Transcript Slide 1

EHR Governance, Change
Management and What Keeps Me
Up at Night.
Bud Garrison MBA, CPHIMS
Director, Clinical Informatics
Oregon Health & Science University
October 17, 2014
Objectives
• Review how OHSU’s EHR Governance has changed
over time.
• Review OHSU’s project intake and prioritization
process
• Explore a current Change Management process that
supports data integrity and clinical compliance
• Discuss emerging HIM issues in a fully integrated EHR
and statewide HIE.
• Try and Smile a little!
Overview
Implementation
Governance
Projects
Future
Introductions!
Bud Garrison MBA, CPHIMS
Healthcare Informatics Work = 20+ years in
system implementation, process improvement,
clinical workflow and clinical outcomes
reporting.
Clinical Background = Periop Administration,
Surgical Technician, Emergency Medical
Technician x 8 yrs
What I am not…..
OHSU
• Oregon’s only Academic
Medical Center
• Level 1 Trauma Center
• 2 Hospitals – 572 Beds
• 70+ Clinics
• 28 Locations
• 14,000 Employees
• 2,200 Providers
• 2,849 Students
• 1 Tram!
Implementation
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251,033 Patients/Year
876,553 Visits
31,513 IP Stays
88% patients from
Oregon
• 48% of IP patients from
Outside Portland Metro
• 1/3 of hospitalized
patients are uninsured or
underinsured **
Governance
Projects
Future
And YES,
YOU CAN
VALET
YOUR BIKE
AT THE
BASE OF
THE TRAM!
OHSU’s EMR Implementation
Started 2005
• Completed 60+ Clinics in 2008
• Staged Inpatient Project 2008
– CPOE
– Nursing Documentation – CPM
– Peds CPOE
Stats:
14,000 PCs
3500+ concurrent users
96% BCMA Compliance
85% CPOE
Since Go-Live
• Monitor integration
• Oncology
• Lab Integration
• Periop Integration
• Transplant Module
• Optimize all clinics X2
• CEI (Opthamology) Integration
• BCBA, BCMA
• Magnet
• Data Warehousing
Informatics Focus
Pilot Users,
Needs,
Standards
and Clinic
Templates
Pilot
Does this Thing
Work?
Help Users
Meet the
Standard.
“Parking Lot”
for
Customizations
Roll Out
“Get Them
Live!”
Empty the
Parking Lot!
Clinic and
User
Satisfaction
Optimization of
Clinics and
Users
Reduce the
complexity for
the users.
OHSU
System
Standardization
and Process
Improvement
Implement Optional Modules.
System Stability
Systems Focus
Stage 7 – Fully
Implemented
EMR Governance – Where We Started
Initial Governance
Principles/Challenges
• Use existing structures if possible
• Involve clinical stakeholders
• I.T. driven project so I.T. leads governance
Challenges:
• Fast moving project – Slow moving Governance
• Clinical representatives didn’t understand informatics
issues
• Compliance not EMR trained or included in many decisions
• Too many disparate groups not tied to clinical work, too
many decisions, no one knew where to take an issue!
EMR Governance – What Happened
So, Now what…
What do we need to manage changes
in a complex system
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Clinical areas should own the process not ITG/Informatics!
Subject matter based groups that can evaluate changes for STANDARDIZATION!
Move away from changes for individual users
Quick, efficient decisions
Have the right people at the table
• Workflow
• I.T. Builders
• Clinicians
• Clinical Operational Support
• Billing
• Compliance
• Leadership
• EMPOWER SMALLER GROUPS TO MAKE DECISIONS –
• Have the right people at the table to bring issues up through other groups based
on system impact
How do Decisions get made? Design = CM and Regulatory Groups then Build with I.T.
Groups
BUILD
Build
Unless it is a bad decision…….
BUILD
Build
Work and Project Intake Process
• “Fix-it” Tickets – Epic Support desk
– About 40% of our effort
– Must Do Work – Must Not Do work
– User education on workflows
• Project Work
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Patient Safety Improvements
Workflow optimization
Compliance/regulatory
Quality improvements
New Modules
Project Prioritization – 1st Step
Align with Clinical I.T. Strategic
Initiatives
Project Prioritization – 2nd Step
Calculate Prioritization Score
Project Prioritization – 3rd Step
Collect More Data to Resource/Schedule Project
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Benefits
In Scope / Out of Scope
Business Sponsor
Project Manager
Lead Work Unit
Participating Work Units
Program
Estimated Work Effort
Desired Start date
“Let’s get real” Start Date
Desired Go Live
Based on this data the
Resource groups assigns
resources and sets project
schedule
“The List”
At the moment: 100+ Clinical Projects
What keeps me up at night?
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HIE, Data Exchange is Now so Fast!
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What happens when we get patients mixed up?
Labs resulted to wrong patient, etc
Now automatically exchanged with other institutions.
How do we fix this when it goes wrong?
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EMR driving clinical/operational best practices not the other way around.
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In an environment with 20,000+ charting tools and now MDs building more every day, how do we
ensure complaince?
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DOWNTIME and Recovery!
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Integration of patient reported data
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How do we reduce risk to the organization?
Who monitors and follows up?
What happens if we miss something?
Medical Home and the push for quality metrics over coding? What roles do HIM professionals play
in this new environment?
Bud Garrison MBA, CPHIMS
Director, Clinical Informatics
Oregon Health & Science University
[email protected]
503-494-7542
The vision of the Clinical Informatics
Department is to realize the full benefits of
OHSU’s clinical information systems. The
department will apply the science of
informatics to enable excellence in patient
care, to educate learners, and to advance the
methods of applied informatics.