Rural Iowa Redesign of Care Delivery with EHR Functions Mercy Medical Center North Iowa Trinity Heal

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Rural Iowa Redesign of Care Delivery with EHR
FunctionsMercy Medical Center North
IowaTrinity Health- NoviThe University of
IowaMercy Medical Center ClintonAHRQ THQIT
Implementation 1 UC1HS015196-01

• Jane M. Brokel, PhD, RN - Co-Principal
  Investigator
• Donald Crandall, MD Principal Investigator
• Douglas Wakefield, PhD Investigator
• Marcia M. Ward, PhD - Investigator

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Case Presentation- Rural

• Build the electronic health record
• Monitor the use
• Sustain the use
• Buy-in at Clinician Level
• Issues with integration, interoperability and
  sharing of data in rural settings

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Clinical Practice Guidelines

• Built Form Screen Designs with Evidence-Based
  Content
• CDC criteria for Immunizations
• Scales
• Glasgow Coma, NIHSS (stroke)
• Braden Assessment (skin), Morse Risk (falls),
• Aldretti 1 2 (post anesthesia),
• Use of Display Screens pull the story
• Monitor - completion
• Issues

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Service Specific Order Sets

• Built Care Sets Executable Knowledge
• Zynx Health Authorspace
• References for Multi-disciplinary Evidence
• Monitor of use perceptions
• Sustain Use value for all venues
• Issues - Operational Definitions EHR
• Protocols
• Standing Orders
• Evidence-based Guideline
• Standard of Care/Practice

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Clinical Decision Support Rules

• Build Discern Expert Rules
• Evoke form a Clinical Event
• If-Then Conditional Logic Evidence
• Action Responses not just messages
• Monitor - Uniform Nomenclature Use, Outcome
• Sustain Use - Evidence-Based Practice
• Citations
• Issues controlled changes to the EHR

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Integrated Role-based Work Flow Charts

• Redesign processes - early
• Reduce variation among disciplines
• Increase understanding of redesigned care
  delivery
• Build in evidence-based practices in care
  delivery
• Monitor Pre and Post Activation
• Sustain Use - Life-cycle change/adaptation
• Issues integration of roles and HIT systems

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Implications

• Integrate processes for each role patient,
  nurses, physicians, clinical departments, health
  information record services, registration/admitti
  ng accounting departments
• Common terminology between and among disciplines
  and finance
• Orders catalog is a clinical language not a
  financial coded term
• Focus on patient care being transformed, the EHR
  and other HIT just helps us do it.

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Project

• Clinical Data Repository 3 years
• Easy Remote Access 2 years
• Clinic EHR 1 year
• Hospital EHR Activation - July 8th
• Clinic Activation November
• Clinic Activation - May