Transcript EHR Adoption – Barriers & Solutions John Weir Illumisys – A Division of Lumetra.

EHR Adoption – Barriers &
Solutions
John Weir
Illumisys – A Division of Lumetra
Illumisys

Established in 2005

Mission: to assist healthcare
organizations and their providers
transform their patient environments
through the adoption of technology.

Core Competencies:
HIT Adoption Programs
Systems Implementation
Systems Integration
Operations Strategy
HIT Project Management
www.illumisys.net
Presentation Outline
Provide an outline of the state of systems
adoption, common barriers & solutions.
Offer proven considerations for addressing
barriers and implementation suggestions
targeted on success.
www.illumisys.net
Ambulatory System Adoption
100
75
50
25
0
100
75
50
25
0
% EHR Adoption in
Physician Group
Practice
17.6
23.9
26
30
2003
2005
2006
2007
CDC's 2006 National Ambulatory
Medical Care Survey of 3,350
office-based physicians
Health Affairs, How Common Are
EHRs in the US? -2006.
% Adoption based
on Practice Size
47
Large
34
Medium
24
Small
Modern Healthcare 10/30/2008
www.illumisys.net
HIT Adoption in Physician Offices
90
Billing
80
Scheduling
70
Laboratory
60
EHR System
50
ePrescribing
Disease Registry
40
None
30
Other
20
Telehealth
10
Patient Portal
0
Small (n=34)
Medium (n=36)
Small (n=226)
Source: HIT Adoption in Physician Offices – A Summary of Findings in Iowa; August 2007, Iowa Foundation for Medical Care
www.illumisys.net
Why is Adoption So Difficult?
Training &
Education
HIT
Implementation
Data
Analysis
Change
Process
Patient
Care
Patient
Safety &
Compliance
Initiatives
Quality
Reporting
& P4P
Requirements
Running
the
Business
www.illumisys.net
Perspectives of EHR…
What we want…
What we often get…
Complexity of configuration and user base needs.
No one size fits all products.
Lack of trained professionals.
Too much going on in the office to focus.
www.illumisys.net
EHR Adoption Barriers
Financial
Cultural
EHR Barriers
Technical
Organizational
www.illumisys.net
Major Adoption Barriers
70
Have a Functional
EHR
Do Not Have a
Functional EHR
60
50
40
30
20
10
0
Lack of Capital
Finding
Systems to
Meet Needs
ROI
Uncertainty
System
Obsolecence
Loss of
Productivity
Capacity to
Implement
Physician
Resistance
Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record Keeping
among Physicians & Group Practices in the US, Preliminary Data, November 2007
www.illumisys.net
SO WHAT DOES THIS MEAN AT THE
PHYSICIAN OFFICE LEVEL?
WHAT CONSIDERATIONS SHOULD BE
MADE?
www.illumisys.net
Financial Barriers
Upfront
Costs
Integration
Costs
Ongoing
Costs
Financial
Solutions &
Benefits
Lost Time
Services
www.illumisys.net
Financial Solutions
1.
Upfront Costs
2.
Ongoing
Costs
Services
Lost Time
Integration
Costs
1.
2.
Smart Contracting:
•
Go live and milestone clauses.
•
Consider group purchasing where feasible.
Lease purchasing and deferrals on initial billing.
3.
Consider an hosted environment server (ASP) that can be paid for monthly.
Consider hardware depreciation, support fees, upgrade costs &
miscellaneous expenses such as new staff training.
Negotiate longer term Interface costs upfront.
1.
2.
3.
Ensure implementation, training and go live support is covered.
Consider having a source for vendor management and hand holding.
Build in-house product expertise within staff.
1.
2.
3.
Purposefully schedule for less patients during initial go live.
Look at who can be reassigned for assuming certain project responsibilities.
Create goals that balances lost time against high impact automation and
decreased data entry.
1.
Create an ROI process to track the benefits of the system. E.g. value of
eRx, reduced transcription against system costs.
Improvements in timeliness of claims submission.
Include consumers by incorporating email and online visit protocols.
2.
3.
www.illumisys.net
Key Areas of Financial Focus
 High impact cost savings:
Elimination of paper charts & encounter form
Decrease in data entry and transcription
Increase physicians’ ability to submit new and refill prescriptions directly to
the pharmacy
Improvement in claims capture – billing revenue
Decrease patient & administrative staff time
 Further time/cost savings:
Enhanced clinical processes & practice workflow efficiency
Provide decision support
Decrease documentation & improve legibility - Safety
Increase timeliness patient tracking & follow-up
Reduce time of administrative staff filing, finding and pulling records
Use e-mail messaging
www.illumisys.net
Technology Barriers
Technical
Support
Complex
System
Customization
Privacy &
Security
Technology
Barriers
Product
Expectations/
Implementation
Resources
Fragmented
Standards &
Data Exchange
www.illumisys.net
Technology Solutions
Technical
Support
Complex
System
Customization
Fragmented
Standards &
Data Exchange
1.
2.
3.
Create performance guarantees associated with vendor support & uptime.
Have a maintenance plan that is tested and works.
Plan for, implement and transition upgrades with care.
1.
Establish system review process before enhancing templates & workflow.
•
If it works don’t customize it.
Plan out the system workflow with feedback from all staff.
2.
1.
2.
3.
4.
Product
Expectations/
Resources
Privacy &
Security
Standards bodies have emerged and working with certification programs.
Ask your vendor about terminologies and vocabulary sets used.
Established interface needs early and have a clear set of specifications
that can be shared between vendors.
Broker vendor communications to eliminate any he said/she said scenarios
3.
If you’re not clear on functionality vs. your needs prior to purchasing - ASK.
Make sure you have people who understand how the system will work for
your office.
Hire experts where you need to.
1.
2.
3.
All systems must comply with HIPAA
Ensure data is encrypted where transmission is involved.
Create levels of security for users where data access should be limited.
1.
2.
www.illumisys.net
Organizational Barriers
Infrastructure
Technical
Capacity
Leadership
Organizational
Barriers
Operational
Capacity
Goal
Alignment
www.illumisys.net
Organizational Solutions
Infrastructure
1.
2.
3.
Establish change management processes.
Create a process for decision making.
Develop a process for issue escalation.
Technical
Capacity
1.
2.
3.
IT Network has bandwidth and capability for new system.
IT Support protocols established.
Communications created for implementation process through the business.
Operational
Capacity
1.
2.
3.
4.
Staff appropriately with internal, vendor and where necessary consultants.
Review and establish appropriate workflows focused on improvement.
Understand training needs and have vendor work to that need.
Create paper migration plan with vendor input.
Goal
Alignment
1.
2.
3.
Build consensus across the organization with management and providers.
Build commitment from staff to meet timelines and USE the system.
Create a focus on quality from system performance/capability to outcomes.
1.
2.
3.
4.
5.
Identify physician champion who will remain committed to the project.
Entrust authority with implementation lead and physician champion.
Maintain project ‘VISION’ throughout the implementation and Go Live.
Establish management reporting and staff updates.
Address legal issues upfront.
Leadership
www.illumisys.net
Cultural Considerations
Technical
Competency
Consumers
Cultural
Solutions &
Benefits
Leadership &
Accountability
Change
Management
www.illumisys.net
Cultural Solutions
Technical
Competency
1.
2.
3.
Leadership &
Accountability
Consumers
Change
Management
Ready staff for what may be new technology. E.g. MS Windows, browsers.
Have staff involved in requirements development and system planning
feedback.
Address the change process in a proactive and benefits oriented manner.
1.
2.
3.
Establish good project management practices; maintain a plan and timeline.
Manage the vendor and seek clear recommendations.
Proactively communication progress and goals achieved within the
organization.
1.
2.
3.
4.
Integrate access to relevant components. E.g. PHR, email, scheduling.
Inform patients of the transition; make the benefits apparent and set
expectations.
Involve the patient in their care and look at improved outreach methods.
Stem privacy and security concerns.
1.
2.
3.
4.
Address resistance to change by illustrating system capabilities.
Incorporate staff in the entire process including goal setting, build & testing.
Match roles and functions to staff skills and fill the gaps with training.
Conduct team meetings and communicate project outwards.
www.illumisys.net
HOW DOES THIS GET ACTED UPON?
www.illumisys.net
Solutions –
Readiness & Preparation
 Build practical understanding of:
Barriers & risks;
Current state workflow;
Future state workflow that create improvements;
Gaps associated with the project.
 Determine financial capacity.
 Create ground rules for moving forward.
 Establish and prioritize needs.
There are no secrets to success. It is the result of preparation,
hard work, and learning from failure. - Colin Powell
www.illumisys.net
Solutions - Planning






Establish a team with goals.
Set framework for measurable success.
Provide vendor with clear objectives.
Keeps the project focused and on track.
Creates leadership and confidence.
Outlook on go live reductions in productivity.
He who every morning plans the transaction of the day and
follows out that plan, carries a thread that will guide him
through the maze of the most busy life. But where no plan is
laid……chaos will soon reign. – Victor Hugo
www.illumisys.net
Solutions - Implementation
 Phase I Incorporate basics & workflow:
Registration & scheduling (assuming integrated system)
Patient eligibility and check-in process
ePrescribing fundamentals
Commence paper migration (scanning & data entry)
 Phase II Building core functionality
Nursing documentation
Patient histories, vitals, chief complaints
Lab orders (where applicable to staff)
Slide 1 of 2
www.illumisys.net
Solutions - Implementation
 Phase III Incorporate Physician
Full exam recorded in EMR (voice / template driven)
Charge coding
Lab order and results
Cross-staff tasking & messaging
Reporting
Interoperability components (electronic referrals)
 Phase IV Other
Integrate device interfaces
Claim management within an integrated system
Slide 2 of 2
www.illumisys.net
Solutions - Implementation
Training

Entire staff needs to be trained: EHR in changes how the practice does everything.

During training, plan to minimize business interruption and monitor organizational
progress.

Hands-on EHR training may incorporate basic terminology, workflow, security,
usability, communications, and interoperability.
Paper Migration

Avoid parallel paper and electronic data entry
Enter information in advance OR as you go
Scan key recent reports and transfer past information

Maximize electronic data exchange
Set up efficient data exchanges between systems

Redesign work processes to eliminate paper-based clinical processes
www.illumisys.net
Success Principles
1. Build user based acceptance & diffusion.
2. Balance goal setting across staff.
3. Identify high impact issues that can be solved
relatively quickly and painlessly.
4. Keep it simple: Initiatives must be in ‘chewable’
pieces.
5. Wins create momentum.
www.illumisys.net
Legislative Landscape
Can the next 5 years get us beyond the tipping point?
 Financial Assistance:
Loans
Grants
Incentives
 Technical Assistance:
Regional Resource Centers
Workforce training
Demonstration projects
www.illumisys.net
Keep The End In Mind
 Improvements in quality care.
 Increased decision support & patient safety.
 Increased provider – patient communication.
 Improved revenue management.
 Increased information access & interoperability.
 Reductions in medical errors.
 Improved staff efficiency.
www.illumisys.net
Questions/Discussion
www.illumisys.net
Contact Information
John Weir
President
Illumisys
1 Sansome Street
San Francisco, CA 94104
P: 415-677-2083
C: 510-931-9389
E: [email protected]
W: www.illumisys.net
www.illumisys.net