Avera Health’s HIMSS Analytics Stage 7 Journey: Lessons Learned May 17, 2017 Avera Health’s HIMSS Analytics Stage 7 Journey: Lessons Learned Susan Feilmeier, PharmD IT Clinical Services Officer Avera Sacred Heart IT Regional Information Officer

“A strategic roadmap for effective EMR adoption and maturity” Journey to HIMSS Stage 7 Award EMRAM (EMR Adoption Model) “A strategic roadmap for effective EMR adoption and maturity” The HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) incorporates methodology and algorithms to automatically score hospitals around the world relative to their Electronic Medical Records (EMR) capabilities. This eight-stage (0-7) model measures the adoption and utilization of electronic medical record (EMR) functions. Move your organization closer to achieving a near paperless environment that harnesses technology to support optimized patient care by completing each stage www.himssanalytics.org

Journey to HIMSS Stage 7 Award HIMSS EMRAM

HIMSS Analytics Stages 2016 Q3 2016 Q4   N:5449 N:5478 7 4.6% 4.8% 6 30.5% 5 34.5% 34.9% 4 10.1% 10.2% 3 14.1% 13.9% 2 2.2% 2.3% 1 1.7% 1.4% 2.4% 1.9% www.himssanalytics.org

Complete HIMSS Annual Study Scoring HIMSS Annual Scoring HIMSS Annual Scoring Tool Complete HIMSS Annual Study Scoring

HIMSS Stage 6 – Telephone Interview Survey Integrated Delivery Network –Self Attest

Journey to HIMSS Stage 7 Award HIMSS EMRAM

Journey to HIMSS Stage 7 Award – Original Timeline

Use your EMR Vendor Go and See Mock it Up Timeline Realism Lessons Learned Use your EMR Vendor Go and See Mock it Up Timeline Realism

VENDOR Baseline Assessment Lesson #1: Use your EMR Vendor Journey to HIMSS Stage 7 Award - Tools Lesson #1: Use your EMR Vendor VENDOR Baseline Assessment

HIMSS Stage 7 Reviewer Guide Journey to HIMSS Stage 7 Award - Tools

Criteria Scoring Document Journey to HIMSS Stage 7 Award - Tools

Journey to HIMSS Stage 7 Award

Lesson #2: Go and See Journey to HIMSS Stage 7 Award Visit Other Health Systems HIMSS Stage 7 Surveys Visit your own Departments and Observe

Acute CPOE Pervasiveness Acute BMV Pervasiveness OR/PACU Medication Journey to HIMSS Stage 7 Award - GAPS Journey to HIMSS Stage 7 Award Acute CPOE Pervasiveness Acute BMV Pervasiveness OR/PACU Medication Code Blue Medication 24-7-365 Clinical Relevant Document Scanning Breast Milk Scanning TAR

>90% for 4 consecutive months Providers & Midlevels Journey to HIMSS Stage 7 Award - GAPS Journey to HIMSS Stage 7 Award Acute CPOE Pervasiveness Acute BMV Pervasiveness OR/PACU Medication Code Blue Medication 24-7-365 Clinical Relevant Document Scanning Breast Milk Scanning TAR >90% for 4 consecutive months Providers & Midlevels

>95% for 4 consecutive months Patient and Medication Scan Journey to HIMSS Stage 7 Award - GAPS Journey to HIMSS Stage 7 Award Acute CPOE Pervasiveness Acute BMV Pervasiveness OR/PACU Medication Code Blue Medication 24-7-365 Clinical Relevant Document Scanning Breast Milk Scanning TAR >95% for 4 consecutive months Patient and Medication Scan

Journey to HIMSS Stage 7 Award - GAPS Acute CPOE Pervasiveness Acute BMV Pervasiveness OR/PACU Medication Code Blue Medication 24-7-365 Clinical Relevant Document Scanning Breast Milk Scanning TAR OR and PACU Medications Entered into the EMR prior to patient transfer out of PACU

Journey to HIMSS Stage 7 Award - GAPS Acute CPOE Pervasiveness Acute BMV Pervasiveness OR/PACU Medication Code Blue Medication 24-7-365 Clinical Relevant Document Scanning Breast Milk Scanning TAR Code Blue Medications Entered into the EMR prior to patient transfer to next level of care

Clinical Relevant (<24hours) Clinically Irrelevant (<72 hours) Journey to HIMSS Stage 7 Award - GAPS Journey to HIMSS Stage 7 Award Acute CPOE Pervasiveness Acute BMV Pervasiveness OR/PACU Medication Code Blue Medication 24-7-365 Clinical Relevant Document Scanning Breast Milk Scanning TAR Clinical Relevant (<24hours) Clinically Irrelevant (<72 hours) Document Scanning into EMR

If NICU, Breast Milk scanning to mom and baby Journey to HIMSS Stage 7 Award - GAPS Journey to HIMSS Stage 7 Award Acute CPOE Pervasiveness Acute BMV Pervasiveness OR/PACU Medication Code Blue Medication 24-7-365 Clinical Relevant Document Scanning Breast Milk Scanning TAR If NICU, Breast Milk scanning to mom and baby

>95% for 4 Consecutive Months Patient and Product Scan Journey to HIMSS Stage 7 Award - GAPS Journey to HIMSS Stage 7 Award Acute CPOE Pervasiveness Acute BMV Pervasiveness OR/PACU Medication Code Blue Medication 24-7-365 Clinical Relevant Document Scanning Breast Milk Scanning TAR >95% for 4 Consecutive Months Patient and Product Scan

Journey to HIMSS Stage 7 Award – Methodology Plan Do Check Adjust

Journey to HIMSS Stage 7 Award Lesson #3: Mock it Up

Vendor Mock Survey with Presentation Formal HIMSS Survey Journey to HIMSS Stage 7 Award Vendor Mock Survey Self Mock Survey Vendor Mock Survey with Presentation Formal HIMSS Survey

Journey to HIMSS Stage 7 Award – Mock with Surveyor Guide

90-120 Minutes Key Features Demographics and Awards Journey to HIMSS Stage 7 Award - Presentation 90-120 Minutes Key Features Demographics and Awards Health System Overview Pervasiveness Data and CDS IT Governance CIBI 3 + Case Studies HIE Data Integrity, Security and Recovery

Honored Subject Matter Experts Journey to HIMSS Stage 7 Award - Presentation Case Studies >12 mos RIO data Required 80-120+ hours Honored Subject Matter Experts Highlight previous Paper-spaces converted to revenue-generating spaces

Lesson #4: Time Estimate 12+mos Journey to HIMSS Stage 7 Award Lesson #4: Time Estimate 12+mos December 2015

Avera McKennan Hospital 12/2015 Avera Sacred Heart Hospital 10/2016 Journey to HIMSS Stage 7 Awards Avera McKennan Hospital 12/2015 Avera Sacred Heart Hospital 10/2016 Avera Queen of Peace Hospital 12/2016

Journey to HIMSS Stage 7 Award – New HIMSS Tools

Clinical Data Repository HIE Clinical Charting Clinical Order Entry Journey to HIMSS Stage 7 Award- O-EMRAM Clinical Data Repository HIE Clinical Charting Clinical Order Entry eRX/Med Rec CPOE eMessages (referrals, consultants, patient messaging) CDS Provider Documentation Incorporate Encounter, Growth Charts, Data in structured data Exam Results Patient Monitoring Summary of ToC Patient reminders letter Patient/Consumer Functions

Stage 7 Stage 6 Stage 5 Stage 4 Stage 3 Stage 2 Stage 1 Journey to HIMSS Stage 7 Award- Proposed New Stages Anesthesia EMR CPOE Infusion Pumps Stage 7 CPOE, BMV, TAR, Breast Milk, Barcode specimen collection Security risk assessment submissions to authority Stage 6 Provider Documentation/NLP create discrete data Portable Device Security Stage 5 >90% Allied Health & Nursing electronic documentation/eMAR/TAR & ED Live Business Continuity: Meds, Allergies, Problems, Labs Stage 4 >50% Allied Health & Nursing electronic documentation/eMAR/TAR & ED Live Role-based security and intrusion detection Stage 3 Clinical DR and context aware Security, encryption, disposal policy, antivirus and firewall program Stage 2 PACS Non-DICOM image storage Stage 1

THANK YOU FOR YOUR TIME.