How to Transition from Paper to EMR: Optimizing Performance

Room Winsor AJune 22,20123:00-4:15 pm

J.H. Maxwell M.D.Medical Director

Stedman-Wade Health Services, INC.

You have to start sometime…Why not now?

In the Morning!

The Summary of this talk

• Our Story- A historical summary of trial and errors of our medical errors at Stedman-Wade Family Medical Centers, INC.

• But that was 12 years ago!– A lot of things have changed

Summary of what EMR conversion what look like in 2012

• Keep the Money Flowing – How can CHC’s make this transition without losing there shirt

REPORT TO CEO ON

CLINIFLOW ELECTRONIC

1. Reasons to move to the electronic record

• to handle the vast amount of data that we are going to have to accumulate to obtain and maintain funding and accreditation.

• to reduce the cost of manpower: data entry and re-entry, transcription costs, billing costs, mailing costs, faxing costs, insurance company communications, lab and diagnostic facility communications.

• risk management issues: immediate access to the record for providers and patients, automatic updating of problem lists, drug lists, allergy lists and identification of drug interactions, and accurate medical and billing records.

(Continuation)

• improvement in reimbursement rates

• proper coding to eliminate insurance and Medicare/Medicaid fraud risk

• ease of compliance with the new HIPPA regulation

• easier record storage of records

• theoretically more secure storage of records

• decrease the liability of compensable injuries from carrying of heavy piles of documents

• recruitment and retention issues

• decrease the cost of filling prescriptions and refills

• decrease the liability associated with medication errors

• improve patient call-backs

• improve patient satisfaction

• improve patient education

• improve patient communication

2. Why this one?

• interfaces with Health Pro• interfaces with Lab Corp• can interface with other

diagnostic facilities• on site training and

continued support• other CPH members are

likely to go to this one• other CHC’s have already

used this program• it seems to have all

features we need now and are likely to need in the future

• very user friendly• the only one I’ve seen that

integrates medication lists and problem lists

• the only one I’ve seen that can easily report data on precise groups such as disease states, medications, demographics.

• Tremendously versatile functionality that can be designed with very specific characteristics of the Wade FMC style of practice and prevention services

3. Why not this one?

• Cost – may need to get some innovative ideas about how to get some grant money

( talk to Doug Smith )

• I think that even the inferior products like Logician at Tri County cost more than this one

4. Why now?

• movement to EMR (electronic medical record ) at this time would only be appropriate as part of a CPH initiative. The value of the information alone would be worth it for the sponsor of the grant (i.e. CDC)

• our records are in considerable disrepair right now and we stand to incur significant losses due to replacement costs. These costs and the savings listed above could figure quite favorably into a win-win for us.

5. Why not now?

• JCAHO is a major thrust right now and we don’t need distraction

• Cost• Like all technology stuff, if you wait

the price will decrease and the quality will improve ( however you don’t want to miss the boat)

 

Work closely with the CPH partners on this and move when the consensus says go. I believe that the power of the potential data retrieval from our 60,000 combined patients will be very attractive to the people who want to see quick results from their grant dollars. For example, this system would allow us as a network to come up with clinical data instantly that is practically unheard of in the whole country. I think moving toward an EMR in the near future will be essential anyway. ( the AAFP has set a goal of 2005 for it to be the standard of practice) So if we do it as a network we can really put Stedman Wade on the map and ensure our financial future.

My Recommendation

What things are irrelevant still today?

Identify a Need

•Data Rules•Need to control costs•Need to control risks•Need to improve reimbursement•HIPPA compliance•Need to insure proper coding•Easier record storage•Decrease the cost of filling prescriptions•Need for improved recruitment and retention•Need to improve patient satisfaction•Need to improve patient education•Need to improve patient communication

Where there is a Will There is a Way

• Convince CEO and Board

• Convince Clinical Staff

• Convince Provider Staff

• Convince Front Desk Staff

• Convince Billing Staff

Where’s the Will?• EMR issues is a heading at every meeting

– Management– Concerns and Suggestions– Performance Improvement– Health Disparities Collaborative

• EMR solutions for new problems: i.e. refills, patient communications, phone messages and patient flow.

• EMR solutions to each of the risk management problems

• Prime the pump, kids can’t wait until Christmas morning

Where’s the Way?

• Community Partners Health Net to the rescue, sharing resources is key.

Funding Constraints

• Integrated service delivery initiative

MIS funds

• State funds

• Operation’s money

Resource Deficiencies

• Computer literacy?

• Physical plant problems

• Hardware choices

• Budgeting for downturn in productivity

Clinical Staff Turnover

• Provider buy-in mandatory

• Nursing staff really here to support us

• Emphasize the good parts: i.e., a lot of people’s jobs are going to be easier

• Job creation, some jobs will go away but others will come on big time

Competing Priorities

• Encounters, encounters, encounters

• Something’s got to give – some programs will go but others will grow.

• Empower the entire staff to contribute to the prioritization process.

• Everybody gets to vote.

Technology Limitations

• User friendliness

• Provider style: i.e. Look the patient in the eye

• Speed doesn’t kill but helps the provider thrive

Technology Weaknesses

• Have a plan in place for everything

• People, people, people

• Keep the juice coming

Provider Adoption

• Do I get adopted after buy in or do I have to buy in to get adopted?

• Personalize goals

• Expectations

• Deadlines

• Rewards

• Timeline

Workflow Changes

• Better get up early to do your workout!• Face-to-Face• Procedural Remuneration• Referral tracking• Room flags• TV cameras• Advanced Access• Frequent Meetings• Tech support• Keep those templates updated!• The Cognos reports

Analyzingthe

Value of Proposition

• Cost : missed encounters = $lost staff = $ lost patients = $

Value Proposition • Benefit:

– practice guidelines implemented– higher and more accurate coding– decision support– templates

• Easy patient recall for prevention programs and Advanced Access

• Health Disparities Collaborative reports produced directly from Cognos Report Writer

• Providers can record on-call interactions with patients “real-time”!

• Fewer medication errors• Reduced risk of fraud• No lost charts• Fewer “on the job” injuries• Higher profile in the community• Better continuity of care• Better risk management

Summary

Cost is offset by the benefit!

Financial loses less than 10% in one year which included evacuation for renovation.

That was 12 years ago

Y2K

A lot of things have changed

Think!

Reporting

• Reporting USD

– See the attached hand out which is a copy of the slide presentation which is the new measures.

Table 6 BSection C

Childhood Immunization

– Need to be able to report Immunizations of 2 year olds

Section DPAP TEST

• Females between the ages of 24-64– Need to report not only the PAP test

they perform but also those that others have performed

– Need to subtract the hysterectomies. – V88.01

Section EWeight Assessment

& Counseling for Children

– Need to be able to pick up on the BMI– Calculating the percentile– Document the Counseling

Weight Screening Intervention

– Report on the BMI and Interventions

Section G 1Tobacco Assessment

• Table G 2– Tobacco Intervention

Section HAsthma with Controller Meds

– Need to be able to report

The new Table 6 Measures

– Need to report 50-75 who receive a colorectal screening

Coronary Artery Disease & Lipid Lowering Therapy

– NQF O74

Ischemic Vascular Disease & Aspirin or Antithrombotic Therapy

– NQF 0068

Colorectal Screening

– NQF 0034– Your EMR needs to be capable of counting the

colonoscopies and the Hemasure tests.

Reporter 2Health Care Plan

• Measures will be in line with Meaningful Useand the UDS.

– See the UDS training hand out.

Reporter 3Meaningful Use