1. Metrics Lessons Learned Managing Risks Howard Hays, MD, MSPH Medical Informatics Consultant Carolyn Johnson, RPh, CAC

2. Today’s Presentation  Metrics: Productivity Productivity Patient Care / GPRA Patient Care / GPRA Collections Collections  Lessons Learned / Managing Risks

3. Productivity Metrics

4. Provider Productivity  All sites see a transient decrease in provider productivity (pts/day) at first  Typically takes 1-3 months to recover to pre-EHR levels  Mitigate by staggering implementation, either by provider or by function, or both  Efficiencies in other areas (phone calls, chart reviews) can improve productivity

5. Provider Productivity (Site A) EHR

6. Site C Productivity

7. Patient Care Metrics

8. Medication Errors (Site A) EHR

10. Pharmacy Waiting (Site D)

11. GPRA Indicator - Flu Vaccine 65+ (Site A) EHR

12. GPRA Indicator – Pneumovax over 65 y/o

13. GPRA Indicator – DV Screen Age 15-40 (Site A) EHR

14. GPRA Indicator – Tobacco Assessment (Site A) EHR

15. GPRA Indicator – Medication Education (Site A) EHR

16. GPRA Indicator – BMI 2-74 y/o (Site A) EHR

17. GPRA Indicators – 1 st Qtr ‘05 (Site C)

18. Collections Metrics

19. EHR Creates the Potential to Increase Collections Due to:  More Complete documentation with templates  Provider notifications – received automatically if they forget to enter POVs or codes  Superbills, ICD/CPT Pick Lists – make it easier to find correct codes  Coding Tools and Training with EHR

20. Automatic Notifications

21. Superbill link to Billing RPMS Billing Package

22. Coding Tools in EHR  Links to coding sites, reference guides, E&M Coder

23. Medicare/Medicaid/PI Collections 10% increase

24. Itemized Billing Collections Partial EHR Year 22% increase

25. Medicaid Collections (Site B) 16% Increase from FY03 to FY04

26. PI collections (Site B) 29.9 % Increase from FY03 to FY04

27. Podiatry Billing (Site D)

28. Optometry Billing (Site D)

29. Identifying and Managing Risks The Good The Bad The Ugly

30. Lessons Learned / Managing Risks  Unsigned notes/orders are invisible Med Rec Supervisor should run “unsigned notes/orders report” daily Med Rec Supervisor should run “unsigned notes/orders report” daily  Server room environment is critical Backup generator Backup generator Backup cooling system Backup cooling system  Decreased provider productivity at first Planned / staggered implementation Planned / staggered implementation Monitor and adjust Monitor and adjust Tweak templates to facilitate rapid documentation Tweak templates to facilitate rapid documentation Future – dictation / voice recognition for some notes Future – dictation / voice recognition for some notes  Management plan for staffing changes Proactive business process plan Proactive business process plan Medical Records role changes Medical Records role changes

31. Lessons Learned / Managing Risks  HIPAA/Privacy: Use of CHAT instead of BROADCAST Use of CHAT instead of BROADCAST  GPRA/CRS: Be consistent: Be consistent: Who enters each data elementWho enters each data element Where/How data is enteredWhere/How data is entered Incorporate Cheat Sheets in Your EHRIncorporate Cheat Sheets in Your EHR  Medication Order Errors/Frustration at startup Use Pharmacy Quick Orders Use Pharmacy Quick Orders

32. Lessons Learned / Managing Risks  Lengthy PCC Error Report (everyone wants to start the visit) Keep a pulse on the error reports Keep a pulse on the error reports Fixed by patches (soon!) Fixed by patches (soon!) Train providers on visit creation Train providers on visit creation  Ongoing Cost of Ergonomics, Computers  Go-live is just the beginning – continue to meet and train regularly afterward  Template approval process in place  Cutting & Pasting can transfer patient A’s data into patient B’s chart

33. EHR-The Wave of Change Think of EHR as a tidal wave of change…. How do YOU react to change? 1. D o nothing….. 2. R un….. 3. R ide the Wave!!

34. Evaluations  http://porwsp-b/wspintranet/EHR/EHR.htm http://porwsp-b/wspintranet/EHR/EHR.htm