Transition from Paper to Electronic: Are you ready?

1. Transition from Paper to Electronic: Are you ready? Laura Pait, RHIS, CDIP, CCS Senior Director Health Information Management

2. Agenda With the implementation of technology an opportunity to increase staff productivity, reduce operating costs, and strengthen the integrity of the medical record. We will discuss a winning approach in three key steps. • Build a Guiding Team • Communicate for Buy-In • Create Short Term Wins

3. Assessment Identify the impact on HIM

4. Building a Guiding Team Form a group that has the capacity – in membership and method of operating – to guide a very difficult change process

5. Laura Pait Sr. Director of HIM Administrative Specialist III AD Transcription Manager Transcription Manager Transcription Vacant AD of HIM Manager HIM-TMC Manager HIM-MPH/FMC Manager HIM-BCH Manager HIM-RRMC Manager HIM-PHH Manager HIM-PHM Vacant Manager HIM-PH/POH Vacant Manager HIM-FRMC Vacant Supervisor HIM-USMC Reorganization was Required Organizational structure 2009

6. HIM Senior Director Transcription Assistant Director Coding Assistant Director vacant Manager existing Manager existing Market Manager Records Management GCM reclassified Corp HIM Includes MPI/BSA’s Market Manager Coding reclassified Market Manager Coding GWSM reclassified Market Manager Records Management GWSM reclassified First Pass – 2010/2011

7. Senior Director Laura Pait Prince William Assistant Director Records Management Assistant Director Acute Care Coding Manager NMG/Acute Care Transcription Market Manager GCM Market Manager GWSM Market Manager GCM Market Manager GWSM Now we have some structure- 2012

8. What Works? • Enthusiasm and Commitment • Trust and Teamwork • Structure • Energy

9. Health Information Management (HIM)-Records Management Release of Information Permanent File Maintenance (electronic, onsite - offsite) Chart Completion (includes Transcription) Regulatory Maintenance and Readiness Acute Care Records Management services are currently located at each facility. Records Management is where we impact the patient care areas through our service to patients, payers, and the medical staff. Timely access of the health information is imperative in the support of medical decision making. Each facility is charged to provide support in the following key areas: • Understanding these workflows now allow us to translate with confidence: • Discharge chart reconciliation • Open Chart Review process • Pre-audit workflow analysis • Provider Based Record access

10. Health Information Management (HIM) - Coding Audit Responses Production Business Services Education Acute Care Coding services are currently corporate services. Recently modeled after the transcription consolidation experienced in 2009. Un-coded accounts are managed at a market level with a pool of coders. The coding services have been separated into the following key areas to help better manage coding related issues. With a new structure you can guide the conversations and create new workflows

11. What does NOT Work? • Weak task forces • Single individuals • Fragmented top teams • Not confronting difficult conversations • Work around the head of the team

12. Communicate for Buy-In Communicate change visions and strategies effectively so as to create both understanding and a gut-level buy-in.

13. 2015 Strategic Plan Physician Partners Engaged Employees Committed Communities Vision Elements Strategic Stakeholders Safety Quality Authentic Personalized Relationships Strategic Levers Voice & Choice • Health Information Technology • Integration & Strategic Growth • Partnerships & Affiliations • System Financial Health Easy For Me Affordability 13 13 13

14. Vision and Guiding Principles FrameworkFor Decision Process Implementation Plans Effectively translates the operational and business strategy, goals and objectives into a compelling and clear vision which: • Sets a direction • Aligns the enterprise culture • Defines high level operating model and desired outcomes Vision • Guiding principles help provide a construct for how decisions will be evaluated, issues managed and how transformation will be sequenced and targeted throughout the project. • Guiding Principles help manage buy-in, set expectations, and facilitate sustainability by Executive Leadership and operational areas. Guiding Principles Implementation plans serve as the foundation for enterprise-wide communication and change management planning. They assist in managing project timelines, milestones, interdependencies and resource conflicts. 14 14

15. Dimensions Acute Program Background Novant chose Epic as their vendor of choice for both clinical and revenue cycle transformation across the enterprise. Winter 2011 Current Phase: Deployment Project Planning Project Launch November 2010 Ambulatory Epic selected as vendor Novant Strategic Plan c Acute Spring 2012 September 2011 GOAL: One Patient, One Record, One Remarkable Patient Experience Project Launch Epic selected as vendor Current Phase: Pre-Planning 15 15

16. System Integration – Current and Future State Current State Future State The long-term goal of Dimensions is to evolve where practical, to a fully-integrated system. The implementation will prioritize opportunities to eliminate paper handoffs and maximize efficiencies. Documentation Paper Handoff Inpatient Care Department Ancillary Department Paper Handoff & Limited Automation Paper Handoff PATIENT Content Orders ED/OR Minimal Exchange ofInformation Medication Management Registration and Patient Billing Various Outpatient Settings Goal: “One Patient, One Record, One Remarkable Patient Experience” “Disjointed, Inefficient and Complex” 16 16

17. What Works? • Communicate simple and heartfelt messages • Do your homework • Speak to anxieties, confusion, anger, and distrust • Get rid of the “junk” communications • Help people “see” the vision

18. The Role of Thinking Thinking differently can help change behavior and lead to better results. • Collect data, analyze it • Present the information logically to change people’s thinking • Changed thinking, in turn, can change behavior

19. The Role of Feeling Feeling differently can change behavior MORE and lead to even better results. • Create surprising, compelling, and, if possible, visual experiences • The experiences change how people feel about a situation. • A change in feelings can lead to a significant change in behavior.

20. Key Activities to Date • Define the Legal Health Record and the Designated Record Set • Create a record/document matrix

21. Key Activities to Date Data Conversion Conversations must be early to understand what legacy information (may equal paper) will convert over.

22. Key Activities to Date Evaluate key HIM Workflows to value staff time and paper creation

23. Team Member Selection • Can they see the vision? • Could they articulate it? • Will they be bold in their thinking? • Can you work with that? • Questioning attitude with the strategic goals in mind

24. New Policies to be Created • Define managing access and disclosure • Define access rules for Outside Reviewers • Guidelines for authorship and printing of the medical record

25. Be Seen • Rounding • One-on-One meetings • Create a flyer • Create a SharePoint site • Attend leadership meetings

26. Understand your Audience “Paper to Electronic” message means transition not only to HIM departments but to the entire organization. Is HIM viewed as a: Facilitator Champion Partner

27. What does NOT Work? • Under communicating • Speaking down to staff • Not walking the talk

28. Choose Short Term Wins Produce sufficient short-term wins, sufficiently fast, to energize the change helpers, enlighten the pessimists, defuse the cynics, and build momentum for the effort

29. What Works? • Early wins • Wins that are visible • Wins that penetrate emotional defenses • Wins that are meaningful toothers • Wins that speak to powerful players whose support you need • Wins that can be achieved cheaply and easily

30. Measure/Track • Key performance indicators • Scanning productivity • Chart Deficiencies • Suspension Policy • Chart Correction • Physician Adoption

31. What does NOT Work? • Launching fifty projects at once • Providing the first win too slowly • Stretching the truth

32. Questions Laura Pait, RHIA, CDIP, CCS Senior Director Health Information Management Revenue Cycle Services Novant Health 336-277-7274 lpait@novanthealth.org