1 / 64

Ambulatory EHR Implementation at UCSF Medical Center

Ambulatory EHR Implementation at UCSF Medical Center. Brian Herrick, M.D. July 18 th , 2008 Slide Recognition to Russ Cucina M.D., William Hersh M.D., Angelina Chang, and Kathy Lehto. Outline. Implementation resources Implementation lessons from the literature Implementation chasm

emily
Download Presentation

Ambulatory EHR Implementation at UCSF Medical Center

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Ambulatory EHR Implementation at UCSF Medical Center Brian Herrick, M.D. July 18th, 2008 Slide Recognition to Russ Cucina M.D., William Hersh M.D., Angelina Chang, and Kathy Lehto

  2. Outline • Implementation resources • Implementation lessons from the literature • Implementation chasm • UCSF Medical Center EHR implementation

  3. Choosing EHR (Adler, 2005) • Identify decision makers in a practice • Clarify goals • Write a Request for Proposal (RFP) • Review proposals to narrow the field • Vendor demonstrations • Check references • Rank the vendors • Site visits • Select finalist • Solidify organizational commitment • Negotiate contract

  4. Resources • eHealth Initiative EHR Master Quotation Guide (2005): Guide for obtaining vendor quotes • EMR Guide for Small and Mid-Sized Practices (2006): Detailed implementation guide for smaller practices • DOQ-IT University (elearning.qualitynet.org): Free on-line courses developed by Centers for Medicare and Medicaid Services (CMS)

  5. Resources AAFP resource: http://www.centerforhit.org/ ACP resource: http://www.acponline.org/running_practce/technology/ehr/roadmap/ AAP resource: http://www.aapcocit.org/ Agency for Healthcare Research and Quality website

  6. Implementation Guidelines and Lessons • HIMSS • CEO Survival guide • AAFP EHR Pilot Project

  7. HIMSS Ambulatory Paperless Clinics (2007) • Project management must include • Development of scanning/abstracting policy • Create shared need in practice • Analyze workflow • Develop implementation plan • Facilitate third-party interfaces • Template development • Training

  8. CEO Survival Guide to EHR Systems (2006) • Develop a vision for Patient Care • Understand environmental factors affecting EHR systems • Become aware of the supports available for EHR system planning, acquisition, and implementation: ONCHIT, DOQ-IT, Medicare QIOs, AHRQ, AAFP, CCHIT • Develop an EHR system organizational strategy • Identify clinical champions

  9. CEO Survival Guide to EHR Systems (2006) cont. • Communication • Implement work process transformations • Develop training plans • Develop capital and operating budgets to support acquisition, implementation, and ongoing management • Select the application • Implementation: Incorporate EHR systems into clinical and administrative operations • Prepare for the future: PHRs, RHIO/IHE

  10. Brief Report of the AAFP’s EHR Pilot Project: Key Learnings from Six Small Family Practices (2005) Keys to success: • 1. Building a Community of Learners • 2. Planning/re-designing practice workflows • 3. Starting with “Easy Wins” • 4. Connectivity increases the value of an EHR i.e. pharmacies, labs Barriers: • 1. Partial implementation • 2. Variability among medical practice and physician styles • 3. The lack of structured data entry

  11. Implementation Chasm (Lorenzi 2008)

  12. Design • Systems must be customized to accommodate the activities of workers and the workers must also change their practices • Examples at UCSF MC: Vital Sign Capture and UCare Note Writer

  13. Vital Sign Capture • Tablet or PC • Wireless or hard wired • Dynamap with Temp, HR, BP, and O2 Sat • Importation to the EHR flow sheet

  14. UCare Note Writer • UCSF developed web application for clinical documentation. • UCNW acquires patient context and other data from the EHR to import into the document • Other design features.

  15. Import of Vital Signs from UCare - range calculation over last 24-hour

  16. Import of Lab Results from UCare - last 24 hours of basic labs - structured visual representations

  17. Save draft within Note Writer

  18. Publish “Preliminary” Note (resident)

  19. Publish “Preliminary” Note (resident)

  20. Publish “Final” Note (attending) - resident and attending notes as one unified note

  21. Required Fields • note cannot be published to UCare without them • Service Chiefs may define resident and attending requirements

  22. “Copy-forward” controls - Service Chiefs may forbid or permit carry-forward of information day to day

  23. Template Development by Service Chiefs • web-based template design • changes can be made real-time

  24. Template Development by Service Chiefs • web-based template design • changes can be made real-time

  25. Template Development by Service Chiefs • web-based template design • changes can be made real-time

  26. Template Development by Service Chiefs • web-based template design • changes can be made real-time

  27. DNU Abbreviation Correction • Clinician writes a note containing DNU abbreviations

  28. DNU Abbreviation Correction • Note Writer guides clinician through correcting abbreviations

  29. DNU Abbreviation Correction • On sending the note to UCare, UCare Note Writer takes clinician through a dialog to correct DNU abbreviations • Clinician’s choices • accept automatic fixes • manually fix • Submitting the note to UCare with the DNU Abbreviations in place is not an option and is prevented

  30. Implementation Chasm (Lorenzi 2008)

  31. Management • Capacity for change • Context of change • Vendors have limited knowledge of both capacity and context, therefore it is important to organizations take responsibility for these issues

  32. Organization • Operational-organizational issues: downtimes, workflow changes, help desk, perception of IT department not listening to or being disconnected from the operational needs

  33. Assessment • Organizational readiness, assessing the immediate context for implementation, evaluating the implementation in formative and summative manners

  34. UCSF Ambulatory EHR Pilot Implementation • Pilot of Ambulatory administrative functionality to 6 practices in a variety of specialties • Functionality Deployed: • Viewing labs, reports, radiology, inpatient documentation, outpatient transcription • Patient tracking • Vital sign capture • Documentation of Point of Care Testing

  35. EMR Ambulatory User Survey Summary and Results: April 2008 UCSF Medical Center CIS Department Ambulatory Team April 24, 2008

  36. Goals of Assessment • What functions are being utilized? • Who is using the functions and where are they using them? • What are some of the hurdles? • Users wish list? • Respond to concerns, questions, and gap in knowledge

More Related