Presentation Transcript

1. The Federal Bureau of PRISONS ELECTRONIC MEDICAL RECORD (BEMR)FRom Sojourn to Odyssey

   2011 USPHS Scientific and Training Symposium/ New Orleans, Louisiana Lynn G. Price, DMD, MSPH CAPT USPHS Federal Bureau of Prisons Mid-Atlantic Regional Chief Dentist FBOP Dental Informatics Specialist
2. OBJECTIVES Discuss the electronic health record (EHR ) adoption provision of the HITECH Act health care reform law and goals of EHR meaningful use. Discuss the development and implementation of BEMR Summarize the benefits and challenges of electronic health record adoption in the Federal Bureau of Prisons.
3. A little bit about me… DMD and MSPH from the University of Kentucky USPHS Dental Officer since 1985 detailed to the Federal Bureau of Prisons Medical Referral Center in Lexington, Kentucky In 2006 accepted a “temporary assignment” for 3 years to implement the dental portion of the Bureau of Prisons Electronic Medical Record (BEMR). 2011 FBOP MidAtlantic Regional Chief Dentist Collateral Duty as Dental Informatics Specialist 5 years later and we still have a long journey ahead

4. The Health information Technology for economic and clinical health (HITEcH) ACT

   This provision of the Recovery Act of 2009 created a historic opportunity to improve the health of Americans and the performance of the nation’s health system through an unprecedented investment in health information technology (HIT). Electronic health record adoption is one of the most important aspects of this initiative.
5. GOALS of the HITECH Act Achieve adoption and information exchange through Meaningful Use of Health IT. Improve care, population health and reduce health care costs through the use of Health IT. Inspire confidence and trust in Health IT Empower individuals with Health IT to improve their health and the health care system. Achieve rapid learning and technological advancement
6. Meaningful Use The American Recovery and Reinvestment Act(ARRA) specifies three main components for meaningful use: Use of certified electronic health records(EHR). Use of certified EHR technology for electronic exchange of health information to improve quality of health care . Use of certified EHR technology to submit clinical quality and other measures.
7. A recent article in the ADA News outlined how beginning in 2012 , dentists who provide services under Medicare may be subject to a payment adjustment if they are not “successful electronic prescribers”. While this is part of the Medicare Improvements for Patients and Providers Act it shows how the government will use payment incentives to assure compliance with health IT adoption.
8. Bureau of Prisons Electronic Medical Record (BEMR) The Federal Bureau of Prisons was among some of the early adopters of an integrated electronic health record system beginning in 2004 with the development of BEMR (BOP Electronic Medical Record), a point-of-care direct entry web-based system record.
9. Bureau of Prisons Electronic Medical Record(BEMR) Implemented in phases starting in 2007. BEMR-Dental fully integrated into the electronic medical record. BEMRx – computerized prescriber order entry including a fully integrated pharmacy program Currently being used at 114 correctional institutions by approximately 3,600 healthcare providers for about 240,000 inmate patients.
10. BEMR BEMR was designed to: Improve patient safety Streamline staff workloads Increase continuity of care. I believe we can say that we have for the most part achieved the improvement in patient safety and increase in continuity of care through our adoption of BEMR. Staff workloads are still following the natural curve that most organizations see with adoption of an electronic health record where efficiency actually decreases at the beginning and then exceeds previous levels when users become proficient.
11. Genesis of the BEMR-Dental Program In 2004 the Bureau of Prisons explored the feasibility of implementing an electronic health record comparing commercially available off the shelf (COTS) products with developing a custom-made product. Most COTS programs were heavily geared toward patient billing and insurance filing which did not fit the need of the BOP. Contracted with Advanced Technologies Group (ATG) who had already developed other correctional information programs to develop the electronic medical record which was named BEMR.
12. The journey began… In October 2006 I was selected as the dentist responsible for the development of the BEMR dental chart program. Again we reviewed the feasibility of using a COTS program vs. a customized program. Due to concerns with management of an interface it was determined that ATG would develop a customized dental program that would be fully integrated with the medical portion of BEMR.
13. Used the prototype program that ATG had developed for the State of Iowa Dept of Corrections and produced a customized dental program. Beta tested in 2007 and first phase was rolled out to the field in October 2007. The BEMR dental program was made mandatory for use in January 2008. Ongoing program enhancements continued to be rolled out on a semi-yearly basis. The development cycle includes identifying and prioritizing needs, securing of funding, code development, scope document review, beta testing, rollout, testing and improvement.

14. BENEFITS OF INTEGRATED ELECTRONIC DENTAL RECORD

15. Benefits of Integrated Dental & Medical Electronic Record Instant access to patient medical information in a coherent and detailed format. Interactive health history assessment which engages the provider in direct patient discussion regarding health issues. Ability for remote record review whether at another clinic in the institution complex or at the regional and national level. Legibility and organization of information improves information retrieval and continuity of care.
16. Benefits (cont’d) Production and epidemiological data retrieval will be improved as the data is certified. Communication with Regional Chief Dentists possible through BEMR referrals Dental Utilization Review Process (DURP) has been implemented for standardization. Elevates the importance of Oral Health as part of the patient’s overall medical condition.
17. Challenges of BEMR-Dental Program User acceptance has been challenging. It is always hard to teach an “old dog new tricks.” Hesitation on drawing a line in the sand when users have difficulty accepting the electronic format. Dental users find the ICD 9 diagnosis codes unfamiliar and difficult to use. Hardware is not standardized across all facilities. No dedicated IT department.
18. The graphical chart has still not been implemented (ATG elected to purchase a program that will be integrated into BEMR rather than trying to hire medical artists). Some of the PDF documents that are produced are not in a familiar format but improvements are being considered. Data integrity has not been certified for reporting purposes.
19. Training is limited due to funding limitations and lack of manpower for training. New users come on board nearly every week and it is impossible to train each person. Utilizing a train-the-trainer super-user model is not perfect. The program enhancement process is slow and requires a long-term view (odyssey).
20. QUESTIONS?Contact information: Thank you for your attention. CAPT Lynn G. Price lgprice@bop.gov 859-255-6812 ext 5459