IHS EHR Indian Health Service Electronic Health Record

IHS EHR Indian Health Service Electronic Health Record Carolyn Johnson & Michele Miller Warm Springs Health & Wellness Center

Preparation & Implementation Today’s Presentation Ø Medical Records Ø Medical Clinic Ø Lab Ø PHN Ø PCC & Billing Ø PHN/Community Health/ Diabetes Ø CAC/Computer Support

Medical Records Process When to stop pulling the chart Ø Filing notes in chart during the transition? Ø Print And File Chart Copies? Batch Print? Ø Release Of Information? Ø Outside Consults? Scanning? Ø Transcription Ø

Medical Records Supervisory Process Changes Daily Report: Unsigned Orders Ø Daily Report: Unsigned Notes Ø Retracting /Correcting Incorrect Entries Ø Paper P&P changed to Electronic P&P Ø Sensitive Pt Tracking Ø Medical Records Supervisor: Business rules/HIPAA Ø l l Who can view which parts of EHR Works cooperatively with RPMS Site Manager

Medical Records Staff Changes at Warm Springs Ø Staff shift from Medical Records to other departments : l l l 2 Medical Records are in PCC part time 1 Med rec tech is a nurses aid 1 Med rec tech is a Benefits Coordinator More nurses aids after EHR Staff will be utilized to scan documents once Vist. A Imaging is implemented

Medical Clinic Preparations Ø Formed Teams Ø Practiced EHR (on paper) Ø Defined Roles Ø Computers everywhere

Medical Clinic Process Using templates/graphs instead of flow sheets Ø Using the scheduling gui for visual routing of pt flow Ø Selecting ICD/CPT codes Ø Using GUIs: Ø l l Ward Order Lab Entry RCIS Behavioral Health Scheduling

Lab Preparations All Labs need to be entered in RPMS l l l On-site Labs Reference Labs State Labs Ø Computer Access Points Ø Changing from Esig to EHR

IHS EHR Indian Health Service Electronic Health Record PCC/Coding Krisanne Billy

Objectives for this Session Ø Role Changes Ø PCC Data Entry Coding Process Ø Error Report Ø Communication Ø New Coding Queue

Role Changes Ø Coding & Data Entry are a combined position. Ø Instead of 2 data entry clerks, we have 70 data entry providers who encode data. Ø Auditor Ø Educator

PCC Coding Process Ø Coders are assigned days. (ODD/EVEN) Ø Coding/Auditing from a coding queue Ø We code from EHR/RPMS not the chart Ø Corrections communicated to provider via notification (demonstration)

PCC Error Report Ø Daily Error Reports should be run Ø Most Common Errors: l l Missing POV Missing E&M Code. 9999 - Uncoded diagnosis (Separate Report) Duplicate Visits • 2 visits created on the same day – have to be merged

Coding Queue Ø Ø Paperless list on RPMS that shows every visit for a specific date range, that have not been audited by the coder. Pros • • • No more VGEN lists (only for research purposes) Everything is there. Flag errors & incomplete chart notes.

PCC-Business Office Communications Ø Bills are generated before PCC has reviewed the visit. Communicate with Business Office. • What can they bill?

Questions?

Business Office Process Services Pick List Development, Installation, And Training Ø No Hard Copy To Work With Ø No more missing E&M Codes Ø EHR Notes Are Legible Ø Great Opportunity For Improved Provider Documentation & Increase Billing/Collections Ø

Preparation/Implementation CAC

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Step 1: Submit Site Survey

Step 1 -Site Survey

Step 2: EHR Site Tracking

Implementation Team l Administrator/Executive Leadership Clinician Nurse Pharmacy l Medical Records l l l Billing/Coding Information Technology staff Clinical Application Coordinator

Implementation Team Roles Monitor and Execute Implementation Plan Ø Identify and define Policies and Procedures Ø Address staffing and scheduling during transition Ø Peer Training & Marketing Ø Design and Approve EHR Menus, templates, etc Ø

Identify Clinical Applications Coordinator (CAC) Ø Works cooperatively with Site Manager Ø Coordinates Implementation Ø EHR User Support Ø Training Ø Customize Software Ø Workflow Ø Portland Area CAC: Bob Adams R. Ph.

Help Desk Requests Warm Springs Computer/Cac Department

Implementation Strategy Implementation-Who and When Ø Everyone at once Ø Lab ordering , then radiology ordering, then pharmacy ordering, then notes Ø Bring up one team/dept at a time

Implementation. Hardware/Infrastructure upgrade Ø RPMS server Ø Backup/Training server Ø Thin Clients, laptops, pcs? Ø Network Ø Lab Interface Upgrade Ø Workstation Access-Everywhere Ø Backup Power

Costs Associated with EHR Ø Workstations l Laptops, tablets, pc, thin clients Ø Ergonomic Support Ø Backup Server Ø Backup Generator Ø Clinical Applications Coordinator GS 12 Ø Training costs Ø Software-$0. 00

EHR Costs Staff coverage Ø Travel Ø Computers: Ø l l l 1 per room 1 per provider Extras in ward area

Ballpark Timeline Ø Scheduling Software (PIMS) l l l Scheduling application-improved Has a Windows based component Sensitive Patient Tracking feature Ø Radiology 5. 0 -after PIMS Ø Pharmacy 5/7 -needs to be scheduled with ITSC l Allow several months for file preparations • • Adverse drug reactions : 1 month (4 staff) RPMS/Scriptpro Format : 1 -2 days (2 Staff) Dosages in Pharmacy 7: 1 week (2 Staff) Quick orders : 2 weeks (2 Staff) Ø Installation of EHR client – after Pharmacy Ø EHR Set-up; Site visits - after Pharmacy Ø Go-live – 3 -6 months after Pharmacy

EHR Setup Ø Customize order menus l Lab, Pharmacy, Radiology Ø Setup Referrals/Consults Ø Progress Note Templates l l Design our own Share with other sites Ø User Setup Ø ICD/ CPT Pick Lists

EHR before Configuration

EHR after Configuration

Preparation-Customizing Orders

Preparation-Customizing Templates • Templates can be shared with other IHS and VHA facilities • More Complete Documentation

Training/Marketing Ø EHR Demo Movie Ø VA Training Modules l l Pharmacy CPRS Ø ITSC Web-Ex Demo for our clinic Ø Show and Tell l l Newsletters Web Updates Meeting Updates Email Quizzes

EHR Trainings Ø EHR CAC & Implementation Team training l l Must have 5/7 installed Must have RPMS packages Optimized EHR Setup (on site) Ø Super end user training (on site) Ø Go Live (on site assistance from OIT) Ø EHR for Techies, EHR for Inpatient, EHR for HIM and Business Office Ø http: //www. ihs. gov/CIO/EHR/index. cfm? module= rpms_ehr_training Ø

Going Live Week

How the Week First Goes Growling at CAC’s Cat in the microwave TGIF Crying, gnashing of teeth Excited

Going Live Intense CAC and IT Support Ø Make Appropriate Scheduling Adjustments Ø Daily Debriefings…. Ø l l Procedural Questions Technical Issues How did it work before EHR? More Training-Email training

Next Steps Ø Reminders Ø Vist. A Imaging Ø Voice Recognition Ø Electronic Dental Record

Questions?