Information Management for Health Care Group E Presentation
Building Consensus for Electronic Health Records
Jacksonville University Online School Nursing NUR353
2. What is EMR?
Digital
paper chart
Medical & treatment history
Track data over time
Determine when due for check up
Check parameters such BP & vac.
Monitor quality of care within practice
Difficult
to transfer out of facility
Little improvement over paper charting
Garrett & Seidman, 2011
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3. What is EHR?
Total
health of patient
Reach beyond initial health organization
Share health information
Other providers
Laboratories
Specialists
Moves with the patient
Accessed by all involved in patient care
including patients
Garrett & Seidman, 2011
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4. Advantages of EHR
Contain and share patient information from
all providers
Reduce medical error
Improves accuracy
Clarity of medical records
Available information
Reduce
Duplicate tests
Delay in treatment
Patient well informed
Better decisions about care
CMS.gov, 2012
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5. Drawbacks to EHR
Acquisition costs
Hardware and software
Loss of revenue due to decreased productivity
One study involving several internal medicine
clinics estimated a productivity loss of 20% in the
first month, 10% in the second month, and 5% in
the third month, with productivity subsequently
returning to its original levels.
Full-time salaries for employees hired to input
existing patient data
Ongoing maintenance costs
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6. Drawbacks to EHR
Patient
privacy
Liability concerns by physician/hospitals with
respect to protecting electronic data
Inability
to do a thorough “look back” in a
patient’s record without piling through
volumes of data
Wang, Middleton, & Prosser et al., 2003
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7. Building consensus- Steps to
gaining consensus
Step 1: Assess readiness
Where is the facility now in terms of automation? Is
anything currently automated? What stage is the facility at
in terms of the HIMSS Analytics Adoption Model?
Stage 0: Automation exists but not all systems are operating
Stage 1: Laboratory, pharmacy, and radiology departments
installed
Stage 2: Clinical documentation automated, EMR present
and integrated with clinical data repository
Stage 3: Nursing documentation/flow sheets are in place and
physicians can retrieve/view basic documentation
Stage 4: Computerized provider order entry in place (CPOE)
Stage 5: Barcode medication administration (BCMA) or radio
frequency identification (RFID) implemented
Stage 6: Physician documentation, full clinical decision
support system and picture archiving and communication
system in place
Stage 7: Completely paperless
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8. Building consensus-Steps to
gaining consensus
Step 1: Assess readiness (continued)
Is there commitment from administration to
implement EHR?
Support from administration imperative for
implementation to occur
Are funds available to implement EHR?
Cost
Size, location, system
Well designed and correct implementation of EHR
will reduce errors, improve quality of
care, increase physician and patient satisfaction
which will lead to lower costs
Haugen & Sebelius, 2008
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9. Building Consensus- Steps to
gaining consensus
Step
1: Assess readiness (continued)
How much experience does the current staff
have with technology?
For success in implementing EHR, clinician
involvement and acceptance of changes is
imperative
Resistance to change from medical staff
Consider technical proficiency of staff when selecting
a system
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10. Building consensus- Steps to
gaining consensus
Step
2: Conduct focus groups
Have representation from all stakeholders
affected by the change involved in the focus
groups
Members of the focus group(s) identify
needs form a clinical and administrative
perspective.
Members discuss impact of workflow
Appoint a leadership team to oversee
implementation
Hebda & Czar (2013)
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11. Building Consensus- Steps to
gaining consensus
Step
3: Set goals for the EHR system
Goals should be “SMART”
Specific
Measurable
Attainable
Relevant
Time bound
HealthIT.gov, 2012
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12. Building Consensus- Steps to
gaining consensus
Step
3: Set goals for the EHR system
(continued)
Examples of goals
Establishment of a focus group
Selection of EHR system
Creating a time line
Allocating resources
Training hospital staff
Launching the system
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13. Building Consensus- Steps to
gaining consensus
Step 3: Set goals for the EHR system (continued)
Goals should coincide with meaningful use. What is
meaningful use?
Discrete structured data available through other
healthcare facilities
Meaningful use Stage 1 criteria
Computer provider medication orders
Medication list
Allergies
Problem list
Discharge instructions
Decision support tools
Growth charts for children
Providing patient electronic health information
Patrick, 2013
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14. Building Consensus- Steps to
gaining consensus
Step
3: Set goals for the EHR system
(continued)
Meaningful use Stage 2 criteria
Tracking medication from order to
administration
Secure electronic messaging
Outpatient lab reporting
Discharge prescriptions
Recording clinical notes
Patient family history
Exchange of health information
McCartney, 2013
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15. Building Consensus-Steps to
gaining consensus
Step
4: Prioritize goals
Short-term goals
Focus groups
Time line
Selecting vendor
Long-term goals
Installing EHR
Training staff
Launching system
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16. Building Consensus-Steps to
gaining consensus
Step
5: Select a vendor for EHR
Form a focus group
Written request
Demonstrations
Rank vendors
Contract
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17. Building Consensus- Steps to
gaining consensus
Step
6: Create a plan/timeline for
implementation
Request input from clinical and support staff
Perform workflow analysis
Arrange for workflow redesign
Create an abstraction plan
Create a timeline for implementation
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18. Building Consensus-Steps to
gain consensus
Step
7: Communicate
Communication should happen often and to
all employees of the facility throughout the
entire transition to EHR
When “go-live” is ready to occur, a meeting
should occur whereby the leadership
committee/team assigned by presents the
plan for the entire facility
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19. Timeline for EHR
implementation
Nine
to 12 months before go-live
Obtain support from facility leadership
Submit request for proposals
Choose vender and make a shortlist
Plan training and implementation
Evaluate current project management
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20. Timeline for EHR
implementation
Six to nine months before go-live
Name a project team and define roles and
responsibilities
Develop workflows
Plan abstraction for transferring paper
information to system
Examine templates and data elements
Evaluate data elements for billing and
patient encounters
Define necessary hardware/software needs
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21. Timeline for EHR
implementation
Three
to six months before go-live
Install hardware
Assess readiness of staff
Plan for training of staff and super users
Compare installation timeline with vender’s
timeline
Notify patients of new system, explain
benefits and ask for feedback
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22. Timeline for EHR
implementation
One
to three months before go-live
Build and test interfaces
Test readiness system
Fill in patient records
Adjust schedules for patients
Arrange staff schedules
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23. Timeline for EHR
implementation
About
30 days before go-live
Customize templates
Decrease patient load for going live
Test and recheck system, workflows, etc.
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24. Timeline for EHR
implementation
From
30 to 120 days after go-live
Examine provider’s templates in system
Share protocols among staff
Create a network with other facilities for
support and feedback
Discuss with vendor about concerns or
questions
Ehrintelligence, 2012
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25. Summary
Learned
what an EMR/EHR are and
their differences
Benefits and challenges of EHR
Steps to building a consensus
Assessment of readiness in a facility
Process to conduct focus groups
Importance of setting SMART goals that
coincide with meaningful use
How to choose a vendor
Created a plan for implementation
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26. References
Benefits of ehr's. (n.d.). Definition and benefits of electronic medical records . Retrieved from
http://www.healthit.gov/providers-professionals/electronic-medical-records-emr
EHR implementation timeline for hospitals. (2012, June 14). EHRintelligencecom. Retrieved from
http://ehrintelligence.com/2012/06/14/ehr-implementation-timeline-for-hospitals/
Electronic Health Records. (2012, March 26). - Centers for medicare & medicaid services. Retrieved from
http://www.cms.gov/Medicare/E-Health/EHealthRecords/index.html
Garrett, P., & Seidman, J. (2011, January 4). Health it buzz emr vs ehr what is the difference Retrieved from
http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/
HealthIT.gov. (n.d.). Selecting an ehr system or upgrading an ehr system. Retrieved from
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-2-plan-your-approach
Hebda, T., & Czar, P. (2013). Handbook of informatics for nurses & healthcare professionals (5th ed.).
Boston: Pearson.
McCartney, P. (2013). Meaningful use stages 1 and 2. Health information
technology, 38(January/February), 1st ser., 56.
Mooney, B. L., & Boyle, A. M. (2011, May 10). 10 steps to successful her implementation | medical
economics. Medical Economics. Retrieved from
http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modernmedicine-feature-articles/10-steps-successful-ehr-imple
Patrick, K. (2013, November 7). How to convert paper charting to electronic charting [Personal interview)
Wang, S. (2003). A cost-benefit analysis of electronic medical records in primary care. The American
Journal of Medicine, 114(5), 397-403. doi: 10.1016/S0002-9343(03)00057-3
Zandieh, S. O., Yoon-Flannery, K., & Kuperman, G. J., et al.(2008). Challenges to ehr implementation in
electronic. Journal of General Internal Medicine, 23(6), 755-761. doi: 10.1007/s11606-008-0573-5
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