1. Madelyn Pollock MD, Jay Morrow DVM, Donny Graneto MD, Alison Dobbie MD U. Of Texas Southwestern Medical Center at Dallas Transitioning your Residency to an EHR – Strategies for Success

2. We are: A Chair, using EPIC in faculty clinic A Residency Director, former EHR consultant, newbie with EPIC An “IT guy” and EPIC optimizer A Resident, in the midst of an implementation of EPIC at a major publicly funded hospital

3. Needs Assessment Who – Has already introduced a residency EHR? Plans to do so in the next 6 months? Plans to do so in the next year? What are some of your concerns?

4. Session Objectives: Participants will: Describe common challenges to residency EHR implementation Perform a SWOT analysis of their residency’s readiness for an EHR Outline an EHR implementation plan for their residency Take home “pearls” that you can use now

5. Session Agenda Mini-lecture 1. – common challenges to residency EHR implementation Participants SWOT analysis exercise Mini-lecture 2. – strategies for successful EHR implementation Group discussion Summary, reflection and wrap up

6. Common Challenges to Residency EHR Implementation training and integrating multiple levels of learners fulfilling the Primary Care exception attestation requirements staying in compliance with Medicare documentation rules

7. The Learner’s View: Needs Optimism from everyone (no curmudgeons!) Unified expectations Timeliness (agree on standard to closure of a chart) Perfection (feedback is good, but there’re limits) Clear role definition – nurse, learner, faculty Minimal interference in the doctor-pt interaction Reward for grunt work: time, money, food, etc. Continued learning during transition

8. The Learner’s View: Needs Optimism from everyone (no curmudgeons!) Unified expectations Timeliness (agree on standard to closure of a chart) Perfection (feedback is good, but there’re limits) Clear role definition – nurse, learner, faculty Minimal interference in the doctor-pt interaction Reward for grunt work: time, money, food, etc. Continued learning during transition Don’t push me over my 80 hrs… O p t i m i s m i s K e y !

9. The Learner’s View: Pearls Make training brief Teach fundamentals initially Follow-up with weekly problem-based sessions Uncompromised patient care Results routing accuracy assured No “IT-speak” on buttons Help me take better care of my patients with access to online resources

10. It’s a People Thing Who are your people?

11. The Writer

12. The Procrastinator

13. The Computer Phobe

14. The computer Hypnotee

15. The Perfectionist

16. The Iconoclast

17. It’s a Systems Thing

18. Workflows Are they defined? Are they uniform? Are they written? Will they transfer to the electronic world? Will they incorporate new workstations? How is precepting incorporated? How do they foster learning and follow-up?

19. SWOT Analysis Exercise (10 mins) On the YELLOW handout, note the Strengths Weaknesses Opportunities Threats You face in implementing the EHR in your residency

20. Implementation: Strategies for Success 1. Planning 2. Planning 3. Planning Take notes on the BLUE Planning Chart

21. Immediate actions (1) 1. Evaluate adequacy of paper med lists and problem lists and consider changes for EHR 2. Evaluate exam rooms for placement of CPUs or thin clients 3. Assess all users’ email skills and ensure 100% information dissemination via email or web.

22. Immediate Actions (2) 4. Assess paper chart data fields for preventive measures, immunizations, growth charts, etc. and plan for their transfer to the EHR 5. Consider a site visit a residency program that uses your proposed electronic system 6. Discuss electronic precepting with compliance officials to assure mutual understanding of faculty attestation requirements

23. About 6 months prior to “Go Live” 1. Choose a project leader – up to 50% time 2. Form an EHR committee with faculty, staff and residents 3. Evaluate all clinical workflows and map out how these will work in the electronic world. 4. Assess facilities for support of wireless tablets or laptops or decide on hard-wired system 5. Plan for and request additional workstations 6. Optimize communication streams to update users

26. 2-3 months prior to “Go Live” (1) 1. Formally assess all residents’ computer and keyboarding skills 2. Book computer labs for resident group teaching 3. Begin gathering “pre-load” information (Problem lists, medication lists, basic demographic data) on paper 4. Train residents in a group to load their own patient data 5. Begin using the EHR for messaging. Residents should enter problem lists and medication lists with each message

27. 2-3 months prior to “Go Live” (2) 6. Evaluate all planned absences to assure critical personnel are available 7. Celebrate every milestone reached 8. Develop a disaster plan – what if all the computers are stolen/broken/system goes down? If the electricity goes out? 9. Consider ways to absorb the patient overflow from drastically decreased short term access 10. Train faculty in use of electronic attestations 11. Develop strategies for review of resident charts/dual signature

28. Around “Go Live” 1. Schedule time for pre-loading patients appointed during first “go-live” session 2. Decrease patients scheduled by 50% for first 1-2 weeks 3. Plan gradual return to regular schedules and ongoing pre-loading of patients prior to their appointments 4. Plan celebrations and opportunities for congratulations

29. Follow-up, The Optimization

30. Post-implementation milestones 2-3 weeks: Clinic can work alone with the EHR with a few calls to the Help Desk. 3-6 months: Clinicians “get” the electronic medical record Bad habits and workarounds help many “get by” inefficiently Good time to check-in for re-training Break workaround and bad habits Reinforce good practices Lay groundwork for training as an iterative process

31. Optimization Clinic/institution should establish working group to prioritize and guide EHR changes As the EHR evolves, clinics can be revisited to retrain, reinforce efficient practices Identify “superusers” in each clinical dept/unit to retrain, upgrade, and disseminate change Involve superusers in upgrades and feature update planning with IT. They serve as a link to the real clinical world.

32. Summary and Wrap up Did we achieve our objectives? 1. completing a SWOT analysis and 2. drafting EHR implementation plan? What ONE thing did you learn? How will you change you EHR implementation as a result of this session?

33. THANK YOU Contact info: madelyn.pollock@utsouthwestern.edu