EHR Adoption

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EHR Adoption Barriers Solutions

• John Weir
• Illumisys A Division of Lumetra

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Illumisys

• Established in 2005
• Mission to assist healthcare organizations and
  their providers transform their patient
  environments through the adoption of technology.
• Core Competencies
• HIT Adoption Programs
• Systems Implementation
• Systems Integration
• Operations Strategy
• HIT Project Management

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Presentation Outline

• Provide an outline of the state of systems
  adoption, common barriers solutions.
• Offer proven considerations for addressing
  barriers and implementation suggestions targeted
  on success.

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Ambulatory System Adoption
CDC's 2006 National Ambulatory Medical Care
Survey of 3,350 office-based physicians Health
Affairs, How Common Are EHRs in the US? -2006.
Modern Healthcare 10/30/2008
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HIT Adoption in Physician Offices
Source HIT Adoption in Physician Offices A
Summary of Findings in Iowa August 2007, Iowa
Foundation for Medical Care
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Why is Adoption So Difficult?
Training Education
Patient Safety Compliance Initiatives
HIT Implementation
Data Analysis
Change Process
Running the Business
Patient Care
Quality Reporting P4P Requirements
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Perspectives of EHR

• What we want

What we often get

• Complexity of configuration and user base needs.
• No one size fits all products.
• Lack of trained professionals.
• Too much going on in the office to focus.

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EHR Adoption Barriers
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Major Adoption Barriers
Source MGH Institute for Health Policy, George
Washington University and RTI, A National Survey
of Health Record Keeping among Physicians Group
Practices in the US, Preliminary Data, November
2007
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• SO WHAT DOES THIS MEAN AT THE PHYSICIAN OFFICE
  LEVEL?
• WHAT CONSIDERATIONS SHOULD BE MADE?

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Financial Barriers
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Financial Solutions

• Smart Contracting
• Go live and milestone clauses.
• Consider group purchasing where feasible.
• Lease purchasing and deferrals on initial billing.

Upfront Costs
Ongoing Costs

1. Consider an hosted environment server (ASP) that
   can be paid for monthly.
2. Consider hardware depreciation, support fees,
   upgrade costs miscellaneous expenses such as
   new staff training.
3. Negotiate longer term Interface costs upfront.

Services

1. Ensure implementation, training and go live
   support is covered.
2. Consider having a source for vendor management
   and hand holding.
3. Build in-house product expertise within staff.

1. Purposefully schedule for less patients during
   initial go live.
2. Look at who can be reassigned for assuming
   certain project responsibilities.
3. Create goals that balances lost time against high
   impact automation and decreased data entry.

Lost Time
Integration Costs

1. Create an ROI process to track the benefits of
   the system. E.g. value of eRx, reduced
   transcription against system costs.
2. Improvements in timeliness of claims submission.
3. Include consumers by incorporating email and
   online visit protocols.

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Key Areas of Financial Focus

• High impact cost savings
• Elimination of paper charts encounter form
• Decrease in data entry and transcription
• Increase physicians ability to submit new and
  refill prescriptions directly to the pharmacy
• Improvement in claims capture billing revenue
• Decrease patient administrative staff time
• Further time/cost savings
• Enhanced clinical processes practice workflow
  efficiency
• Provide decision support
• Decrease documentation improve legibility -
  Safety
• Increase timeliness patient tracking follow-up
• Reduce time of administrative staff filing,
  finding and pulling records
• Use e-mail messaging

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Technology Barriers
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Technology Solutions

1. Create performance guarantees associated with
   vendor support uptime.
2. Have a maintenance plan that is tested and works.
3. Plan for, implement and transition upgrades with
   care.

Technical Support

• Establish system review process before enhancing
  templates workflow.
• If it works dont customize it.
• Plan out the system workflow with feedback from
  all staff.

Complex System Customization

1. Standards bodies have emerged and working with
   certification programs.
2. Ask your vendor about terminologies and
   vocabulary sets used.
3. Established interface needs early and have a
   clear set of specifications that can be shared
   between vendors.
4. Broker vendor communications to eliminate any he
   said/she said scenarios

Fragmented Standards Data Exchange

1. If youre not clear on functionality vs. your
   needs prior to purchasing - ASK.
2. Make sure you have people who understand how the
   system will work for your office.
3. Hire experts where you need to.

Product Expectations/ Resources

1. All systems must comply with HIPAA
2. Ensure data is encrypted where transmission is
   involved.
3. Create levels of security for users where data
   access should be limited.

Privacy Security
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Organizational Barriers
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Organizational Solutions
Infrastructure

1. Establish change management processes.
2. Create a process for decision making.
3. Develop a process for issue escalation.

Technical Capacity

1. IT Network has bandwidth and capability for new
   system.
2. IT Support protocols established.
3. Communications created for implementation process
   through the business.

Operational Capacity

1. Staff appropriately with internal, vendor and
   where necessary consultants.
2. Review and establish appropriate workflows
   focused on improvement.
3. Understand training needs and have vendor work to
   that need.
4. Create paper migration plan with vendor input.

Goal Alignment

1. Build consensus across the organization with
   management and providers.
2. Build commitment from staff to meet timelines and
   USE the system.
3. Create a focus on quality from system
   performance/capability to outcomes.

Leadership

1. Identify physician champion who will remain
   committed to the project.
2. Entrust authority with implementation lead and
   physician champion.
3. Maintain project VISION throughout the
   implementation and Go Live.
4. Establish management reporting and staff updates.
5. Address legal issues upfront.

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Cultural Considerations
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Cultural Solutions
Technical Competency

1. Ready staff for what may be new technology. E.g.
   MS Windows, browsers.
2. Have staff involved in requirements development
   and system planning feedback.
3. Address the change process in a proactive and
   benefits oriented manner.

Leadership Accountability

1. Establish good project management practices
   maintain a plan and timeline.
2. Manage the vendor and seek clear recommendations.
3. Proactively communication progress and goals
   achieved within the organization.

Consumers

1. Integrate access to relevant components. E.g.
   PHR, email, scheduling.
2. Inform patients of the transition make the
   benefits apparent and set expectations.
3. Involve the patient in their care and look at
   improved outreach methods.
4. Stem privacy and security concerns.

Change Management

1. Address resistance to change by illustrating
   system capabilities.
2. Incorporate staff in the entire process including
   goal setting, build testing.
3. Match roles and functions to staff skills and
   fill the gaps with training.
4. Conduct team meetings and communicate project
   outwards.

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• HOW DOES THIS GET ACTED UPON?

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Solutions Readiness Preparation

• Build practical understanding of
• Barriers risks
• Current state workflow
• Future state workflow that create improvements
• Gaps associated with the project.
• Determine financial capacity.
• Create ground rules for moving forward.
• Establish and prioritize needs.

There are no secrets to success. It is the result
of preparation, hard work, and learning from
failure. - Colin Powell
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Solutions - Planning

• Establish a team with goals.
• Set framework for measurable success.
• Provide vendor with clear objectives.
• Keeps the project focused and on track.
• Creates leadership and confidence.
• Outlook on go live reductions in productivity.

He who every morning plans the transaction of the
day and follows out that plan, carries a thread
that will guide him through the maze of the most
busy life. But where no plan is laidchaos will
soon reign. Victor Hugo
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Solutions - Implementation

• Phase I Incorporate basics workflow
• Registration scheduling (assuming integrated
  system)
• Patient eligibility and check-in process
• ePrescribing fundamentals
• Commence paper migration (scanning data entry)
• Phase II Building core functionality
• Nursing documentation
• Patient histories, vitals, chief complaints
• Lab orders (where applicable to staff)

Slide 1 of 2
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Solutions - Implementation

• Phase III Incorporate Physician
• Full exam recorded in EMR (voice / template
  driven)
• Charge coding
• Lab order and results
• Cross-staff tasking messaging
• Reporting
• Interoperability components (electronic
  referrals)
• Phase IV Other
• Integrate device interfaces
• Claim management within an integrated system

Slide 2 of 2
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Solutions - Implementation

• Training
• Entire staff needs to be trained EHR in changes
  how the practice does everything.
• During training, plan to minimize business
  interruption and monitor organizational progress.
• Hands-on EHR training may incorporate basic
  terminology, workflow, security, usability,
  communications, and interoperability.
• Paper Migration
• Avoid parallel paper and electronic data entry
• Enter information in advance OR as you go
• Scan key recent reports and transfer past
  information
• Maximize electronic data exchange
• Set up efficient data exchanges between systems
• Redesign work processes to eliminate paper-based
  clinical processes

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Success Principles

1. Build user based acceptance diffusion.
2. Balance goal setting across staff.
3. Identify high impact issues that can be solved
   relatively quickly and painlessly.
4. Keep it simple Initiatives must be in chewable
   pieces.
5. Wins create momentum.

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Legislative Landscape
Can the next 5 years get us beyond the tipping
point?

• Financial Assistance
• Loans
• Grants
• Incentives
• Technical Assistance
• Regional Resource Centers
• Workforce training
• Demonstration projects

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Keep The End In Mind

• Improvements in quality care.
• Increased decision support patient safety.
• Increased provider patient communication.
• Improved revenue management.
• Increased information access interoperability.
• Reductions in medical errors.
• Improved staff efficiency.

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Questions/Discussion
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Contact Information

• John Weir
• President
• Illumisys
• 1 Sansome Street
• San Francisco, CA 94104
• P 415-677-2083
• C 510-931-9389
• E jweir_at_illumisys.net
• W www.illumisys.net

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