IHS EHR Indian Health Service Electronic Health Record Carolyn Johnson, Rph. Computer Support Team Director Warm Springs Health & Wellness Center

Objectives  Implementation  Impact on Process  Cost Estimates  Impact-Outcome Data

Implementation

Implementation-Commitment  Confirmed Leadership support  Tribal Endorsement  Area Office Support  Patient Awareness  Clinician driven

Implementation-Staffing  Provider support during implementation  Staff shift from Medical Records to other departments : 2 Medical Records are in PCC part time 2 Medical Records are in PCC part time 1 Med rec tech is a nurses aid 1 Med rec tech is a nurses aid 1 Med rec tech is a Benefits Coordinator 1 Med rec tech is a Benefits Coordinator More nurses aids after EHR More nurses aids after EHR

Staffing-Clinical Applications Coordinator Duties  Works cooperatively with Site Manager  Coordinates Implementation  EHR User Support  Training  Customize Software  Workflow

Implementation-Software  Package upgrades to RPMS Cache Cache Scheduling (PIMS) Scheduling (PIMS) Radiology Radiology Text Integration Utility Text Integration Utility Pharmacy Inpt Suite Pharmacy Inpt Suite Adverse Reaction Tracking Adverse Reaction Tracking Pharmacy 7 Pharmacy 7 Numerous RPMS patches Numerous RPMS patches

Implementation- Hardware/Infrastructure upgrade  RPMS server  Training server  Network  Wireless network  Lab Interface Upgrade  Workstation Access-Everywhere  Backup Power

Implementation Team Members  Clinical Champions from each discipline (lab,rn, rph,md,,etc)  Administration/Executive Leadership  Information Technology  Include Area IRM representation  Clinical Application Coordinator

Implementation Team Roles Identify and define Policies and Procedures Identify and define Policies and Procedures Address staffing and scheduling during transition Address staffing and scheduling during transition Peer Training & Marketing Peer Training & Marketing Monitor and Execute Implementation Plan Monitor and Execute Implementation Plan Design and Approve templates, menus, and ordering lists for E.H.R. Design and Approve templates, menus, and ordering lists for E.H.R.

Project Plan

Implementation Strategy Implementation-Who and When  Everyone at once  Lab ordering, then radiology ordering, then pharmacy ordering, then notes  Bring up one team/dept at a time

Implementation Sample Schedule

Implementation- Configuration  Design templates  Design Menus and Quick Orders Meds, Labs, Rad, Nursing Meds, Labs, Rad, Nursing  Define consults  Pick lists and Superbills  Note Titles  User Setup (keys)  Parameters  Printing Chart Copy and Orders  Print Formats

EHR beforeConfiguration EHR before Configuration

EHR after Configuration

Implementation-Setting up Orders

Implementation-Setting up templates

Implementation-Training/Marketing  Staff Training: EHR Demo Movie Presented in General Staff Meeting EHR Demo Movie Presented in General Staff Meeting Pharmacy Training Module: Pharmacy Training Module: Available on Warm Springs Web SiteAvailable on Warm Springs Web Site Mandatory for all pharmacy staffMandatory for all pharmacy staff CPRS Training Module: CPRS Training Module: Presented at Staff MeetingPresented at Staff Meeting Interactive training posted on Warm Springs Web SiteInteractive training posted on Warm Springs Web Site Mandatory for providersMandatory for providers National Programs Web Demo for our clinic National Programs Web Demo for our clinic

Pre-Implementation Training  2 hour training for everyone on VIEWING patient data in E.H.R.  EHR Test System Loaded On All User’s Computers  Newsletters, Web Updates, Meeting Updates

Implementation Training – Go Live Week  4-6 hours training outside of clinic  Departmental Trainings  Use Knowledgeable Trainers  One-On-One Training Also  Competency Checklists

Going Live  Intense CAC and IT Support  Make Appropriate Scheduling Adjustments  Daily Debriefings…. Procedural Questions Procedural Questions Technical Issues Technical Issues Training Training

Impact on Process

Issues – General  Automation supports well-designed business processes, but makes poorly- designed processes worse.  EHR will shine a light on the cobwebs  Facilities need to be willing to change to maximize the positive impacts of EHR Don’t design workarounds so that you can do things the way you used to... Don’t design workarounds so that you can do things the way you used to... DON’T AUTOMATE WASTE!

Medical Records Process  When to stop pulling the chart  Filing notes AND orders in chart?  Print And File Chart Copies? Batch Print?  Release Of Information?  Outside Consults? Scanning?  Incorrect Entries?  Entering newborns into RPMS asap

Miscellaneous Policies/Procedures  People who aren’t using E.H.R. yet- how are they handled?  Use of personal templates  Template approval process  Flowsheets and other paper documents

Radiology Process Changes  Using RPMS Radiology Package  Providers order the exam electronically  Radiology orders print out automatically

Lab Process/Prep  All Labs need to be entered in RPMS On-site Labs On-site Labs Reference Labs Reference Labs  Computer Access Points  Changing from Esig to EHR  Created Quick Order Menus

Lab Process  How to handle add on labs  How does the lab know when the pt is there?  Lab only visits  How to communicate the “Signs and Symptoms” (lab pov) to the lab

Lab Quick Orders

Pharmacy Process  Outside Prescription Orders  Printing pharmacy service copies for orders  Refill and New prescriptions aren’t always grouped  Printing controlled substances  How to incorporate pharmacy patient signature log  Pharmacy Requirement for Completed/Signed Notes

PCC Coding Process  Coding and Data entry is combined position at our facility  Coders are assigned to provider teams  Coding/Auditing from daily reports (VGEN and Audit Report)  We code from EHR, not the chart  Corrections are communicated to provider via notification

PCC Error Report  Instead of 2 data entry clerks, we have 70 data entry providers who encode data  Daily Error Reports should be run  Most Common Errors: Missing POV Missing POV Missing E&M Code Missing E&M Code Uncoded diagnosis Uncoded diagnosis Duplicate Visits Duplicate Visits 2 visits created on the same day – have to be merged2 visits created on the same day – have to be merged Dental makes 2 visits that need to be mergedDental makes 2 visits that need to be merged Patch comingPatch coming

PCC-Business Office Communications  Bills are generated before PCC has reviewed the visit

What does EHR cost?

Cost Estimates-WSP

Impact

GPRA Indicators - Flu Vax

GPRA Indicators – Pneumovax over 65 y/o

GPRA Indicators – Tobacco Use Assessment

GPRA Indicators – DV/IPV

GPRA Indicator – BMI 2-74 y/o

GPRA Indicators – Med Ed

Revenue  Increased 56% 2005 compared to 2004 More specific coding More specific coding Clinic Efficiency Clinic Efficiency Will improve with PCC patch to correct visit creation errors Will improve with PCC patch to correct visit creation errors

What’s Next?  Scheduling GUI  Vista Imaging  Dental COTS Package  Digital Radiology  Voice/Stylus Data Entry

Questions?