Thayer County Health Services Presentation for Indiana Rural Health Association

1. Thayer County Health Services Presentation for Indiana Rural Health Association The Road to Successful EHR Implementation Joyce Beck, LPN, MHA December 1, 2010

2. Objective of Presentation • Background of Thayer County Health Services EHR Implementation and formation of Southeast Nebraska Health Information Exchange • Outline step by step methods used for EHR implementation and obtaining meaningful use

3. Background of TCHS EHR implementation • As a result of CAH-HIT $1.5M grant TCHS implemented EHR in 2008 • Communication was established with long term care, pharmacy, assisted living, EMT’s and tertiary hospital • As a result, Southeast Nebraska Health Information Exchange was formed • Nationwide interoperability obtained through NHIN

4. The Road to Successful EHR Implementation • Have a commitment to patient safety-you have to want it • Examine culture and address issues • Determine the vision • Evaluation of financial options • Formation of EHR project team • Vendor selection process • Develop timeline with accountability for deadlines

5. Commitment to Patient Safety • There has to be a driving force in the facility to create a safe environment for the patient-you have to want it • In everything you do patient safety has to come first • What are your commitments to patient safety?

6. Commitment to Patient Safety Through Education • Hardwiring Excellence • Practicing Excellence • The 7 Habits of Highly Effective People • If Disney Ran Your Hospital • How Full is Your Bucket • Customer Service in Health Care • Flight of the Buffalo

7. Commitment to Patient Safety Through Process Improvement Tools • TeamSTEPPS • Lean • Balanced Scorecard

8. Results of Patient Safety Commitment

9. Examine Culture and Address Issues • Culture must be a just culture: • Culture in facility must be open and fair • Culture must be one of learning • Culture must design safe systems • Culture must manage behavior choices

10. Behavior Standards • Based off the book Hardwiring Excellence • Developed by employees • They are part of annual review and count equally with job performance • Scores are calculated from peer review • A score of 80 or below requires employee to be on probation • If, in 90 days a repeat peer review does not score higher than 80 they are terminated

11. Culture is by far the most important aspect of successful implementation of EHR

12. Determine the Vision

13. Once vision determined-next step • Perform a gap analysis • What do you currently have in place and is it working for you? • What systems do we need to meet MU? • What other systems do you want in place for patient safety? • What resources do you need to meet goal?

14. Evaluation of Financial Options • What capital is needed? • Considerations should include software, hardware, training, travel, data migration • Disaster recovery costs • Fire suppression and data protection

15. Financing • Is there enough cash on hand for project? • Lease options? • Donations and grant available? • What resources are available through Medicare and Medicaid?

16. Medicare Share • “Reasonable cost” is based on cost incurred for purchase of certified EHR system during the cost reporting period and similarly incurred cost from previous cost reporting period • Includes acquisition costs for the purchase of depreciated assets such as computers and hardware and software

17. Example • CAH A incurred reasonable cost of $500,000 for purchase of certified EHR during previous cost reporting period. The CAH depreciates $100,000 in previous cost report leaving $400,000 of undepreciated costs

18. Calculation for Medicare Reimbursement Formula for calculating Medicare Share: #IP Part A Days + #IP Part C Days Total IP Days x [Total Charges-Charity Care]+20% Total Charges

19. CAH A Information • CAH A had 300 Part A IP days and 400 Part C IP days, total inpatient days were 1000, total charges excluding charity care were $2M, total charges were $2.2M

20. Results for CAH A _____700______ 1,000 x [__$2 M__] [ $2.2 M ] +20% Equals 97% Preliminary Incentive Payment of $388,000

21. Incentive Payment • The best advice concerning incentive payment is: KEEP UP Changes can occur all the time. What you learn today may not apply tomorrow!

22. Formulation of EHR Implementation Team • Team should have representation from all departments • Open communication vital for success of team • All members of the team do not need to agree • Set goals and meet those goals • Total team commitment to get project completed • Regular meetings are important

23. Vendor selection process

24. Develop Timeline for Project • Numerous methods available to use for timeline • Identify tasks and mark the tasks that are mission critical • Set start and stop dates • Identify people in charge of tasks • Hold people accountable for tasks and deadlines

25. Timeline example

26. Accountability for project • Strong leadership must be in place to ensure timelines are met • Accountability can be obtained through the use of just culture and behavior standards

27. Success of Project • Success can be judged by employees and physicians who are satisfied with the system and patients see a positive outcome from implementation

28. References • http://www.csm.gov/EHRIncentivePrograms • Seim Johnson Accounting Firm • CUSP Consultants

29. Contact Information jbeck@tchsne.org