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Physician EHR Adoption: a report from the trenches

Physician EHR Adoption: a report from the trenches. Kiki C. Nocella, PhD, MHA CEO Believe Health, LLC. Goals for Today. Who we are What we did Lessons learned Challenges Best practices. Who is “Believe Health”?. Creator of the first operational HIE west of the Mississippi

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Physician EHR Adoption: a report from the trenches

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  1. Physician EHR Adoption: a report from the trenches Kiki C. Nocella, PhD, MHA CEO Believe Health, LLC

  2. Goals for Today • Who we are • What we did • Lessons learned • Challenges • Best practices

  3. Who is “Believe Health”? • Creator of the first operational HIE west of the Mississippi • LLC that works with small, rural, and underserved communities and providers to enter the HIT superhighway • A firm with unparalleled experience and diverse skills and knowledge of health IT, particularly in rural communities • AHRQ Master Contractor for their HIT portfolio and National Resource Center

  4. What got us on this panel! A simple question: What does it take to implement HIT in a rural region? • Infrastructure • Telemedicine • EHRs and HIE • PHRs • Diabetes Education • Health professions training

  5. Smith, Joe 123 Main St. Anytown, USA Tw2-5053 DOB 12.1.17 Date Dx Tx Date Dx Tx 6.3.52 FXR wrist cast 12.21.68 MVA ASA, letter to Atty 7.12.58 Luies PCN 3.24.62 Tonsilectomy 9.21.66 Obesity Dex Inj 10.15.68 CHF Digitalis

  6. I’m not a magician Spock, just an old country doctor

  7. “Removing ALL Barriers” Dollar Cost Issues Time Cost Issues Personal Skill Set Inequality Issues Issues of Culture Change

  8. Dollar Cost Issues • Dollar Cost Issues • What will it cost me? • Hardware and software expense • Time lost from practice • Re-tasking of employees • New, recurring expenses (ie support, connectivity, upgrades, maintenance) But “Free” is not cheap enough

  9. Time Cost Issues Will I lose even more family time? Training time System Personalization – the joy of template building

  10. Personal Skill Set Inequality Issues • Computer literacy • Physical limitations

  11. Culture Change LAPTOP

  12. Great deal? Or a new cost of business? Source: AHRQ, September, 15,2005 Providers in HPSAs will receive 10% more, however, studies show their average costs are higher as well All dates, calculations, and products are preliminary and subject to change without notice

  13. We’ve learned a lot • “Absolutely” • ASP vs. Local Install • A whole new vocabulary…what does “CCR” mean to you? • The value of legal. And “suits”. • Require legitimacy. Require active listening. It MUST work for you – no one else really matters. • One size DOES NOT fit all! • The need for a business case – it needs to add value to you, your patients, and your practice • Technology is just a tool • “The perfect is the enemy of the good” (Voltaire) • Rip the bandaid off? Or Remove it slowly? • Ride the inertia - “The tendency of an object to continue in motion at the same speed and in the same direction, unless acted upon by force”.

  14. What results in physician buy-in • Relevance • How does EHR implementation help my patients or my practice or my community? • Is the data collection/time effort/culture change worth it? • Fear Resolution • Big Brother • Unethical competitive Practices (data stealing) • Security assurances (HIPAA, System Failure) • Unobtrusive Paced Implementation of EHR • Cost Mitigation

  15. Some Challenges • Money removes some barriers – but there are still the challenges of: • Disruption to clinical workflow • Workflow redesign • Cash outlay in advance of incentives • Policy and Governance (what are the rules, and who makes the rules) • Adoption does not necessarily mean utilization • Its not easy….yet. And it needs to be….soon • Availability of capable and competent workforce • Sustainability

  16. Best Practices: Keys to “success” • Community Based Participatory Research (“CBPR”) – a partnership approach • Just-in-time, concurrent education • Learning together, growing together • How can we enable you? • There are no failures, only findings • Their creation of their common, shared vision • Social capital • Fun, trust, and a little bit of pixie dust!

  17. Best Practices: Resources • www.believehealth.com • K.Nocella@believehealth.com • www.texmed.org • www.cchit.org • http://www.himss.org/EconomicStimulus/ • HITEC-LA

  18. Have a buddy

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