2010 SAAS National Conference and NIATx Annual Summit

1. 2010SAAS National Conference and NIATx Annual Summit Electronic Behavioral Medical Records: Improving your agency’s implementation Jay Ford, PhD Enid Montague, PhD

2. Agenda • Organizational readiness • Meaningful use • Business case for EBHR • Impact on process workflow • Trust in technology

3. Organizational Readiness

4. Why Adopt EBHR? • Productivity & efficiencies • Billing accuracy • Regulatory compliance • Patient safety & reduced errors • Health information security • Leverage data for dollars

5. Reason not to Adopt an EBHR Source: www.satva.org

6. Why is readiness important? It helps organizations detect potential obstacles to and identify opportunities to improve chances of successful implementation.

7. RIS Overall Score by Agency

8. RIS: Enhancing Organizational Readiness

9. Meaningful Use

10. What is meant by meaningful use • Demonstrate use of certified EHR technology • Use certified EHR to submit clinical quality measures • Show that certified EHR is part of a network to promote exchange of health information

11. Stages of Incentive Rollout

12. Making Sense of a Certified Electronic Health Record

13. Meaningful Use Incentives

14. H.R. 5040 • Amends current meaningful use law to include behavioral health providers • Extends eligibility for Medicaid/Medicare implementation funds • Authorizes $15 million grant program to: • Facilitate purchase of HIT • Train staff in HIT use • Improve secure electronic information exchange • Improve HIT adaptation to community BH • Assist with telemedicine implementation • Collaborate & integrate w/ HIT regional extension centers

15. Hospital CIO’s: Ready or Not

16. Level of Implementation for Clinical Information System Components Source: www.satva.org

17. Impact on the Organization • Adapting to meaningful use may … • Result in revised intake processes • Require changes in business practices • Foster and improve inter-agency collaboration • Require an understanding of the business case for adoption

18. Business Case

19. Revenues, Costs, Cost Savings and Benefits

20. Organizational Efficiencies • Administrative efficiencies • Reduce staff and save on labor costs; • Use efficiencies to re-allocate responsibilities; • A combination of both • Clinical efficiencies • Allow staff to spend more time with existing clients or • Use efficiencies to increase capacity

21. Impact on Workflow

22. Impact of EBHR on Workflow

23. Impact of EBHR on Workflow

24. Impact on Intake

25. Oakwood’s eBilling Process

26. Key Implementation Messages • Assess your technological infrastructure • Evaluate organizational readiness • Understand meaningful use • Examine the business case • Map current workflow • Ensure adequate staff training

27. 2010SAAS National Conference and NIATx Annual Summit Enid Montague, PhD Assistant Professor Anna Julia Cooper Fellow Director: HCI lab Industrial and Systems EngineeringUniversity of Wisconsin-Madison enidmontague.com Trust in Technology

28. Outline • Why are we implementing new technologies? • Patient trust in care provider • Patient attitudes about technologies • Provider attitudes about technologies • Tips and considerations Enid Montague, PhD University of Wisconsin-Madison HCI Lab

29. Why are we using EMRs? Image source: Laura Pedrick for The New York Times Enid Montague, PhD University of Wisconsin-Madison HCI Lab

30. Why are we using EMRs? Enid Montague, PhD University of Wisconsin-Madison HCI Lab

31. Nursing shortage US Supply versus Demand Projections for FTE Registered Nurses Source: Data from the Bureau of Health Professions. (2004) Enid Montague, PhD University of Wisconsin-Madison HCI Lab

32. Growth in medical technology industry Enid Montague, PhD University of Wisconsin-Madison HCI Lab

33. Growth in medical technology invention. Enid Montague, PhD University of Wisconsin-Madison HCI Lab

34. Physician shortage Enid Montague, PhD University of Wisconsin-Madison HCI Lab

35. What is trust? Trust is a person’s belief that a person or object will not fail them. Enid Montague, PhD University of Wisconsin-Madison HCI Lab

36. Trust is a popular topic in relation to the provision of health.

37. Trust is a fundamental aspect of all relationships. • Human- human • e.g. worker- worker, parent- child, doctor- patient, • Human-organization • e.g. worker- company, patient- hospital • Human- social institution • e.g. citizens- government, patient- health systems • Human-technology • e.g. user- website, user- device, human- computer Enid Montague, PhD University of Wisconsin-Madison HCI Lab

38. Trust triad model Montague, E., Winchester, W.W. Kleiner, B.M. (in press). Trust in medical technology by patients and health care providers in obstetric work systems. Behaviour & Information Technology.

39. Client- Provider Trust Enid Montague, PhD University of Wisconsin-Madison HCI Lab

40. Patient trust in care provider predicts… • Quality variables such as: • adherence to medical advice • health service seeking behaviors • patient satisfaction • utilization of preventive services • malpractice litigation • health status • sustained enrollment in health plans • Organizational and economic factors such as: • decreases in the possibility of a patient leaving a care provider’s practice • withdrawing from a health plan Enid Montague, PhD University of Wisconsin-Madison HCI Lab

41. As trust declines… • The cost of providing care may increase. • Patients and care providers may engage in self-protection • patients withhold information or avoid seeking care from sources they determine are untrustworthy and care providers practice defensive medicine. • “People are increasingly unwilling to take risks, demand greater protection against the possibility of betrayal, and increasingly insist on costly sanctioning mechanisms to defend their interests” (p 13) (Tyler & Kramer, 1996). • Distrust can “provoke feelings of anxiety and insecurity, causing people to feel uncomfortable and ill at ease and to expend energy on monitoring the behavior and possible motives of others” (p 1) (Fuller, 1996). • When patients feel unsafe, energy that could be devoted to healing is expended on self-preservation. Enid Montague, PhD University of Wisconsin-Madison HCI Lab

42. Ideal environments for interpersonal communication -Full view of the body -Full view of facial expressions -No limitations on making eye contact -Channels are free to focus on listening and responding Enid Montague, PhD University of Wisconsin-Madison HCI Lab

43. How does technology change interpersonal relationships? Nonverbal cues are important for interpersonal communication and trust in clinical encounters • Difficulty using multiple channels (i.e listening, while typing) • Time utilizing technologies might affect total visit time • Difficulty noticing the expressions of others • Difficulty showing appropriate expressions • Mistakes may cause stress and frustration • Time for social touch • Eye contact Enid Montague, PhD University of Wisconsin-Madison HCI Lab

44. Shared computer use can make interpersonal communication difficult. Enid Montague, PhD University of Wisconsin-Madison HCI Lab

45. Typical sets ups that involve technologies can bring new communication challenges. Image source: Mayo SPARC Enid Montague, PhD University of Wisconsin-Madison HCI Lab

46. Patient trust in technology Previous Experiences/ Attitudes Enid Montague, PhD University of Wisconsin-Madison HCI Lab

47. The goal is appropriate trust in technology. Provider Refusing to use technologies that could enhance the provision of care and quality of work Using technologies to enhance human capabilities, while continuing to use medical knowledge Using technologies in ways they were not designed for Using technologies to make decisions in the absence of additional information Client Using technologies in a way they were not designed for Using technologies in lieu of medical care i.e. Google as a first or second opinion Using technologies appropriately to enhance health and care Refusing to use technologies that could enhance the health and the care provision process Enid Montague, PhD University of Wisconsin-Madison HCI Lab

48. Patient attitudes about technologies • Concern over information security/ privacy • Lack of knowledge about technology (technology literacy) Enid Montague, PhD University of Wisconsin-Madison HCI Lab

49. Uncertainty about the health record can contribute to distrusting attitudes. • Have you ever looked at your medical record? (52%) No, I have never looked at my medical record (39%) Yes, it was accurate (16%) Yes, it was inaccurate or incomplete Enid Montague, PhD University of Wisconsin-Madison HCI Lab

50. Beliefs can affect behaviors • Do you believe the information in your medical record is kept secure?(70%) Yes(28%) No • Have you ever avoided telling your doctor something about your health, because you did not want the information to appear in your medical record?(76%) No (20%) Yes Enid Montague, PhD University of Wisconsin-Madison HCI Lab