Very high level overview and benefits of Electronic Health Records systems and a multi-phased approach to implementation. By Michael Loechel & Joy Gupta.

1. Electronic Health Records
Implications for IMO State’s Healthcare System
Presented by:
Michael Loechel & Joy Gupta
IMO State Congress Business Forum
Atlanta, GA
August 2, 2013

2. Context
IMO State recognizes the need for setting up an
EHR as they consolidate their healthcare
infrastructure, and have approached Axioma
Group & Research Solutions, LLC to help in this
process.

3. Agenda
• Electronic Health Records (EHR)
Overview & Benefits
• Approach to EHR in IMO State
• Questions & Answers

4. EHR: Definition
A longitudinal health record that:
• Contains all personal health information
• Is entered and accessed electronically by healthcare
providers over a person’s lifetime
• Includes multiple care settings – inpatient and
outpatient
• Allows a patient’s health record to
travel with them
• Reflects the entire health history
of an individual across his/her
lifetime including data from
multiple providers
Sources: World Health Organization; HealthIT.gov

5. EHR is Comprehensive
Electronic Health Records (EHR)
All personal health information
Electronic Medical Records (EMR)
Diagnosis and treatment information
Electronic Prescribing (EP)
Drugs written and dispensed

6. EHR: Goals
• Improve quality and convenience of patient care
• Increase patient participation in their care
• Improve accuracy of diagnoses and health outcomes
• Improve care coordination
• Increase practice efficiencies and
cost savings
Source: HealthIT.gov

7. EHR in IMO State: Approach
Patient Flow
•Process Mapping: Current
vs. Future State
•Gaps
EHR Plan & Process
•Tweaks
System
requirements based
on Healthcare
practices
•System Selection
System
Implementation &
Training
•Phased rollout
Ongoing Technical
Support

8. Patient Flow & EHR
Origination Evaluation/
Diagnosis
Treatment
Assessment &
Options
Symptomatic/
Asymptomatic
Chronic/
Episodic
Management of
Treatment and
ongoing Care
Emergency/
Non-Emergency
Hospital
Clinic/Primary
Health Center
Home visit
Physical
Examination
Lab tests
Other diagnostics
Drug therapy
Screening
Surgery
Acute Care
Hospitals (inpatient
& outpatient)
Clinics
Primary Care
Institutions
Non-acute Care
Primary Care
Institutions
Home Care
Devices
EHRs can, and should, encompass the continuum of patient care
Doctors
Traditional Healers
Nurses and other
healthcare providers
Other

9. Planning an EHR
Guiding Principles for Implementing National, Regional
and/or Provider EHR Lessons Learned
 Clinical Value: EHR capabilities should have high clinical
value. The identification of capabilities and priorities should
be clinician led.
 Pragmatism: The foundations for EHR need to be built;
capabilities need to be realistic for the timeframe of each
release.
 Staged Development: Evolve capabilities over time to
achieve greater sophistication.
 Balance Risk and Reward: Manage the degree of difficulty
in each release.
Source: Accenture Global Survey
Accurate patient identification is the backbone of an effective and efficient health record system. This should be addressed first
before moving forward to automation.

10. Setting up an EHR System
Review Current
Health Record
System
Identify Issues
and Challenges
Plan for
Introduction
Coverage
Type and form of
records
How maintained & by
whom
Quality and
consistency
To what extent
centralized/ localized
Extent of sharing &
Process
Policies and guidelines
Data entry accuracy
Communication & Training
Literacy/attitude toward
computer technology
Cost and funding
Concerns of providers
Knowledge of disease
classification systems
Human resources
adequacy
Infrastructure – power,
wiring, space
Involvement of clinicians
and administrators
It is extremely important that there is support from the anticipated users of the system who need to be involved from the onset of
discussions.
Form a Steering
Committee
Determine type of EHR
Set achievable
outcome goals that will
meet the needs of both
users and consumers
Devise strategies in
preparation for an EHR
Develop policies for
use in an electronic
health record system
Source: Based on WHO EHR Manual & Experience

11. Implementation Team
Source: WHO EHR Manual

12. Implementation Plan
A sound implementation plan can mean the difference
between success and failure
① Working Groups to Address
– Information Security
– Education and Training – Competent, committed users
– Quality Assurance of data collected and processed
② Consider Key Factors Including
– What computer systems does the institution currently
have?
– What form should the implementation take?
(full/phased)
– How will past data be integrated and old data retained?
Source: Based on WHO EHR Manual & Experience

13. Measuring Success
Key areas of measurement (examples)
• Efficiency
– Patient turnover
– Patient records available at point-of-care
– On time receipt of labs/diagnostics
– Speed of diagnosis
– Clinical alerts
– Speed of medical fulfillment
• Outcomes
– Accuracy of diagnosis
– Accuracy of treatment
– Persistency and compliance with drugs
– Persistence of follow up visits
– Patients receiving preventive exams/procedures
– Distribution of education materials
Source: Based on Experience and Multiple Source

15. Contact Information
Michael Loechel
President
Axioma Group, Inc.
michael@axiomagroupinc.com
(646) 415-8107
Joy Gupta
President
Research Solutions, LLC
Joygupta@earthlink.net
(203) 994-4784