed
Success of implementation of EHR is directly related to the buy-in of end users
Success of EHR and how it affects quality indicators is directly related to the culture of safety in a facility
A physician champion is necessary for the success of the EHR implementation
A team approach is necessary for the success of the EHR implementation
The results of the implementation of EHR on quality indicators was very positive
As a result of project not only was there a positive affect on quality indicators there is also facility pride
EMS units in Nebraska were not allowed to apply 12-lead EKG required TCHS staff to request EMS in Thayer County be allowed to place the 12-lead
Verizon coverage limited in areas therefore transmission of data interrupted
Use of T1 line was restricted to non-profit entities limiting the use of the T1 line
Limitations of software available
Quality indicators were positively affected by implementation of the EHR at TCHS
The positive affects were especially true when the measurement was only on the affects of EHR eliminating variables such as patient compliance
Tests were ordered timely, allowing for close monitoring of chronic conditions, when templates were used
Medication reconciliation was greatly affected by e-prescribing
Medication errors were greatly reduced using EHR as a tool in combination with a culture of safety
Medication error reduction as well as medication reconciliation would impact the cost of healthcare greatly in the nation
