Attendees and telehealth participants to the National EHR Incentive Program Event

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WELCOME

• Attendees and telehealth participants to the
  National EHR Incentive Program Event

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WELCOMERita Luongo, Marketing
Director

• Attendees and telehealth participants to the
  National EHR Incentive Program Event

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Thayer County Health Services Presentation for
National EHR Incentive Program Registration Event

• The Road to Successful EHR Implementation
• Joyce Beck, LPN, MHA January 13, 2011

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Objective of Presentation

• Illustrate TCHS commitment to quality of care
  through the use of health information technology
• Support national efforts promote EHR adoption
• Outline step by step methods used for EHR
  implementation and obtaining meaningful use

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Background of TCHS EHR implementation

• As a result of CAH-HIT 1.5M grant TCHS
  implemented EHR in 2008
• Communication was established with long term
  care, pharmacy, assisted living, EMTs and
  tertiary hospital
• As a result, Southeast Nebraska Health
  Information Exchange was formed
• Nationwide interoperability obtained through NHIN

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The Road to Successful EHR Implementation

• Have a commitment to patient safety-you have to
  want it
• Examine culture and address issues
• Determine the vision
• Evaluation of financial options
• Formation of EHR project team
• Vendor selection process
• Develop timeline with accountability for
  deadlines

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Commitment to Patient Safety

• There has to be a driving force in the facility
  to create a safe environment for the patient-you
  have to want it
• In everything you do patient safety has to come
  first
• What are your commitments to patient safety?

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Commitment to Patient Safety Through Education

• Hardwiring Excellence
• Practicing Excellence
• The 7 Habits of Highly Effective People
• If Disney Ran Your Hospital
• How Full is Your Bucket
• Customer Service in Health Care
• Flight of the Buffalo

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Commitment to Patient Safety Through Process
Improvement Tools

• TeamSTEPPS
• Lean
• Balanced Scorecard

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Results of Patient Safety Commitment
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Examine Culture and Address Issues

• Culture must be a just culture
• Culture in facility must be open and fair
• Culture must be one of learning
• Culture must design safe systems
• Culture must manage behavior choices

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Behavior Standards

• Based off the book Hardwiring Excellence
• Developed by employees
• They are part of annual review and count equally
  with job performance
• Scores are calculated from peer review
• A score of 80 or below requires employee to be on
  probation
• If, in 90 days a repeat peer review does not
  score higher than 80 they are terminated

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Culture is by far the most important aspect of
successful implementation of EHR
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Determine the Vision
US EMR Adoption ModelSM US EMR Adoption ModelSM US EMR Adoption ModelSM US EMR Adoption ModelSM
Stage Cumulative Capabilities 2010Q2 2010Q3
Stage 7 Complete EMR CCD transactions to share data Data warehousing Data continuity with ED, ambulatory, OP 0.8 1.0
Stage 6 Physician documentation (structured templates), full CDSS (variance compliance), full R-PACS 2.6 2.8
Stage 5 Closed loop medication administration 3.2 3.7
Stage 4 CPOE, Clinical Decision Support (clinical protocols) 9.7 10.3
Stage 3 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 50.2 49.7
Stage 2 CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging HIE capable 15.5 15.4
Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 6.8 6.7
Stage 0 All Three Ancillaries Not Installed 11.2 10.5
Data from HIMSS AnalyticsTM Database 2010 Data from HIMSS AnalyticsTM Database 2010 N  5,217 N  5,233
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Once vision determined-next step

• Perform a gap analysis
• What do you currently have in place and is it
  working for you?
• What systems do we need to meet MU?
• What other systems do you want in place for
  patient safety?
• What resources do you need to meet goal?

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Evaluation of Financial Options Michael
Pracheil CFO

• What capital is needed?
• Considerations should include software, hardware,
  training, travel, data migration
• Disaster recovery costs
• Fire suppression and data protection

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Financing

• Is there enough cash on hand for project?
• Lease options?
• Donations and grant available?
• What resources are available through Medicare and
  Medicaid?

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Medicare Share

• Reasonable cost is based on cost incurred for
  purchase of certified EHR system during the cost
  reporting period and similarly incurred cost from
  previous cost reporting period
• Includes acquisition costs for the purchase of
  depreciated assets such as computers and hardware
  and software

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Example

• CAH A incurred reasonable cost of 500,000 for
  purchase of certified EHR during previous cost
  reporting period. The CAH depreciates 100,000
  in previous cost report leaving 400,000 of
  undepreciated costs

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Calculation for Medicare Reimbursement

• Formula for calculating Medicare Share
• __ IP Part A Days IP Part C Days___
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• Total IP Days x Total Charges - Charity Care
  
• 
  Total Charges

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CAH A Information

• CAH A had 300 Part A IP days and 400 Part C IP
  days, total inpatient days were 1,000, total
  charges excluding charity care were 2.0M, total
  charges were 2.2M

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Results for CAH A

• _____700_______
• 1,000 x _2.0 M__
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• 2.2 M Equals 97 Preliminary
  Incentive Payment of
  388,000

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Incentive Payment

• The best advice concerning incentive payment is
  KEEP UP
• Changes can occur all the time. What you learn
  
• today may not apply tomorrow!

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Formulation of EHR Implementation Team

• Team should have representation from all
  departments
• Open communication vital for success of team
• All members of the team do not need to agree
• Set goals and meet those goals
• Total team commitment to get project completed
• Regular meetings are important

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Vendor selection process
Desired Service Vendor 1 Vendor 2 Vendor 3
eRX yes yes yes
Robust CDSS no yes yes
Facility-wide integration yes no yes
Ability to enter future orders no yes yes
Hospital Templates yes yes yes
Fax patients information yes yes yes
cost 1.8M 1.011M 2.1M
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Develop Timeline for Project

• Numerous methods available to use for timeline
  
• Identify tasks and mark the tasks that are
  mission critical
• Set start and stop dates
• Identify people in charge of tasks
• Hold people accountable for tasks and deadlines

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Timeline example
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Accountability for project

• Strong leadership must be in place to ensure
  timelines are met
• Accountability can be obtained through the use of
  just culture and behavior standards

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Success of Project

• Success can be judged by employees and physicians
  who are satisfied with the system and patients
  see a positive outcome from implementation

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An Interoperability OptionDan Engle CIO
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Nationwide Health Information Exchange

• The Nationwide Health Information Network (NHIN)
  is being developed to provide a secure,
  nationwide, interoperable health information
  infrastructure that will connect providers,
  consumers, and others involved in supporting
  health and healthcare. This critical part of the
  national health IT agenda will enable health
  information to follow the consumer, be available
  for clinical decision making, and support
  appropriate use of healthcare information beyond
  direct patient care so as to improve health.

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Challenges

• Few rural existing examples
• Lack of information about options
• Broadband cost and availabilities
• Legal barriers

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TCHS demonstration!
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Thayer County Chose Mirth MUX option

• MUX ( Meaningful Use eXchange )
• National or Global vs. Statewide
• Cost
• Minimal bandwidth requirements
• Non-EHR specific

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CONNECT

• CONNECT gateway ( open source )
• 2 step request for information
• Health Care facilities that have an agreement
• Patients data that is requested displays

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Interoperability demonstration-Reason for
demonstration
Joyce Beck CEO

• Information Technology said it would work
• Test data had only been sent on the NHIN between
  facilities
• There were doubts from other HIEs in Nebraska
  about NHIN
• If NHIN was to be endorsed I had to see it myself
• If our actions do not help a patient than all is
  for nothing

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Wellness Check Began in TCHS in Hebron, Nebraska

• Dr. Bryan Hubl ordered lab test in Hebron for
  wellness check
• Lab results obtained and placed in EHR in Hebron
• Lab results then made available to Redwood MedNet
  in California for actual wellness exam
• Information also available on USB to fulfill
  meaningful use

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Second Step of Trip was Travel to Healdsburg,
California for Wellness and Radiology Exam

• Wellness exam completed by Dr. Jeff Meckler at
  Alliance Medical Center, Healdsburg, California
• Lab results from Thayer County retrieved by
  Redwood MedNet via CONNECT gateway

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Healdsburg, California

• Results of labs and x-ray of left hip taken in
  Healdsburg placed in Alliance Medical Center EHR
• Results could be placed on USB bracelet or card
  at patient request
• This product available through 911 Medical ID or
  Zaptag

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Final Step

• Returned to Thayer County Health Services to be
  seen by Dr. Hubl
• Wellness exam as well as results of lab work was
  available to Dr. Hubl via the NHIN therefore no
  duplication of testing necessary
• Dr. Hubl was able to recommend treatment based on
  information gathered in both Hebron, Nebraska and
  Healdsburg, California

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Interoperability is a part of MU
Dan Engle CIO

• Ask questions
• Talk to vendors
• Dont accept one solution options

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• Dont Worry about Interoperability,
• Until you are Operable!

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References

• http//www.csm.gov/EHRIncentivePrograms
• Seim Johnson Accounting Firm
• CUSP Consultants

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Questions?
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Contact Information

• Joyce Beck, CEO ceo_at_tchsne.org
• Rita Luongo, Marketing Director
  rluongo_at_tchsne.org
• Michael Pracheil, CFO cfo_at_tchsne.org
• Daniel Engle, CIO cio_at_tchsne.org
• www.thayercountyhealth.com