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DOQ-IT in Arkansas Nancy Archer HCQIP Director

DOQ-IT in Arkansas Nancy Archer HCQIP Director. Guess What. We’re in a WHAT pilot??? QUICK, do an Environmental Scan AFMC Staff Stakeholder groups Physician practices Vendors Wiring. What the Scan Identified.

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DOQ-IT in Arkansas Nancy Archer HCQIP Director

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  1. DOQ-IT in Arkansas Nancy Archer HCQIP Director

  2. Guess What... • We’re in a WHAT pilot??? • QUICK, do an Environmental Scan • AFMC Staff • Stakeholder groups • Physician practices • Vendors • Wiring

  3. What the Scan Identified... • AFMC Staff: Valuable relationships with providers and experience in office environment with QI; some with EHR exp. • Stakeholders: 3 Majors interested in HIT, but have NO independent resources— • Physicians: Approx.1570 physician practices---about 73% solo. Some interest in HIT, but no time, need help—ONSITE

  4. What the Scan Identified... • Vendors: Couple of local products, assault on QIO to market products—difficulty understanding QIO role • Wiring: Many dial-up only areas of state—1 of least wired states in country

  5. Physicians Need & Want: • Someone to help that has a CLUE and time to spend in their clinic for free! • Peers to help gain perspective--good and bad. • Someone to assess & research to give them a few good recommendations of products. • Money to buy the system they want • GUIDANCE through the Process...

  6. Barriers • Lack of financial incentives • Change is not widely accepted in the medical community • Gaining “buy-in” consensus from every physician in a group • Vendor market instability • HIPAA and security concerns • Reluctance of administration to change current Practice Management Systems

  7. Moving on Quickly... We must create our own model for DOQ-IT in AR: Consultative Model + Academic Detailing

  8. AR DOQ-IT Roadmap Recruit enroll Assess onsite/everything/team Plan goals/redesign/improve Select software & hardware Implement clinic support Evaluate goals met/data capture Improve care management

  9. Assess, PLAN, Select... • “PLAN” must be stressed • Big implementation errors are often due to lack of thorough planning • You have to know how current processes flow in the practice to be able to plan adequately for a new tool • Educate the physician and office staff that time spent planning will payoff...

  10. Identifying Waste • Flow mapping: examine patient visits • A variety of visits • Observation “through the patient’s eyes” • Details to look for: • Constraints/bottlenecks • Total cycle time and patient-provider time • Customer service • Facility barricades, equipment inadequacies • Paperwork • Waste, duplication, rework • Value-added and non-value added activities • Handoffs

  11. Measuring Encounter Flow • Follow two individuals from the office • Note every step • “First we…then we…” • Differentiate between process steps (something happens) and queues (waits and delays) • Measure time in minutes

  12. Mapping Process Steps • Draw a floor plan (or use OSHA evac map) • Watch one person perform their work, noting where they go and what they do • Do this for each person in the process of focus • Map the process steps

  13. Lessons Learned • Workflow modification must be addressed prior to selecting and implementing an EHR product • Planning is crucial and standardization of processes is a MUST from the standpoint of documentation compatibility and data retrieval • Physicians are engaged and resolute in transitioning to EHRs

  14. Successes • Recruitment efforts • Clinics are moving along the path to being fully implemented • Acceptance of the necessity to address workflow issues prior to implementation • We are a primary resource for the physicians of the state that are interested in EHR adoption

  15. ParticipationAs of 8/15/2005 # of clinics participating 168 # of physicians participating 463 # of NPs participating 57 # of PAs participating 4 # clinics with EHR 39 # of participants planning to implement EHR in next year 75

  16. Arkansas DOQ-IT Team:physicianoffice@afmc.org1-877-375-5700

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