Implementation of Electronic Health Records-The Next Step

1. Implementation of Electronic Health Records-The Next Step Thayer County Health Services Hebron, Nebraska Joyce Beck CEO

2. Objectives of Presentation • Background of implementation of EHR at Thayer County Health Services (TCHS) • Discuss decision process to establish interoperability • Nationwide interoperability demonstration • How quality measures were affected at TCHS through implementation of EHR • Discuss lessons learned, challenges and rewards

3. Implementation of EHR at TCHS-seven goals • Build Bridge with EMS • Improve effectiveness and efficiency of Critical Access Hospital • Connect with tertiary hospital • Improve communication with satellite clinics • Improve communication with pharmacy • Improve communication with long term care and assisted living • Address safety and security of clinical information: compliance with State and Federal Regulations

4. 7 Stages of EMR adoption

5. Decision process to establish Nationwide Interoperability • Two choices for interoperability in Nebraska-NeHII or use CONNECT to reach the Nationwide Health Information Network (NHIN) • Pros and Cons of each explored and choice was made to use open-source connectivity available using CONNECT software • Connection made with Redwood MedNet in Healdsburg, California

6. Interoperability demonstration-Reason for demonstration • Information Technology said it would work • Test data had only been sent on the NHIN between facilities • There were doubts from other HIE’s in Nebraska about NHIN • If NHIN was to be endorsed I had to see it myself • If our actions do not help a patient than all is for nothing

7. Wellness Check Began in TCHS in Hebron, Nebraska • Dr. Bryan Hubl ordered lab test in Hebron for wellness check • Lab results obtained and placed in EHR in Hebron • Lab results then made available to Redwood MedNet in California for actual wellness exam • Information also available on USB to fulfill meaningful use

8. Healdsburg, California • Results of labs and x-ray of left hip taken in Healdsburg placed in Alliance Medical Center EHR • Results could be placed on USB bracelet or card at patient request • This product available through 911 Medical ID or Zaptag

9. Second Step of Trip was Travel to Healdsburg, California for Wellness and Radiology Exam • Wellness exam completed by Dr. Jeff Meckler at Alliance Medical Center, Healdsburg, California • Lab results from Thayer County retrieved by Redwood MedNet via CONNECT gateway

10. Final Step • Returned to Thayer County Health Services to be seen by Dr. Hubl • Wellness exam as well as results of lab work was available to Dr. Hubl via the NHIN therefore no duplication of testing necessary • Dr. Hubl was able to recommend treatment based on information gathered in both Hebron, Nebraska and Healdsburg, California

11. Conclusion made from demonstration • Information flowed from one facility to another without difficulty • Duplication of testing was avoided due to availability of information via the NHIN and patient USB device • Ease of availability of medical information provided better patient care • The NHIN as functioning, provides patients with information needed

12. Affect on Quality Measures • Quality indicators in medication reconciliation were directly related to implementation of EHR • In the area of medication reconciliation, those physicians using e-prescription had 100% medication reconciliation compared to 33%, 17%, 25%,20% and 33% for physicians not using e-prescribing

13. Affects on Quality Measures-Medication Errors

14. Lessons learned • While the EHR is a useful tool it must be accompanied with a culture of safety • Development of employee leadership and accountability are necessary for patient safety • Tools such as Hardwiring Excellence also need to be in place to ensure quality of patient care • Leaders need to hold people accountable, they must ask them to “get off the bus” if necessary

15. Lessons Learned • Technology is improving compared to former implementation and therefore results are improved • Results were realized in early stages of implementation however results improved as implementation progressed • Success of implementation of EHR is directly related to the buy-in of end users • Success of EHR and how it affects quality indicators is directly related to the culture of safety in a facility

16. Lessons Learned • A physician champion is necessary for the success of the EHR implementation • A team approach is necessary for the success of the EHR implementation • The results of the implementation of EHR on quality indicators was very positive • As a result of project not only was there a positive affect on quality indicators there is also facility pride

17. Challenges of project • EMS units in Nebraska were not allowed to apply 12-lead EKG required TCHS staff to request EMS in Thayer County be allowed to place the 12-lead • Verizon coverage limited in areas therefore transmission of data interrupted • Use of T1 line was restricted to non-profit entities limiting the use of the T1 line • Limitations of software available

18. Conclusion • Quality indicators were positively affected by implementation of the EHR at TCHS • The positive affects were especially true when the measurement was only on the affects of EHR eliminating variables such as patient compliance • Tests were ordered timely, allowing for close monitoring of chronic conditions, when templates were used

19. Conclusion (cont) • Medication reconciliation was greatly affected by e-prescribing • Medication errors were greatly reduced using EHR as a tool in combination with a culture of safety • Medication error reduction as well as medication reconciliation would impact the cost of healthcare greatly in the nation

20. QUESTIONS? Joyce Beck jbeck@tchsne.org 402-768-4614