PREPARING FOR AN EHR SYSTEM

Carol Sainsbery Project DirectorLeanne Cox Medical Records Manager

Scanning @ Southern

“One small step for man; one giant leap for mankind”

(Neil Armstrong, 20.07.1969).

Southern Health Vital Signs

• Acute, Sub-acute, Mental Health, Aged & Community

• Service area of 2800 square kms and 750,000 people

• 12,000 staff

• Annual turnover of $700 million

Southern Health Vital Signs

• 110,000 inpatient attendances

• 700,000 outpatient attendances

• 1.8 Million PMI entries

• 2.4 million MR location moves annually

Scanning @ Southern

From this…..

Typical paper based medical records

department;

To this…..

Casey Hospital medical records department following the removal of shelving and installation of scanning workstations

Preparing for an EHR System

How does a Health Service start?

An EHR is a journey, not a destination

WHAT?

Activity One

• Group Activity

• Key Stakeholder Groups

• Brainstorming EHR

WHAT do you want to achieve?

• Paperless Medical Record

• Electronic diagnostics

• Direct entry forms

• Wireless tablets

• Integration between different systems

WHAT do you want to achieve?

• E-Prescribing

• Direct Pathology and Radiology order entry

• Remote access

• Document Management / Archiving

WHAT do you want to achieve?

If you don’t know where you are going,

you surely won’t get there!

WHY?

WHY do you want to do this?

Which would you prefer?

WHY do you want to do this?

• Clinical Care / Continuum of Care

• Timeliness and Accessibility

• Access by multiple users

• Reduces physical storage space

• Reduces the clerical EFT in HIS

WHY do you want to do this?

• Record Transportation – Network record issues

• Decreased record consumables

• HIS Information Systems ‘get smart’

• Quality Management / Auditing

HOW?

HOW will you achieve this?

Think BIG …. Start Small

HOW will you achieve this?

What is available?• Scanning• Direct entry• Voice recognition• Archiving systems• e-Pens• In house or Out house

How will these support your WHAT & WHY?

HOW will you achieve this?

How will you get your chosen product to work?• Working party & steering committee of stakeholders:

- IT- HIMS- Clinicians- Project Team – Ownership and direction- Vendor

What are the expectations of your stakeholders?• Are they aligned, realistic and achievable?

HOW will you achieve this?

Process Redesign• Challenge everything you know about medical records management

Implementing into an existing site• Managing the dual world between paper and scanned records• Individual sites – transition “hump” but it is manageable• Networked records – messy and resource intensive

HOW will you achieve this?

How do we do it?• Ensure chosen solution reflects the look of the paper record

- Minimise the impact in the hospital- Consider containing the change to HIS for a short time- Scan on discharge- Decrease reliance on past paper history- Centralised and decentralised scanning areas

HOW will you achieve this?

Forms – Top Priority

• Forms inventory – Which stay and which go?

• Forms register – Standardise across your service

• Barcode all forms – Document mapping file

• Control forms in one central location

Activity Two

• Medical Record Sample

• Analysis of Content

• Comparison with Scanned Record

Activity Two

Backscanning is a dirty word!

• Consider the pros and cons

• All or nothing or segmented approach?

• Pick a start date – “old” records then become static

• Consider impact on throughput of current records

• What is to be gained – what are current recall rates?

WHO?

WHO should be involved?

• Organisations Executives / Board

• Clinicians / NUMS / Key Clinical Stakeholders

• Steering Committee

• HIMS

• Project Team

• Working Party

• IT / Computer Services

• Forms Co-ordinator / Materials Management / Printer

• HIS Clerks / Scanners

WHO should be involved?

Clinicians

Vendor

Project Team

H.I.S

Computer Services

EHR

Project Steering Committee

Executive

WHEN?

WHEN?

When do you want it?

When can you do it?

What are the known barriers?• Hardware / software• IT Infrastructure

Impact on organisation whilst doing it?• Who will be affected• Staffing required to provide ongoing services

Staged or Big Bang?• Department based or whole of organisation

It’s not going away!

Moving to an EHR is not an alternative. It is not an IF, it is a WHEN!

Don’t get left behind, the planning starts NOW!

HOW MUCH?

HOW MUCH and who pays?

• Funded by the Health Service

• Government / Department funding

• Consortium or partnership arrangement

• Hub & Spoke

• What is the projected return on investment?

Paper Vs Scanning…Some costs

Paper Department EFT = $23.04 per separationScanned Department EFT = $11.40 per separation

51% reduction

Tracking in a paper dept = $1.17 per moveTracking in a scanned dept = $0.58 per move

51% reduction

Paper Record Construction = $1.62 per recordScanned Record Construction = $0.00 per record

100% reduction

Casey KPIs

Scanning Completion Times

0123456789

10

1 2 3 4 5

Week

Days

DaysOutstanding

Activity Three

• Sample Business Case

• Group Activity

• Brainstorming Business Case Development

Project Management Methodology

• Project Start-up• Directing a Project• Initiating a Project• Controlling a Stage• Managing Delivery• Closing a Project

Methodology controls the flow of the Project

Project Management MethodologyClinical Record Information Scanning Project (CRiSP)

Project Vital Signs

People 80%

Product 20%

Project Warning Signs

In Scope

• Application- Deployment- Interfacing- Integration

Out of Scope

• Mapping / translating data tools

• Direct & order entry• Process re-engineering• Legal compliance• Acceptance testing• Archiving• ……

Change Management

PROJECT• Define the purpose

• Stakeholder analysis

• Manage the risks

• Develop evaluation strategies

PEOPLE• Who to engage

• Manage HR / IR issues

• Consult / Communicate

• Develop change agent skills

Change Management

WORKFORCE PLANNING

• Reconsider recruitment • Natural attrition rather than retention• Plan to reach the projected EFT in your business case

TRAINING

• Paper MR clerk @ 8 weeks = $6,271 • Scanning MR clerk @ 1 week = $785

Training costs significantly reduced in scanning environment

Quality Plan

Project

• Customers quality expectations

• Acceptance testing

• Quality responsibilities

• Applicable standards

• Quality control and audit processes

Scanning Solution

• Quality of finished product at scanning and scanned stages

• Record Maintenance – Before, during and after scanning

• Regular scanning audits – Retraining and feedback

• Metadata and audit trails

WHAT IF…?

WHAT IF….?

The most important question a Project Manager must ask hundreds of times each day is

WHAT IF…?

• Clinicians / stakeholders don’t buy in?

• The Unions get involved?

• The system goes down?

• You have poor organisational support?

Also need to confirm your state’s legal position on EHR

The Project Life Cycle

EHR is in reality a project portfolio that is a

collection of projects that must be

co-managed simultaneously

DEFINE the Project

PLAN the Project

IMPLEMENT

MONITOR ADJUST

EVALUATE

CELEBRATE

Laws of Project Management

No major project is ever installed on time, within budget and with the same staff that started it. Yours will not be the first.

When things are going well, something will go wrong. When things can’t get any worse, they will. When things appear to be going better you have overlooked something.

Project teams detest project reporting because it so vividly manifests the lack of progress.

A carelessly planned project will take three times longer to complete than expected. A carefully planned project will take only twice as long.

Key Project Features

• Assess the EnvironmentWho are the key players, who has the power and impact?

• Identify the goals of the key players What are their professional goals or hidden agendas?

• Know yourself What are your own strengths and weaknesses? How are

you perceived by others?

• Define the problems What are all the relevant facts? What is the real situation?

Key Project Features

• Develop solutions that work Avoid premature solutions that don’t consider the previous

four points

• Test and refine the solutionsInitial solutions are rough, they need testing and refining.

• Political Reality A solution that does not take political realities into account is

superficial and naïve.

• Failing to plan is planning to fail

The Five Keys to Project Success

1. Don’t be an accidental Manager Project management is a discipline, understand the

process to achieve the goal.

2. Get it right the first timeDoing things right requires time and effort but it is much more expensive to do it again later.

3. Anticipate inevitable problems Conflict and problems are built into the concepts of

projects, plan ahead to improve your ability to cope.

The Five Keys to Project Success

4. Dig deep to find the real solutionNever accept a project at face value, you must go beneath the surface to discover the real project objective.

5. Be flexibleProjects are full of surprises, an overly rigid system is bound to fail.

Advocate Clarity, Avoid Ambiguity

This is what the organisation conceptualised….

This is what the engineers designed…..

Advocate Clarity, Avoid Ambiguity

This is what the manufacturer built….

Advocate Clarity, Avoid Ambiguity

This is how the builder installed it….

Advocate Clarity, Avoid Ambiguity

This is what the user really wanted….

Advocate Clarity, Avoid Ambiguity

Remember….

• Be brave, be determined, be resolute!

• What may seem impossible today, may be the norm tomorrow!