Treating EHR Pain: Time to Replace It?
Faculty
Professor: Nareesa A. Mohammed-Rajput, MD, MPH, FACP
Disclosure: Has no relationship with any proprietary entity producing health care goods or services consumed by or used on patients.
1.Focus on re-implementation, training, adding features, workflow changes, and changing EHRs. 2.Once you have determined EHR pain points, how do you re-implement an EHR you are already using? 3.How do you go about adding features to your EHR? Are there Meaningful Use implications to adding modules?
4.How do you go about fixing bad workflow?
5.What is involved with changing EHRs? Can it be done and not negatively impact Meaningful Use reporting?
Clinical questions to be addressed:
©2014 American College of Physicians. All rights reserved. Reproduction of Internal Medicine 2014 presentations, or print or electronic material
Treating EHR Pain: Time to
Replace It?
Nareesa Mohammed‐Rajput, MD, MPH, FACP Medical Director of Clinical Informatics Suburban Hospital 2Objectives
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Identifying problems with EMR
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Adding functionality to your current
EMR
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Optimizing your current EMR
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Changing to a new EMR
3Identify the problem
● Inadequate training ● Bad workflow ● Lack of optimization ● Lack of functionality ● Incompatible EHR 4Training issues
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Is each person appropriately trained for their role•
Do people have what they need to do their job?Fixing Bad Workflow
1. Decide what processes to examine 2. Create a preliminary flowchart 3. Add detail to the flowchart 4. Determine who you need to observe and interview 5. Do the observations and interviews Source: http://www.integration.samhsa.gov/pbhci‐learning‐ community/HowDoIEvaluateWorkflow,_ppp,_pdf.pdfOptimizing current EHR
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Training is adequate•
Workflows are optimized•
Making current EHR work more efficiently7
How to get ideas on optimization
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Work with vendor or vendor specific consultant•
Go to vendor specific user group meeting•
Network with other users of the system 8Types of Optimization Requests
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Break‐fix•
Enhancement•
Vendor development 9Criteria to rank optimization requests
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Patient safety•
Physician productivity•
Revenue impact•
Compliance•
Organizational impact•
Work effort required to build/implement 10Adding new features to EMR
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Training is adequate•
Workflows are optimized•
current system is fully optimized•
what other functionality can the vendor offer?Before going live with new features
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BACK UP your current data•
Thoroughly test the upgrade prior to going live with it o how does it affect data collection? How does it affect current workflows?•
Resort back to your backed up data if EHR upgrade fails.Resources for help
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EHR vendor•
Consultants•
Regional Extension Center•
Clinical Informaticist13
Out with the old...
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Required functionality•
Purchasing Cost•
Ongoing maintenance cost•
Data conversion•
Hardware needs 14Selection process
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Find a specific problem to be addressed with implementation of the EMR•
Finding a new vendor•
Site visits to established practices•
Evaluation criteria o http://www.acpinternist.org/archives/2004/04/emr/ cklist.pdf•
Create standard demo scenarios 15Hosting
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External o data is hosted in the cloud o software is accessed via internet o can have a per month cost•
Internal o data is hosted on local servers o software is owned by practice o up front cost to purchase with ongoing maintenance fees 16Data ownership
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Practice owned data o if you change EMR vendors, you get the data to convert•
Vendor owned data o if you change EMR vendors, you do not get the data to convertBackup Strategy/Downtime Strategy
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Backup Strategy for data o Cloud‐based, is there redundancy? o Locally hosted, where is the backup?•
Downtime Strategy o Develop processes for what to do when the system goes down in both planned and unplanned situationsSupport Questions
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Help with break‐fix issues during Go Live•
Help with post go‐live optimization issues•
Help with training pre Go Live and ongoing training•
Help with hardware and devices•
Help with interfaces•
Help with data conversion19
