Implementing Electronic Medical RecordsAn Overview of Lessons Learned
2011 Rural Hospital ConferenceInn at Grand Glaze, Osage Beach
June 2, 2011
Presentation by;Jeff A. Tindle, MHA
Associate Administrator and CFOCarroll County Memorial Hospital
Who is CCMH?
25-Bed Critical Access Hospital in Carrollton, MO
6 Clinics, 5 Physicians, 1 P.A. and 2 N.P.
Current Services: Cardiac Rehab Emergency Room Standard Ancillary (Lab, Rad, Rx, PT, RT, Sleep, Nuc Med) Extensive OP Clinic (Cardiology, Ortho, GI, Surgery,
Podiatry, Urology, Pulmonology, etc.) Home Health
Planned Expansion/Renovation Summer 2011; adding new CT, MRI, complete renovation of
E.R., renovate and relocate Lab and relocate Medical Records
CCMH EMR Timeline
January 1, 2010 HIMSS ENRAM score of 1.7 Running on HMS, purchased in early 1990s
Original Pat. Acct. software, no department integration No CPOE
Added Omnicell Med Dispensing in mid-2009
EMR RFP’s out in January 2010 Site visits in late January, early February Presentation to Board in late February Cerner selected
Implementation Begins March 2010Go Live September 1, 2010HIMSS Stage 6 Designation, February 2011Certification of Meaningful Use Started February 2011
Records
Our Decision-Making Process
Why Purchase a new EMR? Completion of gaps in current system Take advantage of stimulus incentives Improve patient care, quality and workforce efficiency Desire to be an “early adaptor”
Why Cerner? Compliments our mission statement and strategic goals Software as a Service (SaaS) model (Remote Hosted) Implementation approach Trusted they would be certified for Meaningful Use,
confidence in their ability to keep up with changing criteria Good partner
Cerner Partnership
Partnered with Cerner in March 2010Cerner Solutions: Registration/Scheduling CPOE/ePrescribing Nursing and Physician Documentation Inpatient Pharmacy General Laboratory Device Connectivity Ambulatory EMR and Practice Management eMAR with Medication Bar-coding Emergency Department Radiology Patient Accounting EDI Transaction Services Oracle EBS – General Financials
Benefits of the Cerner Model
Years of Experience Project planning and implementation Always on latest code and content releases Cerner handled a large portion of implementation and
training, freeing up our staff to focus on patient care and operations
SaaS Reduces our Dependency on In-House IT We contract out IT – network, PC’s, etc Cerner handles hosting of Cerner Millennium and Oracle
Financials SLA for performance standards Predictable TCO
Upgrades are included Hardware costs are included Application management and help desk support is included
Our Implementation Process
Select internal implementation teamPrepare for Kick-OffAgree to communication planTake pulse of organization Culture Assess comfort of staff with technology
Decide what is negotiableFind your “cheerleaders”Essentially build your StrategyHowever, “Culture Eats Strategy for Lunch Every Day”
Key Lessons Learned
Communication is Key Communicate plans with staff
upfront Executive sponsorship Training Set staff expectations
Doing your Homework Master File clean-up (charge master, formulary, etc) Examine current practices and policies Departmental data collection Identify Subject Matter Experts and Super Users Validate build models against workflow requirements Test, test, test
Key Lessons Learned (cont)
More upfront work = better outcomes Accurate and thorough data collection leads to a build that
imitates your actual workflow, process, and expectations Verify all build and then conduct end user training
Know your staff Culture It’s not personal, it’s business Be prepared for a wide range of comfort levels with
technologyBe prepared for… Appointing a project manager
Do it yourself or appoint someone else
Entering a continuing partnership with your vendor (Cerner)
Additional staffing - mainly nursing during go live Added challenges in maintaining files/accounts for short
period of time Learning more about your organization along the way
Key Benefits
Imperative: Improved Quality of Care Increased Documentation of Pain Assessment Increased % of Allergies Documented On-line Reduction in Medication Variances (Adverse Drug Events & Adverse Drug
Reaction) Increased % of Orders Placed Online by Providers Decreased Incidence of Falls Increased Medication Reconciliation at Each Change of Level of Care Decrease Time to Access Patient Chart Reduce the Number of Missed Doses of Medication Increased Accuracy and Speed in Obtaining Medication History
Imperative: Operational Efficiency Increased Coding Efficiencies Reduced Printing Costs Decrease Time to Access Patient Results (EMR) Reduction in Paper and Form Expenses Reduced Time Spent Managing Prescription Renewal Requests
Meaningful Use – 2011 Planned Attestation
Partnering with Cerner’s Regulatory Compliance team Focused effort and drive to help with attainment of Meaningful UseExposure to what is occurring in the various policy and standards committee and workgroup meetingsReporting and Monitoring of key objectives
Summary Observations
Limit your Vendor analysis to 3-4Remember you are choosing a Partner for the next 5+ yearsSoftware is software, make sure your Vendor can make it work in your Hospital and with your unique Interface needsStrongly consider the pro/con of using a single solution for both the Hospital and ClinicsYour Organization can handle more than you thinkReasonable Implementation time frame is 9-12 monthsCommunicate, Communicate, CommunicateConsider a Vendor that has had success with HIMSS and Meaningful Use AttestationWe over-purchased our peripheral support equipment, COWS, Scanners, etc. Basic will do just fine.You must be Committed to the End Result. It will be Rough Ride
Questions