IHS EHR Indian Health Service Electronic Health Record

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

Preparation, Implementation and Lessons Learned Ø Preparing for Installation l l l Implementation Team CAC OIT Requirements Ø Setup l l EHR CAC & Implementation Training (ABQ) OIT On-site RPMS-EHR setup Ø Go Live Ø Looking Ahead

Where to Start?

Implementation Team l l l l l Clinical Application Coordinator (CAC) Medical Staff (Clinician) Nursing Pharmacy Lab and Radiology Medical Records Billing/Coding Information Technology staff *Administrator/Executive Leadership*

Implementation Team Roles Ø 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

What’s Next?

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 workstations Ø Backup Server Ø Backup Generator Ø Clinical Applications Coordinator GS 12 Ø Training / Travel Costs Ø Software-$0. 00

OIT Requirements http: //www. ihs. gov/CIO/EHR/index. cfm

Step 1 -Site Survey http: //www. ihs. gov/CIO/EHR/index. cfm

Step 2: EHR Site Tracking http: //www. ihs. gov/CIO/EHR/index. cfm

ec is R ion ev ie to C w imp om EH le p R m Es lete W en e t ta bl EH bsi EH Be ish R te R S gi n EHR ite EH S Im ur B R v eg Si ple ey in te m Tr en Be hi ac ta gi rin ki tio n g n n Im ph pr oc g R Te pl ar e ec am m A me ac ess or tte n d y f t o d nd A r. C ru d Be g v L A gi es ers file C n so e cl p R ns R e ea PM roc ur Le act nup S i e cu me arn on T for In st e al rren nt p d c rac Pha l k r l O r pt PIM t, C oce ass ing m 5 im A pa /7 S C ss f ck * O ize H o pt r E ag “ ha im Po e rd iz in e w t In ar PC -of st -S e C al e r Er l v In /co ro ice st nf r. R ” al i ep RP l P gu r or MS e Im ha ts R Pa pl r em ma adi ck ol cy ag A e tte nt 5/ ogy es 7 nd Pa 5 a p nd. 0, C A erl O EH La C es nb t s R ra si R te in G 5. 2 e U in fil Se I EH g l tu R p Su w ith EH per N U at R s ’l G er EH ot ra Li R in ve Te i n w Fu am g i E th ll H ro R N llo Te at’ ut am l D EHR Planning & Implementation 0 1 2 3 5 6 8 10 11 * Most sites contract for external resources to complete pharmacy file preparation. 12 Elapsed time (in months) Please note that this is just a general timeline of how long it might take for your site to implement EHR. Every site will be different, and the amount of time it takes to implement EHR depends upon many factors, including size of the facility, services offered at the facility, current state of RPMS and packages installed and utilized. 24

6 Months of Setup? After Pharmacy 5/7 installation

National EHR Training and Deployment Program recommends at least 6 months Ø Three months of Pharmacy 7. 0 utilization before "Paperless Refill" Ø Three months of "Paperless Refill" and "Coding Queue" before beginning Provider Order Entry (POE) with EHR.

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

Lab All Labs need to be entered in RPMS l l l On-site Labs Reference Labs State Labs Ø Computer Access Points Change from Esig to EHR after Go-Live

EHR Setup

OIT Help / Training Ø EHR CAC & Implementation Team (Set Up) Training in ABQ Ø EHR Onsite Set-Up Team Ø Onsite Go Live Team Ø EHR for Techies, EHR for Inpatient, EHR for HIM and Business Office

Setup by CAC Ø Customize order menus l Lab, Pharmacy, Radiology Ø Setup Referrals/Consults Ø Progress Note Templates l l Design your 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 ftp: //intranetftp. ihs. gov/pub/EHR/ l l Pharmacy CPRS Ø Web. Ex Demos Ø Show and Tell l l Newsletters Web Updates Meeting Updates Email Quizzes

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

Going Live

Go Live Week 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

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

Change is Good

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

Medical Records Supervisory 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

Business Office Ø No Hard Copy to Wait for Ø No more missing E&M Codes Ø EHR Notes Are Legible Ø Great Opportunity For Improved Provider Documentation & Increase Billing/Collections

Medical Clinic Using templates/graphs instead of flow sheets Ø Using the Scheduling GUI for visual routing of pt flow Ø Selecting ICD/CPT codes Ø Reminders Ø Voice Recognition Ø l Ø Dragon Naturally. Speaking Vista Imaging

Staff Changes at Warm Springs Ø More Nurse Aids after EHR l Ø From 2 to 7 Medical Records Staff l l l PCC Data Entry (temporarily reassigned) Benefits Coordinator (temporarily reassigned) Medical Department (temporarily reassigned) • Nurse aids • Medical Receptionist l Shifted to scanning documents into Vist. A Imaging

Next Steps Ø EHR v 1. 1 Ø CPHAD (Public Health Activity Reporting System) Ø Electronic Dental Record (EDR) Ø Visual PHN System (VPS) Ø Vist. ARAD

Questions?

Clinical Applications Coordinator (CAC) Coordinates EHR Implementation l l l New Position / Role Works cooperatively with Site Manager and Medical Records EHR User Support Training Customizes EHR Workflow back