EHR IMPLEMENTATION CASE STUDY DR CHRONO Dorieanne Bati

EHR IMPLEMENTATION CASE STUDY: DR CHRONO Dorieanne Bati Katherine Jose Jonathan Munar

ABSTRACT Healthcare facilities are in the process to go paperless Doctors inability to document notes right away Inefficiency between staff members and Doctors Better communication at the point of care Enabling better patient education through visual aids Elimination of hassle and potential inaccuracies of handwritten prescriptions

INTRODUCTION Government wants the healthcare industry to adopt electronic health records by 2014 Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009, to encourage the adoption of meaningful use of health information technology. Enabled incentive payments through Medicare and Medicaid to clinicians and hospitals when they use HER to help improve in patient care delivery. Incentive payments up to $27 billion over 10 years, and as much as $44, 000 (through Medicare) and $63, 750 (through Medicaid) EHR Implemention

THE PROBLEM Healthcare is buried in paperwork Many providers have been hesitant to take on the task of converting from the paper-based medical record system to the electronic health record It costs nearly $250 billion to process 30 billion healthcare transactions each year 86% or mistakes made in the healthcare industry are administrative Three of every 10 tests are reordered because results cannot be found Patient charts cannot be found on 30% of visits Providers need to fill out an average of 20, 000 forms every year

THE SITUATION DR CHRONO uses the originality of the i. Pad to create the only Patient Care Platform that gives you what you need at the point of care DR CHRONO vs. EMR Meaningful Use Certified Meaningful Use Introduction On. Patient app DR CHRONO vs EMR: Paper check-in clipboard Accurate medical speech-to-text Custom forms and templates Spend less do more (FREE) Accessible anywhere

OPERATIONAL IMPACT Paper filing § Old-fashioned clipboard Frustration § Staff having to keep everything in their head (memorize) and go back to desktop. § Information lost. § Physician and Patient—limited time together § Dr. Chrono: triage notes, conducting history, physical down to discharging patient and emailing a summary. Variable consistency and accuracy of patient record

STRATEGIC IMPACT Time involved in vendor selection process § Nurses need to be involved (time conflicts). § Dedication of “training time. ” § Lack of time and funding to cope with change. Conversion not an upgrade § Not an “easy fix. Process reengineering § Going from paper and pen to i. Pad. § Change in workflow. Short-sightedness § EMR shouldn’t just measure today—it should measure tomorrow.

CULTURAL IMPACT People factors § Personal characteristics and expectations § i. e. prior EMR experience § Staff’s personal time investment in exchange for the benefits expected from the system § Shift in tasks (i. e. documentation by staff vs. physicians) § Could lead to role ambiguity and conflict Staff participation § Culture that support EMR adoption/use There’s a huge unmet demand for acute care for minor injuries and ailments in the downtown area.

POLITICAL IMPACT Dr. Chronos adoption part of overall organizational vision and mission Dr. Sonny Saggar § Only senior health executive (St. Louis Urgent Cares) § Strong vision and awareness of strategies § Must be able and ready to execute strategies to ensure that any obstacles encountered during achieving the ultimate vision and mission. § Must be able to inspire staff, in turn be able to ultimately make a difference in transforming the HCO.

THE PROPOSED SOLUTION Dr. Chrono- a patient care platform that consists of an i. Pad based EHR, an i. Pad based patient portal (onboarding system) and a web based practice management and medical billing system. § It’s like New York, London and Chicago without the big city negatives. There a lot of progressive and conservative people, simultaneously, and they have a healthy blending of science and technology without surrendering their traditional values. ” –Dr. Sonny Saggar on St. Louis The company released the first Pad EHR system to be in accordance with ONC-ATCB stage 1 Meaningful Use criteria by Infogard Laboratories in June 2011. Provides a number of free medical search engines: medical icd-9 search engine, electronic medical insurance payer search engine, and i. Phone ICD-9 search engine. § A place to ask questions about medical billing.

OPERATIONAL IMPACT “The main advantage of using electronic records on i. Pad is that it gives us complete access to everything that’s ever happened with each patient — in the current visit or previous ones. ” § Dr. Sonny Saggar, CEO, founder and medical director, St. Louis Urgent Cares “i. Pad lets us spend more time with each patient and less time typing. ” § Dr. Carol Ann Smith, staff physician, St. Louis Urgent Cares

STRATEGIC IMPACT Customizable templates (clinical forms) § Fits the needs of any practice, no matter the workflow HCO is more efficient overall § Fanning and printing § Legibility issues § Documentation “in hand” for every patient Expedites care § Spending time taking care of patient § Less time typing and document Make life easier for patient § In and out as quickly as possibly Potential for surveys and taking suggestions from patients and neighboring businesses.

CULTURAL IMPACT Enhanced communication between all staff in an HCO. Multimedia experience for both provider and patient § Notes in real-time, X-rays “Tap” through registration § Streamlined experience for all St. Louis Urgent Care is able to provide care to more “downtown” residents (with a 63101 area code) § Satisfies the calling for more acute care in the downtown area § There are no urgent care centers near the downtown area. “They’re traveling 45 minutes to an hour out of the city to be seen for half an hour, and then go back. ” § Others, he says, come by cab from other emergency rooms closer to the city. “When they get there, they see that they’re overflowing, so they come out here. ”

POLITICAL IMPACT Increased trust and respect of employees and partner physicians § Help and allow subordinates work to the best of their abilities. § Seek feedback from direct reports. Meaningful Use certified platform § Potential for tax breaks even with the small size of St. Louis Downtown Urgent Care. Dr. Sonny Saggar wants to have an arrangement with downtown business to make it financially easier for employees to come to the center. “The demographics and market analysis say we’ll be seeing upwards of 100 patients a day, ” he says. “But, in terms of revenue, I’m anticipating 25 people a day, at least at first. ” § “Eventually, we want to be open 12 hours a day, seven days a week, ” he says.

ATTEMPT TO MITIGATE FORESEEABLE PROBLEMS (PRE-IMPLEMENTATION) PRE-IMPLEMENTATION Convince staff early Create timeframe Organization-wide assessment of basic i. Pad skills Training POST-IMPLEMENTATION Weekly meetings Begin with one patient Leadership support

ATTEMPT TO MITIGATE FORESEEABLE PROBLEMS (CHALLENGES & SUCCESSES) CHALLENGES DR CHRONO vision Lack of work flow and data analyses Training from DR CHRONO Strong investment Support

ATTEMPT TO MITIGATE FORESEEABLE PROBLEMS (CHALLENGES & SUCCESSES) SUCCESSES Clear process Weekly meetings One patient Strong Investment Support