EHR Adoption – Barriers & Solutions

1. EHR Adoption – Barriers & Solutions John Weir Illumisys – A Division of Lumetra

2. Established in 2005 Mission: to assist healthcare organizations and their providers transform their patient environments through the adoption of technology. Core Competencies: HIT Adoption Programs Systems Implementation Systems Integration Operations Strategy HIT Project Management Illumisys www.illumisys.net

3. Presentation Outline Provide an outline of the state of systems adoption, common barriers & solutions. Offer proven considerations for addressing barriers and implementation suggestions targeted on success. www.illumisys.net

4. Ambulatory System Adoption CDC's 2006 National Ambulatory Medical Care Survey of 3,350 office-based physicians Health Affairs, How Common Are EHRs in the US? -2006. Modern Healthcare 10/30/2008 www.illumisys.net

5. HIT Adoption in Physician Offices Source: HIT Adoption in Physician Offices – A Summary of Findings in Iowa; August 2007, Iowa Foundation for Medical Care www.illumisys.net

6. Why is Adoption So Difficult? Training & Education Patient Safety & Compliance Initiatives HIT Implementation Data Analysis Change Process Running the Business Patient Care Quality Reporting & P4P Requirements www.illumisys.net

7. Perspectives of EHR… What we often get… What we want… • Complexity of configuration and user base needs. • No one size fits all products. • Lack of trained professionals. • Too much going on in the office to focus. www.illumisys.net

8. EHR Adoption Barriers www.illumisys.net

9. Major Adoption Barriers Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record Keeping among Physicians & Group Practices in the US, Preliminary Data, November 2007 www.illumisys.net

10. SO WHAT DOES THIS MEAN AT THE PHYSICIAN OFFICE LEVEL? WHAT CONSIDERATIONS SHOULD BE MADE? www.illumisys.net

11. Financial Barriers www.illumisys.net

12. Financial Solutions • Smart Contracting: • Go live and milestone clauses. • Consider group purchasing where feasible. • Lease purchasing and deferrals on initial billing. Upfront Costs Ongoing Costs • Consider an hosted environment server (ASP) that can be paid for monthly. • Consider hardware depreciation, support fees, upgrade costs & miscellaneous expenses such as new staff training. • Negotiate longer term Interface costs upfront. • Ensure implementation, training and go live support is covered. • Consider having a source for vendor management and hand holding. • Build in-house product expertise within staff. Services • Purposefully schedule for less patients during initial go live. • Look at who can be reassigned for assuming certain project responsibilities. • Create goals that balances lost time against high impact automation and decreased data entry. Lost Time Integration Costs • Create an ROI process to track the benefits of the system. E.g. value of eRx, reduced transcription against system costs. • Improvements in timeliness of claims submission. • Include consumers by incorporating email and online visit protocols. www.illumisys.net

13. Key Areas of Financial Focus • High impact cost savings: • Elimination of paper charts & encounter form • Decrease in data entry and transcription • Increase physicians’ ability to submit new and refill prescriptions directly to the pharmacy • Improvement in claims capture – billing revenue • Decrease patient & administrative staff time • Further time/cost savings: • Enhanced clinical processes & practice workflow efficiency • Provide decision support • Decrease documentation & improve legibility - Safety • Increase timeliness patient tracking & follow-up • Reduce time of administrative staff filing, finding and pulling records • Use e-mail messaging www.illumisys.net

14. Technology Barriers www.illumisys.net

15. Technology Solutions Technical Support • Create performance guarantees associated with vendor support & uptime. • Have a maintenance plan that is tested and works. • Plan for, implement and transition upgrades with care. • Establish system review process before enhancing templates & workflow. • If it works don’t customize it. • Plan out the system workflow with feedback from all staff. Complex System Customization • Standards bodies have emerged and working with certification programs. • Ask your vendor about terminologies and vocabulary sets used. • Established interface needs early and have a clear set of specifications that can be shared between vendors. • Broker vendor communications to eliminate any he said/she said scenarios Fragmented Standards & Data Exchange • If you’re not clear on functionality vs. your needs prior to purchasing - ASK. • Make sure you have people who understand how the system will work for your office. • Hire experts where you need to. Product Expectations/ Resources • All systems must comply with HIPAA • Ensure data is encrypted where transmission is involved. • Create levels of security for users where data access should be limited. Privacy & Security www.illumisys.net

16. Organizational Barriers www.illumisys.net

17. Organizational Solutions Infrastructure • Establish change management processes. • Create a process for decision making. • Develop a process for issue escalation. Technical Capacity • IT Network has bandwidth and capability for new system. • IT Support protocols established. • Communications created for implementation process through the business. Operational Capacity • Staff appropriately with internal, vendor and where necessary consultants. • Review and establish appropriate workflows focused on improvement. • Understand training needs and have vendor work to that need. • Create paper migration plan with vendor input. Goal Alignment • Build consensus across the organization with management and providers. • Build commitment from staff to meet timelines and USE the system. • Create a focus on quality from system performance/capability to outcomes. Leadership • Identify physician champion who will remain committed to the project. • Entrust authority with implementation lead and physician champion. • Maintain project ‘VISION’ throughout the implementation and Go Live. • Establish management reporting and staff updates. • Address legal issues upfront. www.illumisys.net

18. Cultural Considerations www.illumisys.net

19. Technical Competency Cultural Solutions • Ready staff for what may be new technology. E.g. MS Windows, browsers. • Have staff involved in requirements development and system planning feedback. • Address the change process in a proactive and benefits oriented manner. Leadership & Accountability • Establish good project management practices; maintain a plan and timeline. • Manage the vendor and seek clear recommendations. • Proactively communication progress and goals achieved within the organization. Consumers • Integrate access to relevant components. E.g. PHR, email, scheduling. • Inform patients of the transition; make the benefits apparent and set expectations. • Involve the patient in their care and look at improved outreach methods. • Stem privacy and security concerns. Change Management • Address resistance to change by illustrating system capabilities. • Incorporate staff in the entire process including goal setting, build & testing. • Match roles and functions to staff skills and fill the gaps with training. • Conduct team meetings and communicate project outwards. www.illumisys.net

20. HOW DOES THIS GET ACTED UPON? www.illumisys.net

21. Solutions – Readiness & Preparation • Build practical understanding of: • Barriers & risks; • Current state workflow; • Future state workflow that create improvements; • Gaps associated with the project. • Determine financial capacity. • Create ground rules for moving forward. • Establish and prioritize needs. There are no secrets to success. It is the result of preparation, hard work, and learning from failure. - Colin Powell www.illumisys.net

22. Solutions - Planning • Establish a team with goals. • Set framework for measurable success. • Provide vendor with clear objectives. • Keeps the project focused and on track. • Creates leadership and confidence. • Outlook on go live reductions in productivity. He who every morning plans the transaction of the day and follows out that plan, carries a thread that will guide him through the maze of the most busy life. But where no plan is laid……chaos will soon reign. – Victor Hugo www.illumisys.net

23. Solutions - Implementation • Phase I Incorporate basics & workflow: • Registration & scheduling (assuming integrated system) • Patient eligibility and check-in process • ePrescribing fundamentals • Commence paper migration (scanning & data entry) • Phase II Building core functionality • Nursing documentation • Patient histories, vitals, chief complaints • Lab orders (where applicable to staff) Slide 1 of 2 www.illumisys.net

24. Solutions - Implementation • Phase III Incorporate Physician • Full exam recorded in EMR (voice / template driven) • Charge coding • Lab order and results • Cross-staff tasking & messaging • Reporting • Interoperability components (electronic referrals) • Phase IV Other • Integrate device interfaces • Claim management within an integrated system Slide 2 of 2 www.illumisys.net

25. Solutions - Implementation Training • Entire staff needs to be trained: EHR in changes how the practice does everything. • During training, plan to minimize business interruption and monitor organizational progress. • Hands-on EHR training may incorporate basic terminology, workflow, security, usability, communications, and interoperability. Paper Migration • Avoid parallel paper and electronic data entry • Enter information in advance ORas you go • Scan key recent reports and transfer past information • Maximize electronic data exchange • Set up efficient data exchanges between systems • Redesign work processes to eliminate paper-based clinical processes www.illumisys.net

26. Success Principles • Build user based acceptance & diffusion. • Balance goal setting across staff. • Identify high impact issues that can be solved relatively quickly and painlessly. • Keep it simple: Initiatives must be in ‘chewable’ pieces. • Wins create momentum. www.illumisys.net

27. Legislative Landscape Can the next 5 years get us beyond the tipping point? • Financial Assistance: • Loans • Grants • Incentives • Technical Assistance: • Regional Resource Centers • Workforce training • Demonstration projects www.illumisys.net

28. Keep The End In Mind • Improvements in quality care. • Increased decision support & patient safety. • Increased provider – patient communication. • Improved revenue management. • Increased information access & interoperability. • Reductions in medical errors. • Improved staff efficiency. www.illumisys.net

29. Questions/Discussion www.illumisys.net

30. Contact Information John Weir President Illumisys 1 Sansome Street San Francisco, CA 94104 P: 415-677-2083 C: 510-931-9389 E: jweir@illumisys.net W: www.illumisys.net www.illumisys.net