Physician EHR Adoption: a report from the trenches

Kiki C. Nocella, PhD, MHACEO

Believe Health, LLC

Goals for Today

• Who we are• What we did• Lessons learned• Challenges• Best practices

Who is “Believe Health”?

• Creator of the first operational HIE west of the Mississippi

• LLC that works with small, rural, and underserved communities and providers to enter the HIT superhighway

• A firm with unparalleled experience and diverse skills and knowledge of health IT, particularly in rural communities

• AHRQ Master Contractor for their HIT portfolio and National Resource Center

What got us on this panel!

A simple question:What does it take to implement HIT in a rural region?

• Infrastructure• Telemedicine• EHRs and HIE• PHRs• Diabetes Education• Health professions training

Date Dx Tx

Date Dx Tx

Smith, Joe 123 Main St. Anytown, USA Tw2-5053DOB 12.1.17

6.3.52 FXR wrist cast

7.12.58 Luies PCN

3.24.62 Tonsilectomy

9.21.66 Obesity Dex Inj

10.15.68 CHF Digitalis

12.21.68 MVA ASA, letter to Atty

I’m not a magician Spock, just an old country doctor

“Removing ALL Barriers”

Dollar Cost Issues

Time Cost Issues

Personal Skill Set Inequality IssuesIssues of Culture Change

Dollar Cost Issues

• Dollar Cost Issues– What will it cost me?– Hardware and software expense– Time lost from practice– Re-tasking of employees– New, recurring expenses (ie support, connectivity,

upgrades, maintenance)

But “Free” is not cheap enough

Time Cost Issues

Will I lose even more family time?Training timeSystem Personalization – the joy of template

building

Personal Skill Set Inequality Issues

• Computer literacy• Physical limitations

LAPTOP

Culture Change

Great deal? Or a new cost of business?

Source: AHRQ, September, 15,2005

Providers in HPSAs will receive 10% more, however, studies show their average costs are higher as well

14All dates, calculations, and products are

preliminary and subject to change without notice

We’ve learned a lot• “Absolutely”• ASP vs. Local Install• A whole new vocabulary…what does “CCR” mean to you?• The value of legal. And “suits”.• Require legitimacy. Require active listening. It MUST work for you –

no one else really matters.• One size DOES NOT fit all!• The need for a business case – it needs to add value to you, your

patients, and your practice• Technology is just a tool• “The perfect is the enemy of the good” (Voltaire)• Rip the bandaid off? Or Remove it slowly?• Ride the inertia - “The tendency of an object to continue in motion

at the same speed and in the same direction, unless acted upon by force”.

What results in physician buy-in

•Relevance–How does EHR implementation help my patients or my practice or my community?–Is the data collection/time effort/culture change worth it?

•Fear Resolution–Big Brother–Unethical competitive Practices (data stealing)

•Security assurances (HIPAA, System Failure)•Unobtrusive Paced Implementation of EHR•Cost Mitigation

Some Challenges• Money removes some barriers – but there are

still the challenges of:– Disruption to clinical workflow– Workflow redesign– Cash outlay in advance of incentives– Policy and Governance (what are the rules, and who

makes the rules)– Adoption does not necessarily mean utilization– Its not easy….yet. And it needs to be….soon

• Availability of capable and competent workforce• Sustainability

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Best Practices: Keys to “success”

• Community Based Participatory Research (“CBPR”) – a partnership approach

• Just-in-time, concurrent education– Learning together, growing together

• How can we enable you?• There are no failures, only findings• Their creation of their common, shared vision• Social capital• Fun, trust, and a little bit of pixie dust!

Best Practices: Resources

• www.believehealth.com• K.Nocella@believehealth.com• www.texmed.org• www.cchit.org• http://www.himss.org/EconomicStimulus/• HITEC-LA

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Have a buddy