IHS EHRIndian Health Service Electronic Health Record

Carolyn JohnsonCarolyn Johnson

Warm Springs Health & Wellness Warm Springs Health & Wellness CenterCenter

Facility PlanningFacility Planning

Confirmed Leadership supportConfirmed Leadership support Tribal EndorsementTribal Endorsement Area Office SupportArea Office Support Patient AwarenessPatient Awareness Clinician drivenClinician driven

E.H.R. Team MembersE.H.R. Team Members

Clinical Champions from Clinical Champions from eacheach discipline discipline (lab,rn, rph,md,,etc)(lab,rn, rph,md,,etc)

Administration/Executive LeadershipAdministration/Executive Leadership Health Information Services Health Information Services Information TechnologyInformation Technology Include Area IRM representationInclude Area IRM representation Clinical Application CoordinatorClinical Application Coordinator

EHR Team RolesEHR Team Roles

Identify and define Policies and Procedures Identify and define Policies and Procedures Address staffing and scheduling during Address staffing and scheduling during

transitiontransition Peer Training & MarketingPeer Training & Marketing Monitor and Execute Implementation PlanMonitor and Execute Implementation Plan Design and Approve templates, menus, and Design and Approve templates, menus, and

ordering lists for E.H.R.ordering lists for E.H.R.

Hire a Clinical Applications Hire a Clinical Applications CoordinatorCoordinator

Works cooperatively with Site ManagerWorks cooperatively with Site Manager Coordinates ImplementationCoordinates Implementation EHR User SupportEHR User Support TrainingTraining Customize SoftwareCustomize Software WorkflowWorkflow

Portland and Indianapolis VA 1 CAC for each Portland and Indianapolis VA 1 CAC for each 250 users250 users

The CAC is a new, specialized position The CAC is a new, specialized position separate from Network Specialist, CIO, User separate from Network Specialist, CIO, User SupportSupport

Sample Positions descriptions on EHR Sample Positions descriptions on EHR WebsiteWebsite

Clinical Applications Clinical Applications CoordinatorCoordinator

Clinical BackgroundClinical Background RPMS experienceRPMS experience Project Management /Leadership Project Management /Leadership

SkillsSkills Facility Working Process Knowledge Facility Working Process Knowledge Computer SkillsComputer Skills

Super-Users and AD-PacsSuper-Users and AD-Pacs

Clinical Super Users (rn, rph, lab,dm,md)Clinical Super Users (rn, rph, lab,dm,md) TrainingTraining Peer SupportPeer Support Templates optionalTemplates optional

Pharmacy Ad-PacsPharmacy Ad-Pacs Quick OrdersQuick Orders ART setupART setup Training on medication ordersTraining on medication orders Pharmacy 7 dutiesPharmacy 7 duties

Cherokee ImplementationCherokee Implementation

Implementation Timetable- Wind Implementation Timetable- Wind RiverRiver

Infrastructure upgradeInfrastructure upgrade

RPMS server RPMS server Training serverTraining server Network Network Wireless networkWireless network Lab Interface UpgradeLab Interface Upgrade Workstation AccessWorkstation Access Backup PowerBackup Power

Software Software Package upgrades to RPMS Package upgrades to RPMS

RadiologyRadiology Text Integration UtilityText Integration Utility Adverse Reaction TrackingAdverse Reaction Tracking Pharmacy 7Pharmacy 7 Scheduling (PIMS)Scheduling (PIMS) Pharmacy Inpt SuitePharmacy Inpt Suite Behavioral HealthBehavioral Health CacheCache Numerous RPMS patchesNumerous RPMS patches

Major Software UpdatesMajor Software Updates

Pharmacy Upgrade to version 7 (March 7)Pharmacy Upgrade to version 7 (March 7) Required several days to prepare drug files Required several days to prepare drug files Utilized Portland VHA pharmacist to assistUtilized Portland VHA pharmacist to assist Worked overtime and weekends to get readyWorked overtime and weekends to get ready Major process changes for pharmacistsMajor process changes for pharmacists

Implemented the Pharmacy Allergy and Adverse Implemented the Pharmacy Allergy and Adverse Reaction Tracking System:Reaction Tracking System:

• All of the allergies that have been entered into PCC had to All of the allergies that have been entered into PCC had to be manually entered into the new tracking system and be manually entered into the new tracking system and verified by a pharmacistverified by a pharmacist

Major Software UpdatesMajor Software Updates

Implement the new scheduling package Implement the new scheduling package (PIMS)(PIMS) This software was substantially different than This software was substantially different than

the old version of scheduling and required the old version of scheduling and required facility wide trainingfacility wide training

Checking in pt using the scheduling packageChecking in pt using the scheduling package

E.H.R. ConfigurationE.H.R. Configuration Design templates Design templates Design Menus and Quick OrdersDesign Menus and Quick Orders

Meds, Labs, Rad, NursingMeds, Labs, Rad, Nursing Define consultsDefine consults Pick lists and SuperbillsPick lists and Superbills Note TitlesNote Titles User Setup (keys)User Setup (keys) ParametersParameters Printing Chart Copy and OrdersPrinting Chart Copy and Orders Print FormatsPrint Formats

Setting up OrdersSetting up Orders

Setting up templatesSetting up templates

Staff OrientationStaff Orientation

Staff Training:Staff Training: CPRS Training Module Presented at Staff MeetingsCPRS Training Module Presented at Staff Meetings Pharmacy Training Module: Pharmacy Training Module:

• Available on Warm Springs Web SiteAvailable on Warm Springs Web Site• Mandatory for all pharmacy staffMandatory for all pharmacy staff

CPRS Training Module: CPRS Training Module: • Interactive training posted on Warm Springs Web SiteInteractive training posted on Warm Springs Web Site• Mandatory for providersMandatory for providers

Mary Hager DemoMary Hager Demo Portland VHA visit and hands on trainingPortland VHA visit and hands on training

Pre-Implementation TrainingPre-Implementation Training

2 hour training for everyone on VIEWING 2 hour training for everyone on VIEWING patient data in E.H.R.patient data in E.H.R.

Site Manager Training at VA , Camp Site Manager Training at VA , Camp CPRS, EHealth UniversityCPRS, EHealth UniversityEHR Test System Loaded On All User’s EHR Test System Loaded On All User’s ComputersComputers

Newsletters, Web Updates, Meeting Newsletters, Web Updates, Meeting UpdatesUpdates

Training – Go Live Training – Go Live Week Week

4-6 hours training outside of clinic4-6 hours training outside of clinic Departmental TrainingsDepartmental Trainings Use Knowledgeable TrainersUse Knowledgeable Trainers One-On-One Training AlsoOne-On-One Training Also Competancy ChecklistsCompetancy Checklists

Going LiveGoing Live

Intense CAC and IT SupportIntense CAC and IT Support Make Appropriate Scheduling AdjustmentsMake Appropriate Scheduling Adjustments Daily Debriefings….Daily Debriefings….

Procedural QuestionsProcedural Questions Technical IssuesTechnical Issues TrainingTraining

Questions?Questions?

Medical Records ProcessMedical Records Process

When to stop pulling the chartWhen to stop pulling the chart Filing notes AND orders in chart?Filing notes AND orders in chart? Print And File Chart Copies? Batch Print?Print And File Chart Copies? Batch Print? Release Of Information?Release Of Information? Outside Consults? Scanning?Outside Consults? Scanning? Incorrect Entries?Incorrect Entries?

PCC Coding ProcessPCC Coding Process

Coding done from daily lists of visitsCoding done from daily lists of visits No hard copy to code fromNo hard copy to code from Daily Error ReportsDaily Error Reports No POV, E&M Code, Activity TimeNo POV, E&M Code, Activity Time ICD Coding By ProvidersICD Coding By Providers Duplicate Visit CreationDuplicate Visit Creation

Business Office ProcessBusiness Office Process

Services Pick List Development, Installation, Services Pick List Development, Installation, And TrainingAnd Training

Missing E&M CodesMissing E&M Codes No Hard Copy To Work WithNo Hard Copy To Work With EHR Notes Are LegibleEHR Notes Are Legible Great Opportunity For Improved Provider Great Opportunity For Improved Provider

Documentation & Increase Billing/CollectionsDocumentation & Increase Billing/Collections

Pharmacy Pharmacy

Outside Prescription OrdersOutside Prescription Orders Printing pharmacy service copies for ordersPrinting pharmacy service copies for orders Refill and New prescriptions aren’t always groupedRefill and New prescriptions aren’t always grouped Printing controlled substancesPrinting controlled substances How to incorporate pharmacy patient signature logHow to incorporate pharmacy patient signature log Pharmacy Requirement for Completed/Signed NotesPharmacy Requirement for Completed/Signed Notes

Completing NotesCompleting Notes

Encounters documented by staff members in the Encounters documented by staff members in the electronic health record are expected be electronic health record are expected be completed and signed electronically at least 95% completed and signed electronically at least 95% of the time at the end of the encounter with the of the time at the end of the encounter with the patient. In the other 5 % of cases, these notes patient. In the other 5 % of cases, these notes will be completed and signed at a maximum of will be completed and signed at a maximum of 24 hrs after the encounter. Additional 24 hrs after the encounter. Additional documentation related to that visit (i.e., lab documentation related to that visit (i.e., lab results or delayed documentation of referral results or delayed documentation of referral information) will be added to the note as an information) will be added to the note as an addendum when this additional information is addendum when this additional information is available.available.

Miscellaneous IssuesMiscellaneous Issues Relax Provider schedules during first 2 weeks of Relax Provider schedules during first 2 weeks of

implementationimplementation Productivity issues while learning. Productivity issues while learning. How to handle Flowsheets in E.H.RHow to handle Flowsheets in E.H.R How to get reference lab results in E.H.R. How to get reference lab results in E.H.R. Standardization of Note titlesStandardization of Note titles Specialty Clinic ProvidersSpecialty Clinic Providers

Miscellaneous Miscellaneous Policies/ProceduresPolicies/Procedures

People who aren’t using E.H.R. yet- how are People who aren’t using E.H.R. yet- how are they handled?they handled?

Use of personal templatesUse of personal templates Template approval processTemplate approval process Note content - immunizationsNote content - immunizations Use of chat and broadcastUse of chat and broadcast Handle the missing PCC elements? SHX, Handle the missing PCC elements? SHX,

colonscopy, refusal,mammogram (offsite)colonscopy, refusal,mammogram (offsite) Checking in a ptChecking in a pt How to communicate the “Signs and Symptoms” How to communicate the “Signs and Symptoms”

(lab pov) to the lab(lab pov) to the lab

Template Approval ProcessTemplate Approval ProcessTemplate approval processTemplate approval processRequired Form ElementsRequired Form Elements: Plan that notes be able to stand on their own if printed. This is intended that pertinent : Plan that notes be able to stand on their own if printed. This is intended that pertinent

information related to the visit be a part of the form.information related to the visit be a part of the form.NameNameDate of VisitDate of VisitClinic EncounterClinic EncounterHistoryHistoryPersonal History/GPRAPersonal History/GPRAExamExamDiagnosis/POVDiagnosis/POVPlanPlanEducationEducationRefusalsRefusalsSignatureSignatureNeeds: Patient education templates for adults, GPRA, DM standardsNeeds: Patient education templates for adults, GPRA, DM standards““###” symbols used around information needed to be entered by data entry###” symbols used around information needed to be entered by data entry

Procedures for new formsProcedures for new forms: Deploy new forms in “Test” folder on the Live EHR: Deploy new forms in “Test” folder on the Live EHR: EHR Team will give e-concurrence of the form prior to deployment: EHR Team will give e-concurrence of the form prior to deployment