Empowering Your Practice Practice Improvement Via Office Technology 6th Annual PiVot Conference May

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Empowering Your PracticePractice Improvement
ViaOffice Technology6th Annual PiVot
ConferenceMay 4, 2007Greenway Plaza, Houston
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Traveling the Technology Trail
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We all want

• The e-Health Promise
• Get better information at the point of care
• Reduce paperwork, duplication, and other
  clinician headaches
• Improve care and outcomes while controlling costs

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(No Transcript)
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Is Your Medical Practice Ready?

• In 1816 Rene Laennec invented the stethoscope
• Colleagues viewed this instrument with suspicion
  and distrust
• In 1827, a commentator on the stethoscope wrote,
  "The extent of its usefulness is, as yet, far
  from being ascertained,"
• In the 1850s, skeptics described the new
  diagnostic aid as "a dangerous instrument.
• Source Davis AB. Medicine and Its Technology.
  Westport, Conn Greenwood Press198188-92

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Is Your Medical Practice Ready?

• Most new technologies since then have been
  greeted by similar initial doubts.
• Adding technology to your practice can be a
  successful strategy when approached with an open
  and educated mind.
• Do not be guilted into
• utilizing technology until
• you are PREPARED.

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Is Your Medical Practice Ready?

• Providers dont want to change their behaviors to
  match a computer system. They want a system to
  match their workflow.
• - J. Peter Geerlofs, MD, Chief Medical Officer,
  Allscripts Healthcare Solutions

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Barriers to EHR
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Inherent Challenges for EMR Adoption
Systems
People

• Legacy Vs. New
• Availability
• Best of Breed
• Vendor Strategies
• Integration
• Interoperability
• Devices/Mobility
• Portals/Single Sign-on

• Big Picture
• Culture
• Integration vs. Functionality
• Individual Motivation
• Personnel Cost
• Fear of Computerization

Business Practice

• Clear Vision and Priorities
• Strategic Plan
• Work Flows
• Process vs. Task Orientation
• Data Ownership
• Access and Security
• Patience and Time

Compromise
Compromise
Compromise
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Barriers to EHR

• Financial Barriers
• Cost
• Affordability
• High up-front costs
• Business Case
• Lack of quantifiable benefits (ROI)
• Frustrations
• Measuring value
• Escalating costs

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Barriers to EHR

• Financial Barriers
• High Initial Provider Time Costs
• Implementation timeframes are long
• Upfront time per patient and learning software
  results in longer work days
• Lack of Incentives
• No compensation for electronic communications
• Misalignment of incentives among those who pay
  for IT and those who benefit from it.

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Barriers to EHR

• Technological Barriers
• Lack of Standards CCHIT has helped
• Information Infrastructure
• Inadequate Data Exchange
• Inadequate Technical Support

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CCHIT

• The Certification Commission for Healthcare
  Information Technology or CCHIT is the recognized
  authority in the United States for certifying EHR
  products
• an independent, nonprofit, public/private
  organization that sets the benchmark for
  healthcare information technology
• www.cchit.org

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Selecting Best Product

• The CCHIT Certified seal means the EHR meets
  basic requirements for
• Functionality
• Interoperability
• Security
• Over sixty (60) software products certified
  according to 2006 standards

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Barriers to EHR

• Attitudinal Behavioral Barriers
• Office and providers attitudes and cultures
• Technical Competency
• Leadership
• Data Entry

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Barriers to EHR

• Organizational Change Barriers
• Workflow design
• Migration from paper
• Customizing and reorganizing
• Staff Training

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Practice Readiness Assessment

• Organizational change
• Assess your group to determine where those
  problems may arise.
• Provide data needed to locate and address areas
  of potential concern.
• Reflect strengths and weaknesses.

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• _   Most people think that the change in
  question is a necessary one.
• _   Most people agree that given the
  situation the change represents the best way of
  dealing with it.
• _   The organization's leaders have shown that
  they are committed to the change.
• _   In general, the middle managers are behind
  the change.
• _   So are the supervisors or first-line
  managers.
• _   The details of the change are being
  communicated to those who will be affected as
  quickly as it is practical to do so.

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Barriers to EHR

• Social Barriers
• Security and Privacy
• Legal
• Health care settings
• Stakeholder support
• Consumer Barriers
• Consumer acceptance
• Privacy

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We want an EHR because..

• 83 of office administrators / financial staff
  responding to a survey indicated that the need
  to improve workflow was the 1 motivating factor
  for the adoption of an EHR (M. Amatayakul)
• Top workflow concerns prior to EHR adoption
  (Lumetra survey)
• 63 Results tracking
• 61 Unable to keep up with the schedule
• 56 Patient waits
• 51 Chart chasing
• 49 Refills

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Technology or Bust

• Failure to consider technology solutions because
  they are deemed too expensive will have a
  negative impact on your practice.
• If a technology purchase does not add value to a
  practice, the purchase should not be made.
• Medical practices have not adequately invested in
  technology when compared to other industries.

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Remember

• Adding technology EMR is a step in the Evolution
  of your practice.
• Plan, Prepare and Communicate so it is not a
  Revolution in your practice!

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Is Your Medical Practice Ready?

• What is the Technology IQ of your current
  practice?
• Begin the needs assessment with Practice
  Inventory
• Evaluate the following areas
• People
• Physical Plant
• Technology
• Processes

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Where do we start?

• Practice Inventory
• People
• Physicians and mid-level providers
• Management
• Staff
• Patients

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Practice Inventory

• Physicians and mid-level providers
• How many providers?
• Specialties?
• Differences in practice style?
• Comfort level with technology?
• Personality Type?

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Practice Inventory

• Practice Manager/Administrator
• Comfortable with technology?
• Technology literate?
• Capacity to manage change and turmoil well?
• Communication skills?

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Practice Inventory

• Staff
• Comfortable using the computer?
• Have the ability and desire to change?
• Work well as a team?
• Respond well to training?
• Able to allocate training time?
• Patients
• Prepared for change?
• Already using technology in your practice?

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Practice Inventory

• Physical Plant
• How many locations?
• Staffing and operations (days open)?
• What about office layout?
• Impacts
• Number of computers needed
• Software costs
• Networking costs (wiring and bandwidth)

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Practice Inventory

• Technology
• Physical inventory of ALL hardware and software
• Hard drives
• Processor Speed
• Memory
• Document all serial numbers and warranty
  information
• Version of applications
• Any existing network infrastructure?
• IT Support
• In house
• Third party

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Practice Inventory

• Processes
• Do you use email to communicate within office and
  with outside entities?
• Do you have a website? Is it current? Patient
  interaction via website?
• Digital fax server?
• Digital transcription?
• Do you need a new PMS (Practice Management
  Software)?

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After the Inventory..Needs Assessment

• Complete inventory and focus on needs assessment
• What efficiencies can be implemented to enhance
  practice processes?
• Wish list
• Electronic Charge Capture
• E-prescribing
• Chartless Office
• Assess from all office locations, hospital and
  home

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Practice Needs Assessment

• What do we want this technology to do for our
  practice?
• Check billing codes to reduce rejected claims
• Reduce or eliminate transcription fees
• Improve patient safety and patient communication
• Improve workflow management
• Provide clinical decision support

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Practice Needs Assessment

• What do we want this technology to do for our
  practice?
• Reduce administrative burdens
• File, retrieve and sort medical records
• Gather and help analyze data
• Improve prescription process

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Practice Operational Flow

• Reasons for analyzing your practice processes
• Defining your pain
• What is not smooth and effortless for your
  practice?
• Coumadin tracking?
• Immunization monitoring?
• Visits with the MD that could be done by another
  professional?
• Complex visits with multiple providers?
• Lab visits?

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Practice Operational Flow

• What are we looking for?
• Opportunities for improvement
• Increase room utilization and throughput
• Deploy/utilize most appropriate resources for
  care
• Increase the timeliness of documentation
• Eliminate lost or missed charges
• Improve the patient experience

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Mapping the Process
Nursing
Lic. Nurse
Med Asst.
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Pearls of Wisdom

• Include all staff who touch the process
• Map is complete when all members agree that it
  captures
• all steps
• in proper sequence,
• beginning to end!
• Maintain mapping energy
• Celebrate successes

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Mapping the Process

• The process begins when a medication request is
  received from a pharmacy.
• The Product of Value is that a medication is
  renewed.

Review Request
complete
NOT complete
Contact Pharmacy
Get Pt info
info received
Review Pt Hx Rx request
Provide request Pt info to PCP
waiting
renew
NO renew
Create renew order
Document
Contact Pharm
Give to MA
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Mapping the Process
Review Request
Question Is this familiar to you? What is not
familiar? How is it different? Stay away from
HOW and focus on WHAT.
PCP Well, first our records clerk gets the
request off of the fax. She pulls the patient
chart and puts it in the Medical Assistants
tray. The MA may have to call the patient or the
pharmacy before giving it to the doctor. Also,
the doctor will always have more than one to do
so the MA usually waits until they are all
finished. I dont see that on here.
complete
NOT complete
Contact Pharmacy
Get Pt info
info received
Review Pt Hx Rx request
Provide request Pt info to PCP
renew
NO renew
Waiting
Create renew order
Document
Contact Pharm
Give to MA
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Mapping the Process
Medical Assistant
Records Clerk
Provider
Review Request
Get Rx request
Now that looks like what we do.
complete
NOT complete
Get Pt info
Provide Pt Info to MA
Contact Pharmacy
Review Pt Hx Rx request
Provide request Pt info to PCP
renew
NO renew
info received
Replace records
Waiting
Document
Create renew order
Contact Pharm
another renew request
finished
Document
Return Records
Give to MA
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Mapping the Process

• Look at the Impact Points
• A step or aspect of the process that has a large
  impact on the overall performance
• Fixing the problems that are on the Impact Points
  usually will significantly improve process
  performance
• May require little redesign
• Ask the question
• What single change will make the most
  difference?

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Mapping the Process
Records Clerk
Provider
Medical Assistant
FAX Rx
squeeze in between pts
Find the relevant info
Review Request
Get Rx request
Clip fax to chart, place on desk
complete
NOT complete
Get Pt info
Provide Pt Info to MA
Contact Pharmacy
Review Pt Hx Rx request
Provide request Pt info to PCP
Fill the cart take it to all of the MAs
stations
Chart Pulls
renew
NO renew
info received
Replace records
Waiting
Document
Create renew order
Contact Pharm
another renew request
finished
FAX Rx
Document
Return Records
Give to MA
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Mapping the Process
Medical Assistant
Records Clerk
Provider
Review Request
Get Rx request
complete
NOT complete
Get Pt info
Provide Pt Info to MA
Contact Pharmacy
Review Pt Hx Rx request
Provide request Pt info to PCP
renew
NO renew
info received
Replace records
Waiting
Document
Create renew order
Contact Pharm
another renew request
finished
Document
Return Records
Give to MA
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Mapping the Process
Medical Assistant
Records Clerk
Provider
New streamlined and seamless process
Review Request
Get Rx request
complete
NOT complete
Get Pt info
Provide Pt Info to MA
Contact Pharmacy
Review Pt Hx Rx request
Provide request Pt info to PCP
renew
NO renew
info received
Replace records
Waiting
Document
Create renew order
Contact Pharm
another renew request
finished
Document
Return Records
Give to MA
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Mapping the Process
Medical Assistant
Provider
Provider
Refill request received in EHR
Receiveroute request
Review EHR for meds /refills/orders
Review for action
contact pharm
contact pt
Contact Pt
Contact Phamt
Route to MA
another renew request
complete
finished
Save to permanent record
waiting
Sign all orders
Transmit/fax to appropriate recipient
From 15 steps that involved human resources to
5 with a proportional time savings.
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How do we make selection?

• Request for Proposal
• Written document
• Outlines specific information about your medical
  organization, the services and products you need,
  and the specific requirements vendors must meet
  in order to win your business.
• Establishes a formal relationship between you and
  the vendors.
• Places you in control.
• Communicates, up front, that your most important
  concern is the level of customer service you will
  receive.
• DOQ-IT Example Provided

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Adding Technology

• Systemic Manner
• Planned
• Individual Components
• Each step builds on the previous step
• Success

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References

• Electronic Health Records Transforming Your
  Medical Practice
• by Margaret Amatayakul and Steven S. Lazarus
• EHR Implementation
• by Carolyn P. Hartley and Edward D. Jones, II
• Websites
• www.physiciansehr.com
• www.medrecinst.com
• www.cchit.org
• www.hl7.org/ehr/downloads/index.asp

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The Doctors' Office Quality - - Information
Technology (DOQ-IT)

• Process Slides and Readiness Assessment in this
  presentation courtesy of DOQ-IT
• The Doctors' Office Quality - - Information
  Technology (DOQ-IT) project is funded by the
  Centers for Medicare Medicaid Services (CMS).
• The DOQ-IT project will educate small- to
  medium-sized physician offices on EHR system
  solutions and alternatives as well as provide
  information on cost, risks, and benefits of IT
  adoption.  Works closely with participating
  physician offices, conducts a needs assessment,
  identifying an EHR system from multiple vendors
  that meets specific office needs.
• http//www.medqic.org/dcs/ContentServer?cid111081
  0513596pagenameMedqic2FMQTools2FToolTemplatec
  MQTools

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Lumetra

• Lumetra is a healthcare consulting organization
  dedicated to improving the quality, safety, and
  integrity of healthcare. An independent,
  nonprofit organization with more than two decades
  of experience, Lumetra offers a broad array of
  services to public and private organizations.
• http//www.lumetra.com/

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Thank You

• Cynthia L, Dunn, RN, FACMPE
• Consultant
• Medical Group Management Association (MGMA)
• E-Mail
• Cdunn3_at_gmail.com
• Telephone
• 859-421-2219