Challenges and Strategies When Implementing an Electronic Health Record (EHR): A Ground Level Perspective 1 Guillermo Diaz Jr, MD Chief Medical Information Officer QueensCare Family Clinics

Warning hard work ahead!!!

6 clinical sites: ~ 215 FTE employees 6 clinical sites: ~ 215 FTE employees ~30,000 lives served/yr ~30,000 lives served/yr ~130,000 visits/yr ~130,000 visits/yr 33 FTE providers (MD/NP) 33 FTE providers (MD/NP) Services offered include: Services offered include: 3 Family Medicine Cardiology PediatricsPodiatry OptometryObstetrics Dental

4 Current Practice Management SystemCurrent Practice Management System - 10 years Dictation System forDictation System for -2yrs – Failed Manual Disease registryManual Disease registry 3 years – becoming out-dated3 years – becoming out-dated Electronic Health Record (EHR)Electronic Health Record (EHR) - 2 years years (Full implementation) QCFC’s Health Information Technology History:

5 Implementation Financing: $2.7 million to implement - California Health Financing Authority Grant ~$471,000 Authority Grant ~$471,000 - QueensCare Charitable Foundation ~$550,000 Foundation ~$550,000 - Remainder - Clinic budget

6 Request For Proposal Defined: What do you want out of the system and what does the system have? –109 requirements – 92% of criteria were met

7 Create Workflows Create the As-Is WorkflowsCreate the As-Is Workflows How do you do what you do daily on paper? Create the To-Be WorkflowsCreate the To-Be Workflows How will you do what you do on computer? Validate the To-be WorkflowsValidate the To-be Workflows Establish Best Practices

8 Create a System of Support Created - Support Desk Created - Support Desk - User Groups - User Groups Trained - Trainers Trained - Trainers - By Clinic - By Clinic - Work Type - Work Type - In Groups - In Groups - 1:1 sessions - 1:1 sessions - Online - Online Training continues today… Training continues today…

9 Are providers satisfied?

10 Would providers go back to paper?

Will Quality Improve (cont’d)?

12 Will productivity ever be the same?

13 Challenges & Lessons Learned Have a predefined selection process Have a predefined selection process Be Flexible Be Flexible Interfaces have inherent flaws Interfaces have inherent flaws Scan Today’s Work Today Scan Today’s Work Today Patience is a virtue Patience is a virtue Consider ROI (Return on Investment) Consider ROI (Return on Investment) Be willing to self-evaluate/obtain outside evaluations Be willing to self-evaluate/obtain outside evaluations Communicate / be inclusive Communicate / be inclusive

14 Thank You !!!