WELCOME

•Attendees and telehealth participants to the National EHR Incentive Program Event

WELCOMERita Luongo, Marketing Director

•Attendees and telehealth participants to the National EHR Incentive Program Event

Thayer County Health Services Presentation for National EHR Incentive Program Registration EventThe Road to Successful EHR Implementation Joyce Beck, LPN, MHA January 13, 2011

Objective of Presentation

• Illustrate TCHS commitment to quality of care through the use of health information technology

•Support national efforts promote EHR adoption

•Outline step by step methods used for EHR implementation and obtaining meaningful use

Background of TCHS EHR implementation•As a result of CAH-HIT $1.5M grant TCHS

implemented EHR in 2008•Communication was established with long

term care, pharmacy, assisted living, EMT’s and tertiary hospital

•As a result, Southeast Nebraska Health Information Exchange was formed

•Nationwide interoperability obtained through NHIN

The Road to Successful EHR Implementation•Have a commitment to patient safety-you

have to want it•Examine culture and address issues•Determine the vision•Evaluation of financial options•Formation of EHR project team•Vendor selection process•Develop timeline with accountability for

deadlines

Commitment to Patient Safety•There has to be a driving force in the

facility to create a safe environment for the patient-you have to want it

•In everything you do patient safety has to come first

•What are your commitments to patient safety?

Commitment to Patient Safety Through Education

•Hardwiring Excellence•Practicing Excellence•The 7 Habits of Highly Effective People• If Disney Ran Your Hospital•How Full is Your Bucket•Customer Service in Health Care•Flight of the Buffalo

Commitment to Patient Safety Through Process Improvement Tools•TeamSTEPPS

•Lean

•Balanced Scorecard

Results of Patient Safety Commitment

Thayer County Health Services Medication Errors by Severity

from Q1 2004 to Q4 2008

0

10

20

30

40

50

60

70

80

90

Qtr 12004

Qtr 22004

Qtr 32004

Qtr 42004

Qtr 12005

Qtr 22005

Qtr 32005

Qtr 42005

Qtr 12006

Qtr 22006

Qtr 32006

Qtr 42006

Qtr 12007

Qtr 22007

Qtr 32007

Qtr 42007

Qtr 12008

Qtr 22008

Qtr 32008

Qtr 42008

Quarter

# of

Erro

rs

A B C D E Total Linear (Total)

Pyxis Implemented

Pyxis Cubies E-MARE-MAR

47% of Acute/skilled care personnel agree "Our proceudres and systems are good at preventing errors."

66% of Acute/skilled care personnel agree "Our proceudres and systems are good at preventing errors."

Hardw iring forExcellence

Hardw iring forExcellence

Leadership Leadershi

p CustomerServiceBalanced

ScorecardRoot CauseAnalysis

CPOETeamSTEPP S

Examine Culture and Address Issues•Culture must be a just culture:

1.Culture in facility must be open and fair

2.Culture must be one of learning

3.Culture must design safe systems

4.Culture must manage behavior choices

Behavior Standards

•Based off the book Hardwiring Excellence•Developed by employees•They are part of annual review and count

equally with job performance•Scores are calculated from peer review•A score of 80 or below requires employee

to be on probation • If, in 90 days a repeat peer review does not

score higher than 80 they are terminated

Culture is by far the most important aspect of

successful implementation of EHR

Determine the VisionUS EMR Adoption ModelSM

StageCumulative Capabilities

2010Q2

2010Q3

Stage 7

Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP

0.8% 1.0%

Stage 6Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS

2.6% 2.8%

Stage 5 Closed loop medication administration 3.2% 3.7%

Stage 4 CPOE, Clinical Decision Support (clinical protocols) 9.7% 10.3%

Stage 3

Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology

50.2% 49.7%

Stage 2CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable

15.5% 15.4%

Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 6.8% 6.7%

Stage 0 All Three Ancillaries Not Installed 11.2% 10.5%

Data from HIMSS AnalyticsTM Database © 2010 N = 5,217 N = 5,233

Once vision determined-next step•Perform a gap analysis1.What do you currently have in place and

is it working for you?2.What systems do we need to meet MU?3.What other systems do you want in place

for patient safety?4.What resources do you need to meet

goal?

Evaluation of Financial Options Michael Pracheil CFO•What capital is needed?

1.Considerations should include software, hardware, training, travel, data migration

2.Disaster recovery costs

3.Fire suppression and data protection

Financing

•Is there enough cash on hand for project?

•Lease options?

•Donations and grant available?

•What resources are available through Medicare and Medicaid?

Medicare Share

•“Reasonable cost” is based on cost incurred for purchase of certified EHR system during the cost reporting period and similarly incurred cost from previous cost reporting period

•Includes acquisition costs for the purchase of depreciated assets such as computers and hardware and software

Example

•CAH A incurred reasonable cost of $500,000 for purchase of certified EHR during previous cost reporting period. The CAH depreciates $100,000 in previous cost report leaving $400,000 of undepreciated costs

Calculation for Medicare Reimbursement

Formula for calculating Medicare Share:

__ #IP Part A Days + #IP Part C Days___ + 20%

Total IP Days x Total Charges - Charity Care Total Charges

CAH A Information

•CAH A had 300 Part A IP days and 400 Part C IP days, total inpatient days were 1,000, total charges excluding charity care were $2.0M, total charges were $2.2M

Results for CAH A

_____700_______ 1,000 x _$2.0 M__ +20%

$2.2 M

Equals 97% Preliminary Incentive Payment of $388,000

Incentive Payment

•The best advice concerning incentive payment is:

KEEP UP

Changes can occur all the time. What you learn

today may not apply tomorrow!

Formulation of EHR Implementation Team

•Team should have representation from all departments

•Open communication vital for success of team

•All members of the team do not need to agree•Set goals and meet those goals •Total team commitment to get project

completed•Regular meetings are important

Vendor selection process

Desired Service

Vendor 1 Vendor 2 Vendor 3

eRX yes yes yes

Robust CDSS no yes yes

Facility-wide integration

yes no yes

Ability to enter future orders

no yes yes

Hospital Templates

yes yes yes

Fax patients information

yes yes yes

cost $1.8M $1.011M $2.1M

Develop Timeline for Project

•Numerous methods available to use for timeline

• Identify tasks and mark the tasks that are mission critical

•Set start and stop dates•Identify people in charge of tasks•Hold people accountable for tasks and

deadlines

Timeline example

Accountability for project

•Strong leadership must be in place to ensure timelines are met

•Accountability can be obtained through the use of just culture and behavior standards

Success of Project

•Success can be judged by employees and physicians who are satisfied with the system and patients see a positive outcome from implementation

An Interoperability OptionDan Engle CIO

Nationwide Health Information Exchange

The Nationwide Health Information Network (NHIN) is being developed to provide a secure, nationwide, interoperable health information infrastructure that

will connect providers, consumers, and others involved in supporting health and healthcare. This critical part of the national health IT agenda will

enable health information to follow the consumer, be available for clinical decision making, and support appropriate use of healthcare information beyond

direct patient care so as to improve health.

Challenges

•Few rural existing examples•Lack of information about options•Broadband cost and availabilities•Legal barriers

TCHS demonstration!

Thayer County Chose Mirth MUX option •MUX ( Meaningful Use eXchange )•National or Global vs. Statewide•Cost•Minimal bandwidth requirements•Non-EHR specific

CONNECT

•CONNECT gateway ( open source )•2 step request for information•Health Care facilities that have an

agreement•Patients data that is requested displays

• Information Technology said it would work•Test data had only been sent on the NHIN

between facilities•There were doubts from other HIE’s in

Nebraska about NHIN• If NHIN was to be endorsed I had to see it

myself• If our actions do not help a patient than all

is for nothing

Joyce Beck CEO

•Dr. Bryan Hubl ordered lab test in Hebron for wellness check

•Lab results obtained and placed in EHR in Hebron

•Lab results then made available to Redwood MedNet in California for actual wellness exam

•Information also available on USB to fulfill meaningful use

•Wellness exam completed by Dr. Jeff Meckler at Alliance Medical Center, Healdsburg, California

•Lab results from Thayer County retrieved by Redwood MedNet via CONNECT gateway

•Results of labs and x-ray of left hip taken in Healdsburg placed in Alliance Medical Center EHR

•Results could be placed on USB bracelet or card at patient request

•This product available through 911 Medical ID or Zaptag

•Returned to Thayer County Health Services to be seen by Dr. Hubl

•Wellness exam as well as results of lab work was available to Dr. Hubl via the NHIN therefore no duplication of testing necessary

•Dr. Hubl was able to recommend treatment based on information gathered in both Hebron, Nebraska and Healdsburg, California

Interoperability is a part of MU

•Ask questions•Talk to vendors•Don’t accept one solution options

Dan Engle CIO

“Don’t Worry about Interoperability,

Until you are Operable!”

References

•http://www.csm.gov/EHRIncentivePrograms

•Seim Johnson Accounting Firm

•CUSP Consultants

Questions?

Contact Information

•Joyce Beck, CEO ceo@tchsne.org•Rita Luongo, Marketing Director

rluongo@tchsne.org•Michael Pracheil, CFO cfo@tchsne.org•Daniel Engle, CIO cio@tchsne.org

www.thayercountyhealth.com