More Related Content Similar to Tales from the Trenches: Implementing an EMR (20) More from Health 2.0 (19) Tales from the Trenches: Implementing an EMR2. Agenda
The computer evolution from 4000 B.C. to 2010
Current State of the Market
Where have we been - Where we are going
How to buy the right system for your practice
Top 10 most common mistakes to avoid
Top 20 reasons for I.T. failure
Summary
S
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3. Life Before Computers
p
Memory was something that you lost with age.
An application was something you filled out
for employment.
A cursor was someone who used profanity.
A virus was the flu.
A hard drive was a long trip on the road.
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5. 4000 to 1200 BC inhabitants kept
records on clay tablets
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7. In 1642 Blaise Pascal invented the Pascaline as an
aid for his father who was a tax collector
collector.
(it could only add)
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9. One early success was the Harvard Mark I computer which was built as
a partnership between Harvard and IBM in 1944. This was the first
p p
programmable digital computer made in the U.S. The machine weighed
5 tons, incorporated 500 miles of wire, was 8 feet tall and 51 feet long.
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11. 1970 Unix is developed at Bell Labs by
Dennis Rit hi and K
D i Ritchie d Kenneth Th
th Thomson.
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13. Microsoft Version 1.0 was released in 1985, the more commonly known
Windows version was released in 1990 which was version 3 1
1990, 3.1
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15. The first chip to implement its 64-bit architecture - 1992
p p
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17. Our Progress in Healthcare
50% 40% 10%
use this device use this device use this device
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or desktop 17
20. Putting it into Perspective
Software
Interfacing
•Practice
Practice
•Pharmacy
Management
•Transcription
•Reporting
•Hospitals
Hospitals
•Coding
C di
•Lab
•Document
Imaging •PACS
•EMR
Portals Devices
•Messaging •Desktops
•E-Health •PDAs
•Patient Access •Tablet
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21. Standalone
•Interfacing Development
LAB
•Fragmentation of data challenges
F t ti f d t h ll
EMR •Multiple points of entry
Server & Rack
60 to 70K
•Unable to share with other
Radiology E-Mail
providers
•Version control
•Multiple vendors
•Expensive
PM System Hospital
Imaging
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24. Career Defining Moments in
Healthcare Management
A new physician
A Construction Project compensation
plan An I.T. Project
IT
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25. There is significant amount of pressure, but
little clarity regarding its affect, priority, or
implication
p
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26. OBTAINING PHYSICIAN BUY-IN AND
BUILDING INCENTIVES
There are two simple considerations when
seeking physician b i
ki h i i buy-in:
1. Do they want it?
2. Will they use it?
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27. What is your physician
culture?
O e the
Over t e top “tech-
tec
savvy” MD’s who will Pen & Paper will do me
shoot you with an just fine. You don’t get
infra-red beam from a paid for typing !
Palm-Pilot
Palm Pilot
Or BOTH
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29. Automation
“Automating a bad process not only ensures
that we can do a bad job every time, but that
j y ,
we can do it faster and with less effort than
before.”
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30. Estimated Rate of
Ambulatory EHR Failure
y
According to some researchers there has been
a 30-40% failure rate of EHR implementations
30 40%
These failures are a result of:
Lack of implementation planning
Inadequate research and expectations of technology
Incomplete training of staff
Mismanagement of workflow and staffing changes
Reluctance of providers to take on additional burden
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32. Prerequisites for Complex Change
Action Desired
Vision Skills Incentives Resources Results
Plans
1 Action
X Skills Incentives Resources
Plans Confusion
Conflicts
Vision Action
2 X Incentives Resources Performance
Plans
Anxiety
3 Action Back-
k
Vision Skills X Resources
Plans Sliding
Action Frustration
4 Vision Skills Incentives X & Anger
g
Plans
False
5 Vision Skills Incentives Resources X Starts
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34. 1 - Enthusiastic EMR Project
Leader
The person driving the project is the number one
success f t f an Electronic M di l R
factor for El t i Medical Record d
Implementation!
A Physician committed to the project.
A respected staff member.
Sets expectations and goals for group
Understands EMR product capabilities
Positive attitude and enthusiasm!
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35. 2 - A Implementation Plan
Figure out the business case – costs,
patient flow, increased efficiency
ti t fl i d ffi i
Get buy-in – commitment from all
Consider your options – EMR selection
Ensure support – Training service,
Training, service
support
Prepare to change – develop strategy
for handling bumps – be emotionally
ready
Consider increments
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36. 3 - Good EMR product and
Vendor
Don’t try to write your own EMR
Do reference calls and site visits
Look for excellent support
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Expect to do your part in the
implementation
Templates
Learn the product
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37. 4 - Training
For the project leader - Vendor
supplied, CDs,
supplied CDs Online Tutorials Self
Tutorials, Self-
learning
F the EMR end user - O
For th d One-on-one
training seems to give the best results
Learn one, d one, teach one
L do h
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38. 5 - Provide your staff with
multiple data entry methods
Typing
Templates & “Macros”
V i R
Voice Recognition – S
iti SpeechMike, A
hMik Array
Mike
Handwriting Recognition – Pen Tablet
PCs
Scanning
Interfaces
Dictation with Transcription in EMR
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39. 6 - A Solid Infrastructure
You need a reliable Internet connection
Certified CAT 5, 5e, 6 or 6e wiring
Certify the equipment before going live
Test
Test
T t
Test
Try to break it
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40. 7 - Quality Hardware
Tablets
PCs
COWs
Nurse/MD on a Sti k
N /MD Stick
Printers with network connections
Scanners
Back up
Back-up
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41. 8 – Good computer
support
A company you trust for advice and
pp
support
Takes an interest in what you are trying
p
to accomplish
Provides prompt support and returns
calls
Does preventive maintenance
Does upgrades and patches
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42. 9 – Watch out for Interface
Promises
Interfaces can take months to complete!
Find out exactly what is interfaced
Demographics
Scheduling
Charges
Ch
Has it been done before? Ask for a reference.
Does the price include both vendors
p
Consider looking up information on another system
instead of interfacing
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43. 10 – Ownership
Executive Sponsorship
Physician Champion
Strong Leadership
g p
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44. Tools for Averting Risk
Statement of work
Request for proposal
Payment terms tied to p j
y project milestones
Progress reports
Customized implementation plan
Project budget
Project staffing plan
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G
45. Sample Tools
For a complimentary templates
p
please sent request to
q
jdaigrepont@cokergroup.com
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G
46. Modifying the Contract
Source Code
Acceptance Period (Hardware & Software)
Implementation Caveats
Statement of Work (SOW)
No Front Loading of Support Fees
No Front Loading the purchase terms
Assignment
Future Upgrades and New Releases
Copyright infringements
Warranties
Termination
Future providers and fees (Recurring cost)
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47. Final Thought -
Fi l Th ht
Five Stages Of EMR
g
*Elizabeth Kubler-Ross
Death and Dying
48. 1st Stage: Denial
Occurs from time of purchase
until first few days of go-live
Sees only benefits of EMRs
Denial of any difficulties
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49. 2nd Stage: Anger
Typically lasts one
month
Angry because of
reduced patient
volumes
Staff upset with new
system
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50. 3rd Stage: Bargaining
Lasts 2-4 weeks
Pl d with vendor t
Plead ith d to
make program work
Will d anything
do thi
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51. 4th Stage: Depression
Lasts 3-6 months
A
Assume program will ill
not work
C ’t abandon it
Can’t b d
since it costs so much
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52. 5th Stage: Acceptance
It all starts to fall into
place
See benefits from the
system
You and every one
else live happily ever
after!
Cause for celebration
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53. Thank You
Contact Information
Jeffery Daigrepont, Principal
y g p , p
The Coker Group
jdaigrepont@cokergroup.com
j g @ g
800-345-5829
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