Community Clinics EHR Assessment and Readiness Project EHR

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Community Clinics EHR Assessment and Readiness Project EHR: Pathway to Healthier Communities May 4

Community Clinics EHR Assessment and Readiness Project EHR: Pathway to Healthier Communities May 4 th and 5 th, 2005 Sponsored by the California Health. Care Foundation and Community Clinics Initiative Forum Highlights OBJECT HEALTH Julie V. Murchinson Timathie Leslie 1

What is an EHR? n Electronic, patient-centric clinical record of care encounters to support

What is an EHR? n Electronic, patient-centric clinical record of care encounters to support care processes n Longitudinal across providers, care settings and time n Enables clinical communication and patient care planning n Accessible by authorized healthcare practitioners serving the patient n Enables continuing education and decision support n Documents specific services received by the patient for legal and reimbursement purposes n Source of data for clinical, health services, outcomes research, and public health Source: Computer-based Patient Record Institute, 2002; HIMSS, Standard Insights, 2003. Community Clinic EHR Project 2

Why EHR now? vid ints Da o p p a Czar Bush T I

Why EHR now? vid ints Da o p p a Czar Bush T I t n h t e l d a i e Pres e first H h t s a r Braile IOM calls EHRs an “essential technology” to enable patient safety AHRQ grant demon s awa strat rded e val to ue of healt care h IT Hillary Clinton introdu announc ce legi es plan slation to develop to enco ment of urage a natio informa n a l tion in health frastru includi cture, ng adop ting el ectroni records c. … Bush praised computerized records as a way to avoid medication errors, cut costs and improve care. Promises to have EHRs in 10 years …unprecede nted enthu siasm and c o m s m m itment for a r g o r p changing t ce world of h he day-tod rforman n e a p n e r a o l day o m t f h m o c y a c r a e P e with HIT f r l o e m a d e g r s n o h ip across rom omi asked t sectors. – g are bec n B i r e a i b l e s r D , National avid are outcome Coordinato y t doctors i H e l a a l t u h r E Care Infor trate q mation Tec s” - BT e c i t c “demons a h nology pr istent s n o c r o Kennedy announces health care plan Source: i. Health. Beat. org, Object Health research Community Clinic EHR Project 3

Health Care Delivery Landscape Incomplete knowledge of patients Patient safety & Medical errors ¡

Health Care Delivery Landscape Incomplete knowledge of patients Patient safety & Medical errors ¡ ¡ ¡ Increasing complexity of clinical care ¡ ¡ Increasing cost of care ¡ ¡ Source: i. Health. Beat. org, Object Health research Patient data unavailable in 81% of cases; average of 4 missing items per case 18% of medical errors are due to inadequate availability of patient information Patients receive only 55% of recommended care 44, 000 – 98, 000 annual inpatient deaths due to a preventable medical error Medication errors in 5 – 18% of ambulatory patients; resulting in 131 deaths 17 years to translate medical research into medical practice Physician Desk Reference more than doubled in 20 years to 3, 075 pages 5 th consecutive year of double-digit growth in health care expenditures 30% of health expenditures categorized as “unnecessary spending” = $7. 4 trillion aggregate in US from 2004 - 2013 Community Clinic EHR Project 4

EHR Value Proposition Savings Generated from EHR Clinical Automation ¡ Increased operational efficiencies ¡

EHR Value Proposition Savings Generated from EHR Clinical Automation ¡ Increased operational efficiencies ¡ Improved communication among providers Interoperability ¡ Decrease administrative burden of manual data sharing (fax, courier, mail) ¡ Decrease unnecessary utilization of ancillary tests Decision Support ¡ Decreased medical errors and adverse drug events ¡ Improved patient compliance Source: Object Health Research, Gordian Project Analysis Community Clinic EHR Project 5

Barriers to EHR Adoption Barrier to Adoption Cost of adoption Explanation ¡ ¡ Clinician

Barriers to EHR Adoption Barrier to Adoption Cost of adoption Explanation ¡ ¡ Clinician support ¡ ¡ 3 major studies found as #1 barrier Initial capital and on-going cost exceed financial benefit to physician user Clinician resistance Additional time required for patient care Early stage development of commercial products ¡ “Even highly-regarded, industry-leading EHRs to be challenging to use because of the multiplicity of screens, options and navigational aids. ” Practice transformation changes ¡ Significant operational modifications are key to realizing value of EHR technology Low level of electronic data exchange and lack of standards ¡ Result in high-cost interfaces Result in duplicative processes due to lack of widespread adoption (i. e. paper and electronic) ¡ Source: Promoting Adoption of electronic Health Records: Incentives and Connectivity, September, 2004, Connecting for Health program. Community Clinic EHR Project 6

Top 10 Reasons for EHR Adoption failure 1. 2. Lack of alignment with 4.

Top 10 Reasons for EHR Adoption failure 1. 2. Lack of alignment with 4. No definition or business strategy measures for progress Weak executive-level or success sponsorship 3. 7. 8. No organized mechanism Underestimating impact for communication and on organization feedback No readiness assessment for 9. plan change 5. Unrealistic expectations 6. Lack of an effective, crossfunctional implementation team Lack of formal training 10. Lack of effective physician leadership * EHR does not meet core provider needs Community Clinic EHR Project Source: Health Choice Network presentation, September 19 – 21, NACHC Convention, San Francisco. 7

Lessons Learned from EHR Adoption Successful EHR implementation requires: • • Physician Leadership Effective

Lessons Learned from EHR Adoption Successful EHR implementation requires: • • Physician Leadership Effective change management An EHR that meets defined needs Executive Leadership Technical Leadership Source: NACHC presentations, 2004, Robert Miller, UCSF, 2004 Health Affairs publication Community Clinic EHR Project 8

Heard at the Forum q “Training is forever…” – Ken Bernstein, Darin Camerena Health

Heard at the Forum q “Training is forever…” – Ken Bernstein, Darin Camerena Health Center q “Move slowly pre-EHR, to go faster post. EHR; understand effective EHR use BEFORE implementation” q – Robert Miller, Ph. D, UCSF “Best practice definition is key” – Kwame Kitson, Institute for Urban Family q “Lengthy pilots don’t work; Super User Groups do work!” – Vija Sehgal, MD, MPH, Ph. D, WCCHC Community Clinic EHR Project 9

More Forum Advice… q Lessons Learned q Must be proactive in looking for opportunity

More Forum Advice… q Lessons Learned q Must be proactive in looking for opportunity (fix REAL problems) q Requires high level of organizational awareness & support q Know your capabilities (Design wide; Implement skinny) q Local engagement leads to commitments (People really matter in getting IT done) q Elements of Success q Clarity of goal; organizational alignment q Clinician participation q Key decision makers engaged q Situation must evolve to meet requirements - Jeremy Noble, MD, MPH, Harvard School of Public Health Community Clinic EHR Project 10

Project Goal: Create a Community Pathway for EHR for CA Clinics EHR Self Assessment

Project Goal: Create a Community Pathway for EHR for CA Clinics EHR Self Assessment EHR Educational Forum Clinic Readiness Vendor Assessment Product Readiness EHR Demonstration EHR barriers to adoption EHR product offerings Community Clinic EHR Project 11

Why is Readiness so important? 50% of EHR implementations have FAILED or produced suboptimal

Why is Readiness so important? 50% of EHR implementations have FAILED or produced suboptimal results Community Clinic EHR Project Source: Department of Health and Human Services, 2005. 12

Readiness Attributes – Alignment Organizational Alignment § Culture: values; environment for achieving excellence; ability

Readiness Attributes – Alignment Organizational Alignment § Culture: values; environment for achieving excellence; ability to manage change and maintain flexibility; team approach § Organization: infrastructure to support information flow, decision making, and problem resolution; role of the board and leadership team; vision for quality; ability to collaborate with external organizations § Leadership: the characteristics of leadership team: setting vision, commitment to quality; alignment across organization § Strategy: mission and vision and priorities documented in a strategic plan; internal and external communications Community Clinic EHR Project 13

Readiness Attributes – Capacity Management Capacity § Information Management: quality, accessibility, relevance and communication

Readiness Attributes – Capacity Management Capacity § Information Management: quality, accessibility, relevance and communication of data/information § Clinical and Administrative Staff: staff capacity; staff training and competence; consistent policies and procedures; methods to motivate and drive individuals/groups to achieve goals § Accountability: how results are achieved and mission/vision fulfilled; role and responsibility of patient in care process § Finance & Budget: extent of infrastructure and management of IT budget; capital and operational resources Community Clinic EHR Project 14

Readiness Attributes – Capacity Operational Capacity § Workflow Process: tools and methods for managing

Readiness Attributes – Capacity Operational Capacity § Workflow Process: tools and methods for managing change, developing policies, procedures, protocols; Quality Improvement model; process for monitoring and communicating performance; analysis and actions taken to improve processes and performance § Patient Involvement: preventative and chronic care processes; patient follow-up and care continuum; comprehensive care § Training: Infrastructure and resources dedicated to initial and on-going IT training Technical Capacity § IT Management and Support: IT staff skill-set and capacity for IT management and support; consistent policies and procedures § IT Infrastructure: information systems environment and infrastructure Community Clinic EHR Project 15

In addition to ambulatory small office EHR functional priorities, community clinics desire: Clinic-specific Scenarios

In addition to ambulatory small office EHR functional priorities, community clinics desire: Clinic-specific Scenarios Clinic EHR functionality § Population management and quality initiatives including use of disease registries. § Desired sophistication of decision support features. § Reliance on multiple patient outreach, education, and communication. § Tracking of patient relationships other than genealogy § Collection of patient social status and other social characteristics. § Management of multiple payer types and program enrollment information. Community Clinic EHR Project 16

We are reminded that there is no “silver bullet”, and product gaps exist §

We are reminded that there is no “silver bullet”, and product gaps exist § § Lack of Organized market for shared service and technology offerings (ASP) Integrated population management and decision support programs are immature Patient Health Record (PHR) modules are scheduled for future releases Management of multiple payer types and program enrollment information require customization § § § Clinic specified data elements are not part of the standard data dictionary Limited experience with regional, state and federal reporting Standardized pricing does not account for clinic settings with concurrent and volunteer users Community Clinic EHR Project 17

Assessment (based on self reported data) Community Clinic EHR Project 18

Assessment (based on self reported data) Community Clinic EHR Project 18

When viewing demonstrations, evaluate functionality considering: q Ease of Use q Performed functionality with

When viewing demonstrations, evaluate functionality considering: q Ease of Use q Performed functionality with ease q Performed, but it was not intuitive q Workflow q How would this functionality be done? q By whom among clinic staff? q Does it fit within the current workflow? q Are there impacts to current workflow that represent a change? q If there is an impact to workflow, quantify the impact q Availability q Available in current release? q Requires code modification q Requires configuration q Pricing q Included in price quoted? q Requires hardware/third party software? q How is it maintained? Community Clinic EHR Project 19

Project Takeaways q Community Clinic Mission q Improve the quality of and access to

Project Takeaways q Community Clinic Mission q Improve the quality of and access to care for communities q Clinic model has significant potential to achieve this mission through population health management q EHR is one information tool available to enable population health management, the successful use of which can result in improved quality of care and increased efficiencies q EHR momentum is increasing rapidly across the nation q Team leadership is critical for EHR success q EHR Forum q Goal: Provide information, resources and strategies; determine if there is interest and common need among community clinics that could be supported to accelerate adoption q Day 1 – Clinics assess their own readiness for change and adoption of health information technology to manage and improve clinical care q Day 2 – Clinics assess EHR product readiness to enable quality improvement goals Community Clinic EHR Project 20

Next Steps q Clinics q CHCF and CCI q. Use the Readiness Assessment tools

Next Steps q Clinics q CHCF and CCI q. Use the Readiness Assessment tools to get a better understanding of your clinic’s readiness for EHR adoption q. Take advantage of learning experiences from industry publications, vendors and other clinics q. Communicate your needs and interests to CCI q. Take your time to pursue the right path for your clinic! q. Continue q q q work in this area: Develop specific strategies to define models for adoption Assist the field with determining readiness Work closely with other funders to determine opportunities for collaboration Community Clinic EHR Project 21

Forum Materials Documents presented and distributed at the Forum are available in the Library

Forum Materials Documents presented and distributed at the Forum are available in the Library section at http: //www. communityclinics. org Community Clinic EHR Project 22