IHS EHRIndian Health Service Electronic Health Record

Michele MillerMichele Miller

Warm Springs Health & Wellness Warm Springs Health & Wellness CenterCenter

Preparation, Implementation Preparation, Implementation and Lessons Learnedand Lessons Learned

Preparing for InstallationPreparing for Installation Implementation TeamImplementation Team CACCAC OIT Requirements OIT Requirements

SetupSetup EHR CAC & Implementation Training (ABQ)EHR CAC & Implementation Training (ABQ) OIT On-site RPMS-EHR setupOIT On-site RPMS-EHR setup

Go LiveGo Live Looking AheadLooking Ahead

Where to Start?Where to Start?

Implementation TeamImplementation Team Clinical Application Coordinator (CAC)Clinical Application Coordinator (CAC) Medical Staff (Clinician)Medical Staff (Clinician) NursingNursing PharmacyPharmacy Lab and RadiologyLab and Radiology Medical RecordsMedical Records Billing/CodingBilling/Coding Information Technology staffInformation Technology staff *Administrator/Executive Leadership**Administrator/Executive Leadership*

Implementation Team RolesImplementation Team Roles

Monitor and Execute Implementation PlanMonitor and Execute Implementation Plan Identify and define Policies and Identify and define Policies and

Procedures Procedures Address staffing and scheduling during Address staffing and scheduling during

transitiontransition Peer Training & MarketingPeer Training & Marketing Design and Approve EHR Menus, Design and Approve EHR Menus,

templates,etctemplates,etc

What’s Next?What’s Next?

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 workstationsErgonomic workstations Backup ServerBackup Server Backup GeneratorBackup Generator Clinical Applications Coordinator GS 12Clinical Applications Coordinator GS 12 Training / Travel CostsTraining / Travel Costs Software-$0.00Software-$0.00

OIT RequirementsOIT Requirements

http://www.ihs.gov/CIO/EHR/index.cfm

Step 1-Site Survey

http://www.ihs.gov/CIO/EHR/index.cfm

Step 2: EHR Site TrackingStep 2: EHR Site Tracking

http://www.ihs.gov/CIO/EHR/index.cfm

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

66 Months of Months of Setup?Setup?

After Pharmacy 5/7 installationAfter Pharmacy 5/7 installation

National EHR Training and National EHR Training and Deployment Program Deployment Program

recommends at least 6months recommends at least 6months

Three months of Pharmacy 7.0 utilization Three months of Pharmacy 7.0 utilization before "Paperless Refill" before "Paperless Refill"

Three months of "Paperless Refill" and Three months of "Paperless Refill" and "Coding Queue" before beginning Provider "Coding Queue" before beginning Provider Order Entry (POE) with EHR. Order Entry (POE) with EHR.

Medical Clinic PreparationsMedical Clinic Preparations

Formed TeamsFormed Teams

Practiced EHR Walk-Through(on paper)Practiced EHR Walk-Through(on paper)

Defined RolesDefined Roles

Computers everywhereComputers everywhere

LabLabAll 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

Change from Esig to EHR after Go-LiveChange from Esig to EHR after Go-Live

EHR SetupEHR Setup

OIT Help / TrainingOIT Help / Training

EHR CAC & Implementation Team (Set Up) EHR CAC & Implementation Team (Set Up) Training in ABQTraining in ABQ

EHR Onsite Set-Up TeamEHR Onsite Set-Up Team

Onsite Go Live TeamOnsite Go Live Team

EHR for Techies, EHR for Inpatient, EHR for EHR for Techies, EHR for Inpatient, EHR for HIM and Business OfficeHIM and Business Office

Customize order menusCustomize order menus Lab, Pharmacy, RadiologyLab, Pharmacy, Radiology

Setup Referrals/ConsultsSetup Referrals/Consults Progress Note TemplatesProgress Note Templates

Design your ownDesign your own Share with other sitesShare with other sites

User SetupUser Setup ICD/ CPT Pick ListsICD/ CPT Pick Lists

Setup by CACSetup by CAC

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 Modules VA Training Modules

ftp://intranetftp.ihs.gov/pub/EHR/ftp://intranetftp.ihs.gov/pub/EHR/ PharmacyPharmacy CPRSCPRS

WebEx DemosWebEx Demos Show and TellShow and Tell

NewslettersNewsletters Web UpdatesWeb Updates Meeting UpdatesMeeting Updates Email QuizzesEmail Quizzes

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

Going LiveGoing Live

Go Live WeekGo Live Week 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

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

Excited

Change is Change is GoodGood

Medical RecordsMedical Records

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? When to stop pulling the chart When to stop pulling the chart

Medical Records SupervisoryMedical Records Supervisory

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

Business OfficeBusiness Office

No Hard Copy to Wait forNo Hard Copy to Wait for No more missing E&M CodesNo more missing E&M Codes EHR Notes Are LegibleEHR Notes Are Legible Great Opportunity For Improved Great Opportunity For Improved

Provider Documentation & Increase Provider Documentation & Increase Billing/CollectionsBilling/Collections

Medical ClinicMedical Clinic

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 RemindersReminders Voice RecognitionVoice Recognition

Dragon NaturallySpeakingDragon NaturallySpeaking

Vista ImagingVista Imaging

Staff Changes at Warm SpringsStaff Changes at Warm Springs

More Nurse Aids after EHRMore Nurse Aids after EHR From 2 to 7From 2 to 7

Medical Records Staff Medical Records Staff PCC Data Entry PCC Data Entry (temporarily reassigned)(temporarily reassigned)

Benefits Coordinator Benefits Coordinator (temporarily reassigned)(temporarily reassigned)

Medical Department Medical Department (temporarily reassigned)(temporarily reassigned)

• Nurse aidsNurse aids• Medical ReceptionistMedical Receptionist

Shifted to scanning documents into VistA ImagingShifted to scanning documents into VistA Imaging

Next StepsNext Steps

EHR v1.1EHR v1.1 CPHAD (Public Health Activity Reporting CPHAD (Public Health Activity Reporting

System)System) Electronic Dental Record (EDR)Electronic Dental Record (EDR) Visual PHN System (VPS)Visual PHN System (VPS) VistARADVistARAD

Questions?Questions?

Clinical Applications Clinical Applications Coordinator (CAC)Coordinator (CAC)

Coordinates EHR ImplementationCoordinates EHR Implementation New Position / RoleNew Position / Role Works cooperatively with Site Manager and Works cooperatively with Site Manager and

Medical RecordsMedical Records EHR User SupportEHR User Support TrainingTraining Customizes EHRCustomizes EHR WorkflowWorkflow

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