April 2008

Optimization and Standardization to Promote Utilization in an EHR Matthew J. Davis and Erin Sain

TEPR 2008 - Ft Lauderdale

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The focus of this lecture is to provide guidance on how to optimize and standardize during the implementation process to promote utilization of an EHR.

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Session Outline

• The mission of the session • Basis of Presentation Material• Importance of Educated build decisions • Understanding the Impact an EHR will have on

your Organization.  • The Necessity of Participation and Inclusion for

Buy-in Balanced with Standardization

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Session Mission

• Project teams, existing and future, would be able to walk away with an enlightened vision and an increased knowledge of how to more successfully execute an EHR implementation.

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Presentation Material Basis• The material for this presentation is based on a collection of positive experiences and

lessons learned– Positive Effects

• Physician and Staff Satisfaction• Immediate Benefits• Buy-In for Believers and non Believers• Smooth Go-Live

– Negative• Symptoms

– Formerly Simple Tasks become more effort– Rough Initial part of Go-Live despite Training– 80/20 Flip

• Causes– Inadequate Time to Properly Execute– Inaccurate Representation of Population– Invalid Data

» Poor Understanding» Poor Participation

– Proper Tools Unavailable

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Importance of Educated Build Decisions 

• Efficient Workflows• Opportunistic Re-engineering• Consolidation• Functionality and Consequences• Testing• Sounding Boards for Feedback

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Understanding the impact an EHR will have on your organization

• Quite Possibly Biggest Project ever in Organization to affect Revenue Generating Clinical Staff

• Potential for Bottlenecks to Patients• Potential for Revenue Disruption• Potential for Unlimited Positive Transformation

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The necessity of participation and inclusion for buy-in balanced with standardization

• Everyone has an Opinion• Every Opinion has a Cost and a Benefit

– Buy-In– Maintenance

• Tiered Approach to Meet organizational needs– Adds Structure and Governance– Helps to Communicate Organizational

Decisions/Challenges

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Standardization Level MatrixRequired EMR Content Subgroups  

Level of Standardization     Level of Appeals   User User

Functions   Database Specialty Sub-Group Database Specialty Sub-Group Favorites Override

    (NMG)   (Practice) (NMG)   (Practice)    

                   

Chart Notes Note Type Naming X     X     No No

  Structure of Index   X       X No Yes

  Input Forms   X       X No Yes

  Output Forms   X       X No No

  Output Style X       X   No No

Allergies Medications X¹       X   Yes Yes

  Non-medications X     X     Yes Yes

Vital Signs   X       X   No Yes

Medications     X¹     X   Yes Yes

Immunizations     X¹     X   Yes Yes

Problems (PMH/PSH/FH/SoH/etc.) (Master²) X³   (Master²) X³   Yes Yes

Assessment     X     X   Yes Yes

Orders Laboratory   X     X   Yes Yes

  Radiology   X     X   Yes Yes

  Procedures   X     X   Yes Yes

  Referrals   X     X   Yes Yes

  Other   X     X   Yes Yes

Charges Charge   X¹       X Yes Yes

Care Guides* Category Structure X     X     No No

  Content X     X     No Yes

  QuickSets   X¹     X   Yes Yes

HMP Screening X     X     No Yes

  Disease Management X     X     No Yes

Tasking Task Naming X     X     No No

  Workflow X   X X X No Yes

ChartViewer Scan/Document Naming X     X     No No

  Views   X¹     X   Yes Yes

  Chart Sections X     X     Yes Yes

Reviewed 03/09/08

Definitions:

A. Required EMR Functions - areas of ehr that require full adoption by all users in order to ensure successful communication and

database sharing throughout Sample Medical Group.

B. Level of Standardization - the organizational level at which ehr content will be standardized at the time of implementation.

This may occur at the Sample Medical Group, specialty, or practice levels.

C. Level of Appeal - the organizational level at which ehr content may be modified after implementation.

D. User Favorites/User Override - identifies the areas of ehr that allow for customization at an individual level.

Notes:

1. Denotes a starter set that might be modified by the user over time. This requires less individual feedback up front.

2. These areas will have a standardized "master" list to help problem list organization in the medical chart.

3. A personal "Quick List" of about 50 terms will additionally be available to each user for easy access to common conditions & terms.

This can be modified by the user over time.

* This function is not required. The subsets of functions within the Care Guides are required and utilized in other modules.

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Standardization Committee Decision Calendar

January

S M T W TH F S 1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

February

S M T W TH F S 1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28

March

S M T W TH F S 1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

April

S M T W TH F S 1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

May

S M T W TH F S

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

June

S M T W TH F S 1 2

3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

July

S M T W TH F S 1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 23 25 26 27 27

29 30 31

August

S M T W TH F S 1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

September

S M T W TH F S 1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30

October

S M T W TH F S 1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

November

S M T W TH F S 1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30

December

S M T W TH F S 1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

SC H E D U L E P L A N N E R

PROJECT TOPICS START DATE

END DATE

Planning Meeting 1 – Allergies; Vital Signs; Immunizations

03.27.07 03.29.07

Group Meetings 1 by specialty 03.28.07 04.09.07

Planning Meeting 2 – Charge Diagnoses and Codes; Medication List Favorites

04.10.07 04.12.07

Group Meetings 2 by specialty 04.11.07 04.23.07

Planning Meeting 3 – Problem Lists: active, surgical, family, social

04.24.07 05.01.07

Group Meetings 3 by specialty 04.25.07 05.14.07

Planning Meeting 4 – Chart Views; Order Sets: labs, radiology, procedures, referrals, follow up

05.15.07 05.17.07

Group Meetings 4 by specialty 05.16.07 06.11.07

Planning Meeting 5 – Notes: indexes, input forms, output forms

06.12.07 06.14.07

Group Meetings 5 by specialty 06.13.07 07.09.07

Planning Meeting 6 – Care Guides; Quick Sets 07.10.07 07.12.07

Group Meetings 6 by specialty 07.11.07 08.14.07

Revised 03/15/07

PHYSICIAN STANDARIZATION COMMITTEE CALENDAR

Six planning meetings will be held in each region to distribute the

clinical content material that needs standardization by specialty

2007