EHR Roll Out

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EHR Roll Out

• Learning from the MaineGeneral Experience

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• 14 years rural clinical family practice
• 4 years Faculty, Maine-Dartmouth Family
• Practice Residency
• Assistant Professor of Community and Family
• Medicine, Dartmouth Medical School
• 3 years as Assistant Medical Director of
  Residency Practice
• 2003 Graduate Dartmouths Center for
  Evaluative Clinical
• Sciences Master Program
• Healthcare Systems Engineer, MaineGeneral
  Medical Center
• MaineGeneral Medical Center Outpatient EMR
  Implementation
• leader

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Whadda We Gonna Do?

• Introduce Us
• Community
• Medical Community
• Project Vision
• Project History
• Rapid Rollout
• Previous Serial Implementation
• Parallel / Overlapping Implementation
• Performance Metrics
• Idealized Implementation

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In the Kennebec Region of Maine
A Health System Spanning 5 Rural Maine Counties
Serving 140,000 11 of Population of Maine
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About MGMC
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The Right Care at the Right Time toEvery Person
in the Kennebec Region

• EMR is Foundational
• (Necessary but Insufficient)
• For Balanced Improvement
• Cost
• Access
• Quality/Safety

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A Short History of a Long Project
Allscripts Touchworks
Implentation Jan/03
Evaluate Proposals
Chose 7 Pilot Sites
Analyze the Need
Vendor Demos
RFP
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Where does the grant come in?
End of Grant

• 3 Years to
• Prove the Business Case
• Prove the Quality Case
• Build an Implementation process/team that works

Start of Grant
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September 2004 We are Here
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To get to Here
We have to get here
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Barriers

• Competing Projects
• Implementation Team Fragmented
• Interfaces Missing/Incomplete
• Testing Resources Unavailable or Reassigned
• Lack of Informed User Input
• Serial Logic to Rollout

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Serial Roll Out Logic
Serial Roll Out Reality
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Enter!
The Rapid Roll Out
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Rapid Rollout

• 4 weeks
• for each practice
• In a rolling fashion
• From Current State
• To Full implementation

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Graphically
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Nothing motivates like a deadline

• Finishing / Testing Interfaces
• Work-arounds
• Agreements and Compromises
• Order and install exam room devices
• Assignation of resources

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Staffing is critical

• Hire and Train
• Contract help
• Hardware installation
• Training
• Go-live support

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All of the Ducks in a row

• Technical Survey
• Workflow Analysis
• Order Exam Room Devices
• Determining Implementation Order
• Training Schedule
• Set Expectations

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Schedule
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Setting e Expectations
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e s into the EMR

• e-visit
• e-note Templated
• e-encounter form
• e-orders

• Paper and EMR in Parallel
• Work out the bugs
• contribute to the template build
• test the system with
• e-orders
• e-encounter forms
• Minimum 2 e-visits per clinician per half day
• Write an e on the paper Enc Form

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High Level Workflow
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Click Level workflow
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Training Materials
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More Training Materials
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Challenges

• Implementation Staff-Time is Critical
• Collect and Respond to user input
• to reconfigure
• Build lessons learned into next training
• Each week brought higher support needs
• Practice Staffing is Critical
• For Months to come

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Daily Prescriptions
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New e-Charge Entries
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New Problem Entries
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New Orders
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Completed Tasks
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Transcription Volume
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MDFPR Transcription Volume
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Kennebec Pediatrics Transcription Volume
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Scheduled Patients
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What about next time

• Set Expectations
• Support
• Communication
• 1? Implementation
• Training and Go-live
• Exam Room Devices
• Dictation / Document
• Note / Blended Note
• Rooming Patients
• Messaging
• Prescribing
• Results Feed

• 2? Implementation
• Turn off Paper and Add
• Result Verify Report
• Order
• Charge
• Scan
• Templates and Forms
• 3? Implementation
• Continual Improvement
• Health Management
• Note Templates
• Decision Support

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Implementation Team Expectations

• On-Site support
• targeted times
• Present at the Teachable Moment
• On-Line Product Support
• Website
• Documentation
• FAQs
• Workflow Maps
• e-learning
• Remote Support
• IT Help Desk (Phone)
• emrhelp_at_mainegeneral.org

• Users Group
• Electronic
• Practice Meetings
• SuperUser Network
• Task Forces
• Clinical Documentation Committee
• Charge task force
• Order task force
• Medical Record Committee
• Privacy task force

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Practice Expectations

• Identify
• Clinician Champion
• Communication Leader
• Superusers
• Implementation Team

• Participate
• EMR Steering Committee
• Superuser Meetings/updates
• Medical Record Task Force
• Privacy Task Force
• Orders Task Force
• Charge Task Force
• Clinical Documentation Committee
• Health Management Task Force

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Questions