Electronic Health Records Readiness Assessment for Community Health Centers

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Electronic Health Records Readiness Assessment
for Community Health Centers

• Lori Hooks, MSHP
• Director of Training and Technology
• Texas Association of Community Health Centers

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Objectives

• Current state of IT and EHRs in CHCs
• Strategies for selection
• Strategies for implementation
• Tools and resources

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EMR Use at CHCs

• Approx 27 percent of physicians in TX use EMR
• Slightly lower percentage of CHCs
• Many times, centers will start with Practice
  Management and graduate to EHR systems

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• At least 6 different Vendors in use by CHCs in
  Texas
• Companion
• Med Mgr
• Sevocity by Conceptual Mindworks
• NextGen
• EPIC
• Centricity

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EMR vs EHR

• TMA
• An Electronic Medical Record (EMR), the
  electronic replacement of paper charts, is the
  record of patient health information generated by
  encounters at one particular provider.  This is
  the physicians own electronic record of their
  patients medical care.  When a physician
  purchases software he or she is purchasing an EMR
  system.
• An Electronic Health Record  (EHR) is a record of
  a patients long-term and aggregate health
  information generated by one or more encounters
  in any care delivery setting. Stemming from the
  interoperability of multiple providers, the EHR
  is distinct from the clinical systems that will
  directly support caregivers treating patients. 
  Rather, the EHR connects the various clinical
  systems and providers.  Included in this
  information are patient demographics, progress
  notes, problems, medications, past medical
  history, immunizations, laboratory data and
  radiology reports.   

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Why Use EHR?

• Information sharing for patient care/remote
  access
• Improve documentation/billing support
• Clinical data capture
• Reduce medical errors
• Facilitate clinical decision support
• Improve timeliness of services
• Eliminate chart pulls/lost charts

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• Finding information in the chart
• Drug recalls
• Grants and health initiatives
• Public Health
• Disaster recovery
• Document storage
• Improved security and documentation

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Current State of IT at CHCs

• Varies widely
• LAN
• WAN
• Internet connectivity (bandwidth)
• Texas CHCs received nearly 13 million dollars for
  infrastructure and technology implementation
  between 1998-2002.

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• Largely dependant on available funding and
  infrastructure
• Hardware
• Software
• Monthly line charges (point to point, virtual)
• Upgrades and depreciation
• Must evaluate YOUR network carefully

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Different PM/EHR Models

• Self contained network with single or multiple
  locations
• Retain access to your records
• Maintain control of your data (plus)
• Maintain control of your data (oops)
• Offsite backups?
• Offsite / dial in tech support

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• ASP (hosted) service
• Bandwidth issues
• Possible access issues
• Increased vendor control of data
• Increased security, disaster recovery, tech
  support, service
• Decreases initial cost?

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• Hybrid system
• Onsite server with realtime backup to remote
  location
• Best of both worlds, ease of access and control
  plus offsite benefits
• Bandwidth usage plus onsite hardware costs
• Higher cost?

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• Different platforms and software
• Windows, Citrix, Linux, Oracle
• Proprietary systems
• Open source/government funded
• Each system has its own set of hardware and
  software requirements be very careful!

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Data Sharing and Reports

• HIE
• RHIO ICC other partnered projects
• Federal guidelines
• ONCHIT
• Gulf Coast Initiative
• Texas Guidelines
• Governors Initiative - Texas Health Care System
  Integrity Authority, which is charged with
  developing a network for the secure electronic
  exchange of medical records. Serving on the
  Authority will be representatives of those who
  have a stake in the health care system
  consumers, employers, providers, payers and
  government agencies.
• Texas Roadmap for HIT and HIE (HITAC)

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Strategies for Selection

• Getting Started
• Look at your needs and capabilities
• Put together a committee
• Identify Decision makers
• Spend time thinking about clinic systems
• Have a plan for redesign
• How will you transition from paper?
• In house IT support capabilities
• Be honest!

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• Consider all technical factors listed above
• What is your infrastructure
• Hardware/software

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• Look at TOTAL cost of ownership
• Project yearly fees, licensing, infrastructure
  support, equipment replacement, recurring costs
• Dont forget what you will NOT be paying for
• Transcription, paper storage, MR staff, etc

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• Vendor selection
• What is the business model?
• Going public?
• NOTHING is free
• Ongoing costs
• Scope of use
• Locations remote login
• Per user/per seat
• Third party use

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• Acceptance criteria for customization and sign
  off
• Interoperability
• Scalability
• Warranty
• Installation and training
• Software updates and third party software

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Resources

• Do your research
• IOM
• California HealthCare Foundation
• NHLA
• HRSA/BPHC, DHHS/ONCHIT, AHRQ
• AAFP
• Use each other!

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• Identify your users (CHF)
• Viewers
• Dictate, hand write
• Basic users
• Viewing plus some data entry
• Strivers
• Substantial time investment, data entry and
  documentation, use of templates

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• Arrivers
• Engage in activities that complement EHR,
  reorganizing practice and workflow
• System changers
• Delegate, advocate for more extensive changes,
  focus on quality

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• Identify a champion
• Obtain provider commitment to use the system
• Maximize electronic data exchange
• Arrange comprehensive support
• Incentivize providers to use the system

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Words to the Wise

• Productivity WILL GO DOWN at first
• There may be staff (and provider) casualties
• This process TAKES TIME
• If at first you dont succeed (will you have the
  heart to do it all over?)