Tales from the Trenches: Implementing an EMR

© 2010 The Coker Group 1

Agenda

The computer evolution from 4000 B.C. to 2010 Current State of the Market Where have we been - Where we are goingWhere have we been Where we are going How to buy the right system for your practice Top 10 most common mistakes to avoid Top 10 most common mistakes to avoid Top 20 reasons for I.T. failure

S Summary


Life Before Computersp

Memory was something that you lost with age. An application was something you filled out

for employment. A cursor was someone who used profanity. A virus was the flu. A hard drive was a long trip on the road.


Technology evolution from 4000 B.C. to 2010

in 5 minutes


4000 to 1200 BC inhabitants kept records on clay tablets


3000 BC the Abacus3000 BC the Abacus


In 1642 Blaise Pascal invented the Pascaline as an aid for his father who was a tax collectoraid for his father who was a tax collector.

(it could only add)


Pinwheel calculator with 10-digit setting register, made in S d i 1945Sweden in 1945.


One early success was the Harvard Mark I computer which was built as a partnership between Harvard and IBM in 1944. This was the first p p

programmable digital computer made in the U.S. The machine weighed 5 tons, incorporated 500 miles of wire, was 8 feet tall and 51 feet long.


The first-ever computer mouse in the hand of its inventor

Doug Engelbart. - 1968


1970 Unix is developed at Bell Labs by D i Rit hi d K th ThDennis Ritchie and Kenneth Thomson.


1981- IBM introduced the first desk-top computer


Microsoft Version 1.0 was released in 1985, the more commonly known Windows version was released in 1990 which was version 3 1Windows version was released in 1990, which was version 3.1


First Laptop - 1979


The first chip to implement its 64-bit architecture - 1992p p


2010


Our Progress in Healthcare


50%

use this device

40%

use this device

10%

use this device or desktop

Current State of theCurrent State of the Market & Vendors


Current State of the Vendors


Putting it into PerspectiveSoftware

•PracticeInterfacing

Practice Management

•Reporting

C di

•Pharmacy

•Transcription

•Hospitals•Coding

•Document Imaging

Hospitals

•Lab

•PACS

•EMR

DevicesPortals Devices

•Desktops

•PDAs

•Messaging

•E-Health


•Tablet•Patient Access

Standalone

LAB

•Interfacing Development

F t ti f d t h ll

EMR Server & Rack

60 to 70K

•Fragmentation of data challenges

•Multiple points of entry

•Unable to share with otherRadiology E-Mail

•Unable to share with other providers

•Version control

Hospital PM System

•Multiple vendors

•Expensive

© 2010 The Coker Group 21Imaging

Fully Integrated


Implementation and Selection Strategies


Career Defining Moments in Healthcare ManagementHealthcare Management

A Construction ProjectA new physician compensation

An I T Project


plan An I.T. Project

There is significant amount of pressure, but little clarity regarding its affect, priority, or

implicationp


OBTAINING PHYSICIAN BUY-IN AND BUILDING INCENTIVES

There are two simple considerations when ki h i i b iseeking physician buy-in:

1. Do they want it?

2. Will they use it?


What is your physician culture?

Over the top “tech-O e t e top tecsavvy” MD’s who will shoot you with an infra-red beam from a Palm Pilot

Pen & Paper will do me just fine. You don’t get paid for typing !

Palm-Pilot

Or BOTH


Or BOTH

Reengineering the Process Will Require New Automationq

Automate the “Old” Way


Automation

“Automating a bad process not only ensures that we can do a bad job every time, but that j y ,we can do it faster and with less effort than before.”


Estimated Rate of Ambulatory EHR Failurey

According to some researchers there has been a 30-40% failure rate of EHR implementationsa 30 40% failure rate of EHR implementations

These failures are a result of:These failures are a result of: Lack of implementation planning Inadequate research and expectations of technology Incomplete training of staff Mismanagement of workflow and staffing changes Reluctance of providers to take on additional burden Reluctance of providers to take on additional burden


Implementing TechnologyThe “Happy” / “Sad” Analysis

HAPPY

ppy y

SAD


Prerequisites for Complex Change

ActionPlans

DesiredResultsResourcesIncentivesSkillsVision

Skills Incentives Resources ActionPlans Confusion

Conflicts

1 X

IncentivesVision Resources ActionPlans

Action

Conflicts

Performance Anxiety

k

2

3

X

Incentives

Skills

Skills

Vision

Vision

Resources ActionPlans

ActionPlans

Back-Sliding

Frustration& Anger

3

4

X

X

IncentivesSkillsVision Resources

Plans g

FalseStarts5 X


Top 10 Critical SuccessTop 10 Critical Success Factors

© 2010 The Coker G

33

1 - Enthusiastic EMR Project Leader

The person driving the project is the number one f t f El t i M di l R dsuccess factor for an Electronic Medical Record

Implementation!

A Physician committed to the project. A respected staff member.

Sets expectations and goals for group Understands EMR product capabilities Positive attitude and enthusiasm!

34© 2010 The Coker Group

2 - A Implementation Plan

Figure out the business case – costs, ti t fl i d ffi ipatient flow, increased efficiency

Get buy-in – commitment from all Consider your options – EMR selection Ensure support – Training serviceEnsure support Training, service,

support Prepare to change develop strategy Prepare to change – develop strategy

for handling bumps – be emotionally readyready

Consider increments 35© 2010 The Coker Group

3 - Good EMR product and VendorVendor

Don’t try to write your own EMR Do reference calls and site visits Look for excellent supportpp Expect to do your part in the

implementationimplementation Templates Learn the product Learn the product


4 - Training

For the project leader - Vendor supplied CDs Online Tutorials Selfsupplied, CDs, Online Tutorials, Self-learningF th EMR d O For the EMR end user - One-on-one training seems to give the best results

L d h Learn one, do one, teach one


5 - Provide your staff with multiple data entry methods

TypingTyping Templates & “Macros”

V i R iti S hMik A Voice Recognition – SpeechMike, ArrayMike Handwriting Recognition – Pen Tablet

PCs Scanning InterfacesInterfaces Dictation with Transcription in EMR


6 - A Solid Infrastructure

You need a reliable Internet connectionYou need a reliable Internet connection Certified CAT 5, 5e, 6 or 6e wiring Certify the equipment before going live Certify the equipment before going live Test

T t Test Test Try to break it


7 - Quality Hardware

Tablets PCsPCs COWs

N /MD Sti k Nurse/MD on a Stick Printers with network connections Scanners Back-upBack up


8 – Good computer supportsupport

A company you trust for advice and supportpp Takes an interest in what you are trying

to accomplishp Provides prompt support and returns

calls Does preventive maintenance Does upgrades and patchesDoes upgrades and patches


9 – Watch out for Interface Promises

Interfaces can take months to complete!

Find out exactly what is interfaced Find out exactly what is interfaced Demographics Scheduling

Ch Charges Has it been done before? Ask for a reference. Does the price include both vendorsp Consider looking up information on another system

instead of interfacing


10 – Ownership

Executive Sponsorship Physician Champion Strong Leadershipg p


Tools for Averting Risk

Statement of work Request for proposal Payment terms tied to project milestonesy p j Progress reports Customized implementation plan Customized implementation plan Project budget Project staffing plan

© 2010 The Coker G

44

Sample Tools

For a complimentary templates please sent request to p q

[email protected]

© 2010 The Coker G

45

Modifying the Contract

Source Code Acceptance Period (Hardware & Software) Implementation Caveats Statement of Work (SOW)Statement of Work (SOW) No Front Loading of Support Fees No Front Loading the purchase terms Assignment Assignment Future Upgrades and New Releases Copyright infringements Warranties Termination Future providers and fees (Recurring cost)


Future providers and fees (Recurring cost)

Fi l Th htFinal Thought -Five Stages Of EMRg

*Elizabeth Kubler-RossDeath and Dying

1st Stage: Denial

Occurs from time of purchase until first few days of go-live

Sees only benefits of EMRs Denial of any difficulties


2nd Stage: Anger

Typically lasts one monthmonth

Angry because of reduced patientreduced patient volumes

Staff upset with newStaff upset with new system


3rd Stage: Bargaining

Lasts 2-4 weeksPl d ith d t Plead with vendor to make program workWill d thi Will do anything


4th Stage: Depression

Lasts 3-6 monthsA ill Assume program will not workC ’t b d it Can’t abandon it since it costs so much


5th Stage: Acceptance

It all starts to fall into placeplace

See benefits from the systemsystem

You and every one else live happily everelse live happily ever after!

Cause for celebrationCause for celebration


Thank You

Contact InformationJeffery Daigrepont, Principaly g p , p

The Coker [email protected] g @ g

800-345-5829


Health & Medicine

Tales from the Trenches: Implementing an EMR