Post on 02-Jan-2016
transcript
IHS EHRIndian Health Service Electronic Health Record
Carolyn Johnson & Michele MillerCarolyn Johnson & Michele Miller
Warm Springs Health & Wellness Warm Springs Health & Wellness CenterCenter
Preparation & ImplementationPreparation & ImplementationToday’s PresentationToday’s Presentation
Medical RecordsMedical Records Medical ClinicMedical Clinic LabLab PHNPHN PCC & BillingPCC & Billing PHN/Community Health/ DiabetesPHN/Community Health/ Diabetes CAC/Computer SupportCAC/Computer Support
Medical Records ProcessMedical Records Process
When to stop pulling the chartWhen to stop pulling the chart Filing notes in chart during the transition?Filing notes in chart during the transition? Print And File Chart Copies? Batch Print?Print And File Chart Copies? Batch Print? Release Of Information?Release Of Information? Outside Consults? Scanning?Outside Consults? Scanning? TranscriptionTranscription
Medical Records Supervisory Medical Records Supervisory Process ChangesProcess Changes
Daily Report: Unsigned OrdersDaily Report: Unsigned Orders Daily Report: Unsigned NotesDaily Report: Unsigned Notes Retracting /Correcting Incorrect EntriesRetracting /Correcting Incorrect Entries Paper P&P changed to Electronic P&PPaper P&P changed to Electronic P&P Sensitive Pt TrackingSensitive Pt Tracking Medical Records Supervisor: Business Medical Records Supervisor: Business
rules/HIPAArules/HIPAA Who can view which parts of EHRWho can view which parts of EHR Works cooperatively with RPMS Site ManagerWorks cooperatively with RPMS Site Manager
Medical Records Staff Changes Medical Records Staff Changes at Warm Springsat Warm Springs
Staff shift from Medical Records to other Staff shift from Medical Records to other departments :departments : 2 Medical Records are in PCC part time2 Medical Records are in PCC part time 1 Med rec tech is a nurses aid1 Med rec tech is a nurses aid 1 Med rec tech is a Benefits Coordinator1 Med rec tech is a Benefits Coordinator More nurses aids after EHRMore nurses aids after EHR Staff will be utilized to scan documents once Staff will be utilized to scan documents once
VistA Imaging is implementedVistA Imaging is implemented
Medical Clinic PreparationsMedical Clinic Preparations
Formed TeamsFormed Teams Practiced EHR (on paper)Practiced EHR (on paper) Defined RolesDefined Roles Computers everywhereComputers everywhere
Medical Clinic ProcessMedical Clinic Process
Using templates/graphs instead of flow sheetsUsing templates/graphs instead of flow sheets Using the scheduling gui for visual routing of pt Using the scheduling gui for visual routing of pt
flowflow Selecting ICD/CPT codesSelecting ICD/CPT codes Using GUIs:Using GUIs:
Ward Order Lab EntryWard Order Lab Entry RCISRCIS Behavioral HealthBehavioral Health SchedulingScheduling
Lab PreparationsLab Preparations
All Labs need to be entered in RPMSAll Labs need to be entered in RPMS On-site LabsOn-site Labs Reference LabsReference Labs State LabsState Labs
Computer Access PointsComputer Access Points Changing from Esig to EHRChanging from Esig to EHR
IHS EHRIndian Health Service Electronic Health Record
PCC/CodingPCC/Coding
Krisanne BillyKrisanne Billy
Objectives for this SessionObjectives for this Session
Role ChangesRole Changes PCC Data Entry Coding ProcessPCC Data Entry Coding Process Error ReportError Report CommunicationCommunication New Coding QueueNew Coding Queue
Role ChangesRole Changes
Coding & Data Entry are a combined Coding & Data Entry are a combined position. position.
Instead of 2 data entry clerks, we have 70 Instead of 2 data entry clerks, we have 70 data entry providers who encode data.data entry providers who encode data.
AuditorAuditor EducatorEducator
PCC Coding ProcessPCC Coding Process
Coders are assigned days. Coders are assigned days. (ODD/EVEN)(ODD/EVEN)
Coding/Auditing from a coding queueCoding/Auditing from a coding queue We code from EHR/RPMS not the We code from EHR/RPMS not the
chartchart Corrections communicated to provider Corrections communicated to provider
via notification (demonstration)via notification (demonstration)
PCC Error ReportPCC Error Report
Daily Error Reports Daily Error Reports shouldshould be run be run Most Common Errors:Most Common Errors:
Missing POVMissing POV Missing E&M CodeMissing E&M Code .9999 - Uncoded diagnosis (Separate Report).9999 - Uncoded diagnosis (Separate Report) Duplicate VisitsDuplicate Visits
• 2 visits created on the same day – have to be 2 visits created on the same day – have to be mergedmerged
Coding QueueCoding Queue
Paperless list on RPMS that shows every visit Paperless list on RPMS that shows every visit for a specific date range, that have not been for a specific date range, that have not been audited by the coder.audited by the coder.
ProsPros• No more VGEN lists (only for research purposes)No more VGEN lists (only for research purposes)• Everything is there.Everything is there.• Flag errors & incomplete chart notes.Flag errors & incomplete chart notes.
PCC-Business Office PCC-Business Office CommunicationsCommunications
Bills are generated before PCC has Bills are generated before PCC has reviewed the visit. Communicate with reviewed the visit. Communicate with Business Office.Business Office.• What can they bill? What can they bill?
Questions?Questions?
Business Office ProcessBusiness Office Process
Services Pick List Development, Installation, Services Pick List Development, Installation, And TrainingAnd Training
No Hard Copy To Work WithNo Hard Copy To Work With No more missing E&M CodesNo more missing E&M Codes EHR Notes Are LegibleEHR Notes Are Legible Great Opportunity For Improved Provider Great Opportunity For Improved Provider
Documentation & Increase Billing/CollectionsDocumentation & Increase Billing/Collections
Preparation/ImplementationPreparation/ImplementationCACCAC
Elapsed time (in months)
Decisi
on to
imple
men
t EHR
Review
EHR W
ebsit
e
0
Comple
te E
HR Site
Sur
vey
Begin
EHR Site
Tra
cking
Rec
ord
Begin
hiri
ng pro
cess
for C
AC
Establi
sh E
HR Imple
men
tatio
n Tea
m
Attend L
esso
ns Lea
rned
cla
ss
RPMS c
urrent,
CACHE
Begin
phar
mac
y dru
g file
clea
nup
for P
harm
5/7* Beg
in pr
ocur
emen
t pro
cess
for h
ardw
are
Inst
all P
IMS
Optim
ize “P
oint-o
f-Ser
vice”
RPM
S Pac
kage
s
Optim
ize P
CC Erro
r Rep
orts
Inst
all/c
onfigure
Rad
iolo
gy 5.
0, L
ab 5
.2
Inst
all P
harm
acy
5/7
and E
HR GUI
Imple
men
t Pap
erle
ss R
efill
Attend C
AC trai
ning
On-site
Set
up with
Nat
’l EHR T
eam
EHR Super
Use
r tra
inin
g
EHR Go-L
ive
with N
at’l
EHR Tea
m
Full ro
llout
1 2 3 5 8 106 11 12 24
Please note that this is just a general timeline of how long it might take for your site to implement EHR. Every site will be different, and the amount of time it takes to implement EHR depends upon many factors, including size of the facility, services offered at the facility, current state of RPMS and packages installed and utilized.
EHR Planning & Implementation
* Most sites contract for external resources to complete pharmacy file preparation.
Imple
men
t Adv
erse
Rea
ction
Tra
cking
pac
kage
Step 1: Submit Site SurveyStep 1: Submit Site Survey
Step 1-Site Survey
Step 2: EHR Site TrackingStep 2: EHR Site Tracking
Implementation TeamImplementation Team
Administrator/Executive LeadershipAdministrator/Executive Leadership ClinicianClinician NurseNurse PharmacyPharmacy Medical RecordsMedical Records Billing/CodingBilling/Coding Information Technology staffInformation Technology staff Clinical Application CoordinatorClinical Application Coordinator
Implementation Team RolesImplementation Team Roles
Monitor and Execute Implementation PlanMonitor and Execute Implementation Plan Identify and define Policies and Procedures Identify and define Policies and Procedures Address staffing and scheduling during transitionAddress staffing and scheduling during transition Peer Training & MarketingPeer Training & Marketing Design and Approve EHR Menus, templates,etcDesign and Approve EHR Menus, templates,etc
Identify Clinical Applications Identify Clinical Applications Coordinator (CAC)Coordinator (CAC)
Works cooperatively with Site ManagerWorks cooperatively with Site Manager Coordinates ImplementationCoordinates Implementation EHR User SupportEHR User Support TrainingTraining Customize SoftwareCustomize Software WorkflowWorkflow Portland Area CAC: Bob Adams R.Ph.Portland Area CAC: Bob Adams R.Ph.
Help Desk Requests
Warm Springs Computer/Cac Department
Implementation StrategyImplementation Strategy
Implementation-Who and WhenImplementation-Who and When Everyone at onceEveryone at once Lab ordering , then radiology ordering, Lab ordering , then radiology ordering,
then pharmacy ordering, then notesthen pharmacy ordering, then notes Bring up one team/dept at a timeBring up one team/dept at a time
Implementation-Implementation-Hardware/Infrastructure Hardware/Infrastructure
upgradeupgrade RPMS server RPMS server Backup/Training serverBackup/Training server Thin Clients, laptops, pcs?Thin Clients, laptops, pcs? Network Network Lab Interface UpgradeLab Interface Upgrade Workstation Access-EverywhereWorkstation Access-Everywhere Backup PowerBackup Power
Costs Associated with EHRCosts Associated with EHR
WorkstationsWorkstations Laptops, tablets, pc, thin clientsLaptops, tablets, pc, thin clients
Ergonomic SupportErgonomic Support Backup ServerBackup Server Backup GeneratorBackup Generator Clinical Applications Coordinator GS 12Clinical Applications Coordinator GS 12 Training costsTraining costs Software-$0.00Software-$0.00
EHR CostsEHR Costs Staff coverageStaff coverage TravelTravel Computers:Computers:
1 per room1 per room 1 per provider1 per provider Extras in ward areaExtras in ward area
Ballpark TimelineBallpark Timeline Scheduling Software (PIMS)Scheduling Software (PIMS)
Scheduling application-improvedScheduling application-improved Has a Windows based component Has a Windows based component Sensitive Patient Tracking featureSensitive Patient Tracking feature
Radiology 5.0-after PIMSRadiology 5.0-after PIMS Pharmacy 5/7-needs to be scheduled with ITSCPharmacy 5/7-needs to be scheduled with ITSC
Allow several months for file preparationsAllow several months for file preparations• Adverse drug reactions :1 month (4 staff)Adverse drug reactions :1 month (4 staff)• RPMS/Scriptpro Format :1-2 days (2 Staff)RPMS/Scriptpro Format :1-2 days (2 Staff)• Dosages in Pharmacy 7: 1 week (2 Staff) Dosages in Pharmacy 7: 1 week (2 Staff) • Quick orders : 2 weeks (2 Staff)Quick orders : 2 weeks (2 Staff)
Installation of EHR client – after PharmacyInstallation of EHR client – after Pharmacy EHR Set-up; Site visits - after PharmacyEHR Set-up; Site visits - after Pharmacy Go-live – 3-6 months after PharmacyGo-live – 3-6 months after Pharmacy
EHR SetupEHR Setup
Customize order menusCustomize order menus Lab, Pharmacy, RadiologyLab, Pharmacy, Radiology
Setup Referrals/ConsultsSetup Referrals/Consults Progress Note TemplatesProgress Note Templates
Design our ownDesign our own Share with other sitesShare with other sites
User SetupUser Setup ICD/ CPT Pick ListsICD/ CPT Pick Lists
EHR beforeEHR before ConfigurationConfiguration
EHR after ConfigurationEHR after Configuration
Preparation-Customizing Preparation-Customizing OrdersOrders
Preparation-Customizing Preparation-Customizing TemplatesTemplates
•Templates can be shared with other IHS and VHA facilities
•More Complete Documentation
Training/MarketingTraining/Marketing
EHR Demo Movie EHR Demo Movie VA Training ModulesVA Training Modules
PharmacyPharmacy CPRSCPRS
ITSC Web-Ex Demo for our clinicITSC Web-Ex Demo for our clinic Show and TellShow and Tell
NewslettersNewsletters Web UpdatesWeb Updates Meeting UpdatesMeeting Updates Email QuizzesEmail Quizzes
EHR TrainingsEHR Trainings
EHR CAC & Implementation Team trainingEHR CAC & Implementation Team training Must have 5/7 installedMust have 5/7 installed Must have RPMS packages OptimizedMust have RPMS packages Optimized
EHR Setup (on site)EHR Setup (on site) Super end user training (on site)Super end user training (on site) Go Live (on site assistance from OIT)Go Live (on site assistance from OIT) EHR for Techies, EHR for Inpatient, EHR for EHR for Techies, EHR for Inpatient, EHR for
HIM and Business OfficeHIM and Business Office http://http://www.ihs.gov/CIO/EHR/index.cfm?modulewww.ihs.gov/CIO/EHR/index.cfm?module==
rpms_ehr_trainingrpms_ehr_training
Going Live WeekGoing Live Week
How the Week First GoesHow the Week First Goes
0
20
40
60
80
100
120
Mon
Tue
sW
ed
Thu
rs FriM
on
Tue
sW
ed
Thu
rs
Friday
S tress Level
Growling at CAC’s
Crying, gnashing of teeth
Excited
TGIF
Cat in the microwave
Excited
Going LiveGoing Live
Intense CAC and IT SupportIntense CAC and IT Support Make Appropriate Scheduling AdjustmentsMake Appropriate Scheduling Adjustments Daily Debriefings….Daily Debriefings….
Procedural QuestionsProcedural Questions Technical IssuesTechnical Issues How did it work before EHR?How did it work before EHR? More Training-Email trainingMore Training-Email training
Next StepsNext Steps
RemindersReminders VistA ImagingVistA Imaging Voice RecognitionVoice Recognition Electronic Dental RecordElectronic Dental Record
Questions?Questions?