Multnomah County Health Department EMR project

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Multnomah County Health Department EMR project

• Presentation for NAPHIT Webinars April 19th,
  2006
• by
• Pramod Jacob,
• Clinical Systems Project Manager,
• Multnomah County Health Department

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Multnomah County Health DepartmentEMR project

• Topics covered -
• Strategies for planning an EMR project
• Challenges and issues in implementation
• Integrating EMR with existing Reporting Systems
• - Improvements in outcomes in patient Flow,
  closure of encounters and encounter life cycle
  after EMR.

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Multnomah County Health DepartmentEMR project

• Multnomah County Health Department (MCHD) has
  provided a combination of population-based public
  health services and direct access to primary care
  services for underserved populations since 1860.

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Multnomah County Health DepartmentEMR project

• MCHD services support County citizens, as well as
  other FQHC and Safety Net providers in the
  community
• EMR to be rolled out in -
• 6 Primary care clinics
• 12 School based clinics
• Specialty clinics TB, HIV,STD
• Field Services like Early Childhood Services

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Multnomah County Health DepartmentEMR project

• Went live on the EMR with the first test pilot
  clinic on Oct 25 , 2006. The clinic was the North
  Portland clinic.
• Next clinic going live end of this month on April
  25th, 2006
• Will be followed by a clinic every two months or
  so.

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Multnomah County Health DepartmentEMR project

• How EMR implemented in MCHD
• OCHIN was the service provider who house the Epic
  applications and pipeline it out to MCHD
• Epic Practice Management has been rolled out for
  the last three years
• Now implementing the Epic EMR on top of the Epic
  Practice Management System.

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Multnomah County Health DepartmentEMR project

• Strategies for planning the implementation of the
  EMR
• Formed a Clinical Design Team who designed core
  EMR
• The core EMR was then localized and configured
  to fit the local clinics workflows
• Started implementation on the most vanilla
  clinic and then will progress to increasingly
  more complex clinics

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Multnomah County Health DepartmentEMR project

• Strategies for planning the implementation of the
  EMR
• Built a Clinical Systems Team for MCHD
• Laid out the project plan for the entire roll out
  across the clinic in MS Projects
• Then did the detailed project plan for the local
  clinic on MS Projects

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Multnomah County Health DepartmentEMR project

• Strategies for planning the implementation of the
  EMR
• - Held joint meetings with all the stake holders
  including facilities, hardware, networking etc
  and carried out walkthroughs of the clinic.
• Made the providers of the clinic give their input
  about placement of arms and exam room
  arrangements.

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Multnomah County Health DepartmentEMR project

• Strategies for planning the implementation of the
  EMR
• Took stakeholders input for tasks duration and
  dates and put it into the project plan.
  Stakeholders participated in building the project
  plan
• Kept a tight track of the EMR implementation
  progress using project tracking in MS Projects
• Proactively worked on issues before they could
  become critical or delay the project.

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Multnomah County Health DepartmentEMR project

• Challenges and Issues in Implementation
• 1. Inter-organizational
• 2. Intra-organizational
• 3. Intra departmental

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Multnomah County Health DepartmentEMR project

• Inter-organizational challenges and issues
• - The EMR was a joint effort between different
  organizations needing very close collaboration
  between the EMR vendor , OCHIN and MCHD.
• The different organizations may have different
  perceptions and agendas for the implementation.
• Need for close collaboration and work on
  people-people interaction besides the task driven
  project progress.

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Multnomah County Health DepartmentEMR project

• Intra-organizational challenges and issues
• - Within Multnomah county the Facilities dept
  separate from IT dept separate from Health dept.
• - IT dept has various wings- desktop separate
  from network separate from LAN etc
• Getting a task done like putting terminals on
  arms needed a lot of herding of cats
• Facilities puts up arms then Desktop put up the
  terminals on the arms and then LAN connects the
  terminals
• Reality of working in a county public health
  department

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Multnomah County Health DepartmentEMR project

• Intra-departmental challenges and issues
• Being a public health department, decision making
  is a democratic inclusive process
• Need to get policies and procedures in place and
  well documented
• Getting the providers and clinic support staff
  buy in is crucial. Got to do hand holding for the
  technologically challenged.
• Connecting up with State and Federal Health
  systems

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Multnomah County Health DepartmentEMR project

• Integration of Existing Reporting Systems-
• DEMS and Depression Registry will be phased out
  and EMR will take over these functionalities.
  Difficulty in importing over past labs,
  medications and problem list
• Working on interfacing with State and Federal
  health systems like IRIS
• Integration into existing reporting systems is a
  challenge and being taken up at the level of the
  state health dept, Ahlers etc

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Multnomah County Health DepartmentEMR project

• Outcome improvements after EMR
• There is a trend of significant improvement in
  outcomes like-
• - Cycle time time for a patient to go through
  a clinic visit
• Closure of encounters by providers
• Encounter life cycle time between the encounter
  and billing out a claim for the encounter

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Multnomah County Health DepartmentEMR project

• W.R. E.R. C.O. E to CO
  Tot AC
• Provider A
• Before EMR
• 03/05 22.1 113.5 136.9
• 09/05 30.8
  106.9 135.5
• After EMR
• 12/05 19.2 35.1
  21.5 55.6 77.6
  
• 02/06 28.9 34.7 24.3
  57.1 86.1

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Multnomah County Health DepartmentEMR project
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Multnomah County Health DepartmentEMR project

• W.R. E.R. C.O.
  E to CO Tot AC
• Provider B
• Before EMR
• 09/05 48.4
  93.1 135.8
• 10/05 34.8 149.7 166.4
• After EMR
• 12/05 26.9 24.2 12.4
  36.6 65.0
• 02/06 19.1 25.9 22.3
  47.9 67.9

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Multnomah County Health DepartmentEMR project
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Multnomah County Health DepartmentEMR project

• W.R. E.R. C.O. E to CO
  Tot AC
• Lab Tech
• Before EMR
• 03/05 58.7 108.7 111.3
• 09/05 83.2
  126.7 168.7
• After EMR
• 12/05 5.8
  46.0 57.6
  
• 02/06 19.4 38.2
  58.3

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Multnomah County Health DepartmentEMR project
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Multnomah County Health DepartmentEMR project
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Multnomah County Health DepartmentEMR project
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Multnomah County Health DepartmentEMR project

• In conclusion
• There are strong indicators and trends that show
  the EMR brings about positive changes. The EMR is
  well worth the expense and effort of
  implementation.

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Multnomah County Health DepartmentEMR project

• Contact-
• Pramod Jacob,
• Clinical Systems Project Manager,
• Multnomah County Health Department,
• Tel [phone] extn 24381
• Email pramod.d.jacob_at_co.multnomah.or.us