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Using the EHR to Transform Healthcare

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40 counties (mostly poor, elderly, and underserved) 4 hospitals; 30,000 discharges ... exam, the lungs are clear to auscultation and percussion, the breasts are normal ... – PowerPoint PPT presentation

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Title: Using the EHR to Transform Healthcare


1
Using the EHR to Transform Healthcare
  • James M. Walker, MD
  • Chief Medical Information Officer

2
Geisinger Overview
  • 40 counties (mostly poor, elderly, and
    underserved)
  • 4 hospitals 30,000 discharges
  • 41 clinic sites
  • 650 physicians
  • 2.4 million patients in EHR
  • 200,000 patients in HMO

3
TYLER MEMORIAL HOSPITAL
MOSES TAYLOR HOSPTAIL
COMMUNITY MEDICAL CTR.
MERCY HOSPITAL SCRANTON
LOCK HAVEN HOSP.
CLEARFIELD HOSPITAL
BLOOMSBURG HOSP.
PHILLIPSBURG AREA HOSP.
SUNBURY COMM. HOSP.
CENTRE COMMUNITY HOSP.
POTTSVILLE HOSPITAL
SHAMOKIN AREA HOSP.
LEWISTOWN HOSP.
GOOD SAMARITAN HOSP.
4
Clinical Information Systems
  • Outpatient EHR 10 years, 99 use
  • Inpatient EHR 50 complete
  • Patient EHR 57,000 users
  • Outreach EHR 40,000 records shared
  • Digital, Remote Radiology
  • Regional Information Exchange (RHIO)

5
TYLER MEMORIAL HOSPITAL
MOSES TAYLOR HOSPTAIL
COMMUNITY MEDICAL CTR.
MERCY HOSPITAL SCRANTON
LOCK HAVEN HOSP.
CLEARFIELD HOSPITAL
BLOOMSBURG HOSP.
PHILLIPSBURG AREA HOSP.
SUNBURY COMM. HOSP.
CENTRE COMMUNITY HOSP.
POTTSVILLE HOSPITAL
SHAMOKIN AREA HOSP.
LEWISTOWN HOSP.
GOOD SAMARITAN HOSP.
Non-Geisinger Physicians with EHR access
6
(No Transcript)
7
Definitions
  • Better care higher quality, safer, more
    efficient care
  • Healthcare team Clinicians, the patient, family,
    managers, payers, regulators.
  • (Transformative) EHR

8
(Transformative) EHR
  • Evolving - The ways an organization uses IT to
    improve patient care.
  • A human creation.

9
A Human Creation
  • Isnt smart (not even as smart as the people who
    created it).
  • Requires continuous monitoring and repair (unlike
    humans, who are largely self-managing).
  • Isnt a manager. (See first bullet.)

10
Transformative EHR
  • Evolving
  • A human creation
  • Serves each member of the healthcare team.
  • Supports team work.
  • Provides succinct, valid, actionable information.

11
EHR Demands and Rewards
  • Passion for Transformation
  • Organizational Competencies
  • Attention to All Stakeholders
  • Attention to Process
  • Attention to Safety
  • New Teamwork
  • New Management Skills
  • Transformational Leaders
  • Coherent, Standardized Policies
  • Actionable Information
  • New Learning Style
  • New Forms of Compensation

12
Passion for Transformation
  • The organizations determination and ability to
    transform itself to provide better care is the
    single most critical EHR success factor.
  • The EHR is one of the organizations most
    important tools for transformation.

13
Passion for Transformation
  • The organizations determination and ability to
    transform itself to provide better care is the
    single most critical EHR success factor.
  • The EHR is one of the organizations most
    important tools for transformation.
  • Top leadership uses the EHR to transform
    healthcare.

14
EHR Demands and Rewards
  • Passion for Transformation
  • Organizational Competencies

15
Organizational Competencies
  • Organizational change
  • Continuous improvement

16
Change Episodic or Continuous?
  • EHR implementation is a project, an episodic
    change.
  • Done right, it prompts and supports continuous
    change.

17
Change Episodic or Continuous?
  • EHR implementation is a project, an episodic
    change.
  • Done right, it prompts and supports continuous
    change.
  • A successful EHR project will create more
    clinician demand for process improvement than
    your managers and IT teams can support.

18
Organizational Competencies
  • Organizational change
  • Continuous improvement
  • Adapting systems to users needs (HFE)
  • IT resources (trained, experienced people)

19
EHR Demands and Rewards
  • Passion for Transformation
  • Organizational Competencies
  • Attention to All Stakeholders

20
Attention to All Stakeholders
  • In disconnected systems it wasnt feasible.
  • Necessary for EHR implementation.
  • Cornerstone of reliable care.

21
Cornerstone of Reliable Care
  • Every phase of EHR implementation and
    optimization provides opportunities to improve
    every stakeholders
  • Knowledge and skills,
  • Work processes,
  • Performance, and
  • Satisfaction.

22
Cornerstone of Reliable Care
  • Every phase of EHR implementation and
    optimization provides opportunities to improve
    every patients
  • Knowledge and skills,
  • Self-care,
  • Wellbeing, and
  • Satisfaction.

23
EHR Demands and Rewards
  • Passion for Transformation
  • Organizational Competencies
  • Attention to All Stakeholders
  • Attention to Process

24
Attention to Process
  • What process to implement?

25
What Process to Implement?
  • Not current processes unchanged.
  • Not fully optimized processes.
  • Limits to readiness and ability to change.
  • EHR redefines an optimal process.
  • EHR will itself change.

26
What Process to Implement?
  • Not current processes unchanged.
  • Not fully optimized processes.
  • Limits to readiness and ability to change.
  • EHR redefines an optimal process.
  • EHR will itself change.
  • Iterative analysis and optimization.

27
Attention to Process
  • What process to implement?
  • Iterative analysis and optimization.
  • Process and outcome measurement

28
EHR Demands and Rewards
  • Passion for Transformation
  • Organizational Competencies
  • Attention to All Stakeholders
  • Attention to Process
  • Attention to Safety

29
Safety Demand
  • Highly coupled systems
  • Rapid propagation of error
  • Visible failure?
  • Graceful failure?
  • Repairable failure?

30
Safety Rewards
  • More reliable systems
  • Better situation awareness
  • Prevention of error (commission and omission)
  • Informative feedback

31
EHR Demands and Rewards
  • Passion for Transformation
  • Organizational Competencies
  • Attention to All Stakeholders (solidarity)
  • Attention to Process
  • Attention to Safety
  • New teamwork

32
New Teamwork
  • Changed stakeholder relationships
  • Higher visibility of processes and results
  • Changing value of skills
  • Reassignment of work and responsibility
  • Virtual teams
  • Less face-to-face
  • More interchangeable members
  • More transient members

33
Virtual Teams
  • Generalists and specialists
  • Proxy access to patient EHR
  • Remote pediatric echocardiography
  • e-Consults
  • Virtual group practices

34
EHR Demands and Rewards
  • Passion for Transformation
  • Organizational Competencies
  • Attention to All Stakeholders
  • Attention to Process
  • Attention to Safety
  • New Teamwork
  • New Management Skills

35
New Management Skills
  • Sophisticated information use
  • Process re-design
  • Needs assessment
  • Needs prioritization
  • Coherent policies
  • Understanding the limitations of coercion

36
The Limits of Coercion Hard Stops
  • Hard stops may not be safe.
  • Nor efficient.
  • Nor necessary.

37
The Limits of Coercion Hard Stops
  • Hard stops may not be safe.
  • Nor efficient.
  • Nor necessary.
  • Better care depends on motivated clinicians
    supported by reliable processes.
  • And informative feedback.

38
New Management Skills
  • Sophisticated information use
  • Process re-design
  • Needs assessment
  • Needs prioritization
  • Coherent policies
  • Understanding the limits of coercion
  • Project management support

39
EHR Demands and Rewards
  • Passion for Transformation
  • Organizational Competencies
  • Attention to All Stakeholders
  • Attention to Process
  • Attention to Safety
  • New Teamwork
  • New Management Skills
  • Transformational Leaders

40
Transformational Leaders
  • Required for a transformational EHR.
  • Attracted by the EHRs power as a
    transformational tool.
  • Physicians
  • Nurses
  • Managers
  • Researchers
  • Educators

41
EHR Demands and Rewards
  • Passion for Transformation
  • Organizational Competencies
  • Attention to All Stakeholders
  • Attention to Process
  • Attention to Safety
  • New Teamwork
  • New Management Skills
  • Transformational Leaders
  • Coherent, Standardized Policies

42
Standardization
  • EHRs dont do fuzzy logic.
  • Can enable the transition to standards.
  • Support more flexible standards than paper.
  • Let users justify variance in real time.

43
EHR Demands and Rewards
  • Passion for Transformation
  • Organizational Competencies
  • Attention to All Stakeholders
  • Attention to Process
  • Attention to Safety
  • New Teamwork
  • New Management Skills
  • New Leaders
  • Coherent, Standardized Policies
  • Actionable Information

44
Actionable Information
  • What do we record and report?
  • To ourselves
  • To patients, payers, and regulators
  • What do we ask patients?

45
LBP the Great American Novel
  • The patient notes new low-back pain.
  • There is no personal history of cancer, trauma,
    or long-term steroid use. The patient has noted
    no fever, unexplained weight loss, urinary
    retention, saddle anesthesia, fecal incontinence,
    sciatica, or bone pain.
  • On exam, the lungs are clear to auscultation and
    percussion, the breasts are normal LBP
    PROSTATE9363. There is no spinal tenderness to
    percussion. Both ipsilateral straight-leg raising
    and crossed straight-leg raising are negative.
    There is no ankle-dorsiflexion nor
    great-toe-extensor weakness. LBP REF9365

46
Actionable Information
  • What do we record?
  • What do we ask patients?
  • Display by variance
  • Benefits and risks

47
Benefits and Risks
48
EHR Demands and Rewards
  • Passion for Transformation
  • Organizational Competencies
  • Attention to All Stakeholders
  • Attention to Process
  • Attention to Safety
  • New Teamwork
  • New Management
  • New Leaders
  • Coherent, Standardized Policies
  • Actionable Information
  • New Learning Style

49
New Learning Style
  • Need-based
  • Just-in-time
  • Just-enough

50
New Learning Style
  • Need-based
  • Just-in-time
  • Just-enough
  • Clinicians dont need to learn genomics. They
    need actionable information.
  • Test the UGT1A128 allele before dosing
    irinotecan.

51
Decision Support as Education
  • Bochicchio (2006). J Am Coll Surg 202(3) 459-67.
  • Appropriateness of antibiotic use among ID
    fellows improved throughout a 6-month study.
  • Downs (2006). BMJ.332692-96.
  • Decision-support software and practice-based
    workshops both significantly improved rates of
    dementia diagnosis.

52
EHR Demands and Rewards
  • Passion for Transformation
  • Organizational Competencies
  • Attention to All Stakeholders
  • Attention to Process
  • Attention to Safety
  • New Teamwork
  • New Management Skills
  • New Leaders
  • Coherent, Standardized Policies
  • Actionable Information
  • New Learning Style
  • New Forms of Compensation

53
New Forms of Compensation
  • Required for widespread EHR adoption.
  • 97 of practices have electronic billing systems.
  • EHR makes new forms of compensation feasible.

54
Pay for Performance
  • Individualized population risk management
  • CMMS demonstration project
  • High-reliability procedures
  • Adverse event follow-up
  • 636 evidence-based care-quality measures

55
  • jmwalker_at_geisinger.edu
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