Implementation is Not Enough: Keys to EHR Optimization

Implementation is Not Enough:

Keys to EHR Optimization

Supported via a National Cooperative Agreement with U.S. Department of Health and Human Services, Health Resources and Services

Administration, Bureau of Primary Health Care

Casey Alrich, MPH, CPHIMS

• Director of the Keys to Quality HCCN

Implementation is Not Enough:

Keys to EHR Optimization

Supported via a National Cooperative Agreement with U.S. Department of Health and Human Services, Health Resources and Services

Administration, Bureau of Primary Health Care

Quick Definitions

MU – Meaningful Use, the CMS EHR Incentive program

PCMH – Patient centered medical home (not particular to any accreditation body)

HIT – Health information technology EHR – Electronic health record

PM – Practice management

Goals and Objectives

1. Understand the importance and benefits of a comprehensive HIT needs assessment

2. Identify the necessary steps and team

members for an internal HIT assessment 3. Identify the primary components of a HIT

needs assessment

Drivers of Health Information

Technology

• Federal:

• CMS Meaningful Use Incentive program • Quality reporting requirements

• Medical home designation programs

• Local

• Pay for performance initiatives

Adoption of Health IT

Larger Health Community

Issues with Health IT

1.Usability

2.Interoperability

3.Costs

Issues with HIT - Usability

“Effectiveness, efficiency and satisfaction with which users can achieve a set of tasks in a particular environment.” – HIMSS

• Usable system is one that is intuitive, forgiving of mistakes, and supports through background operations

Issues with HIT – Usability

Issues with HIT - Interoperability

• KLAS report finds that less than half of EHRs work together

• 82% of providers report success creating their own interoperability work-arounds

• Levels of interoperability –

• Between provider entities

Issues with Health IT

1.Usability

2.Interoperability

3.Costs

4.Security and privacy

Internal Health IT Assessment

Benefits of an internal assessment:

• Useful to bring whole group together to discuss • Identifies needs and detrimental practices

• Identifies resources and facilitators to care

• Identify risks related to privacy and/or auditing • Quickly evaluate resource allocation

Health IT Assessment Team

Roles of an internal assessment:

• Executive leadership (CEO, CFO, CIO or COO) • Operations (clinical manager, practice

manager)

• Clinical (CMO, provider champion, RN supervisor)

• IS (application manager, data analyst)

Planning for an HIT Assessment

• Meeting space - enough to accommodate all involved, comfortable, projector

• Time - a full day if at all possible (not all

necessary all the time), feed people, frequency • Documents:

• MU reports

• PCMH reports

• CQM reporting

Components of an HIT Assessment

1. System Infrastructure

2. System Governance

3. Clinical Quality Management and

Reporting

Components of Each Section

• Importance of this section • Issues covered by section

Overview

• Collect staff opinions/exp.

• Connect to strategic priorities

Discussion

• Tie discussion to physical reality • Track progress/growth over time

Components of an HIT Assessment

1.

System Infrastructure

2. System Governance

3. Clinical Quality Management and

Reporting

System Infrastructure

• What are the major HIT systems

• How housed, connected, supported

Overview

• HIT systems by site; new initiatives; connectivity issues; helpdesk

support; training; vendor

Discussion

• Number of sites; products/versions; users; downtime reports; support FTEs; compliance reports

Examples of Infrastructure

System Issues

• NAP conundrum: New sites coming online that need to transfer over to the EHR

• System capacity: New population health management software

• Staff turnover: High clinical staff turnover requires new training program

Components of an HIT Assessment

1. System Infrastructure

2.

System Governance

3. Clinical Quality Management and

Reporting

System Governance

• How do you oversee HIT adoption/use • How to ensure privacy and security

Overview

• HIT governance structure; integrity of the EHR; safeguards for PHI; data security

Discussion

• Privacy and security audit findings; helpdesk reports; chart audits (tools and findings)

Examples of System

Governance Issues

• Minding the store: No one group critically assesses use/need related to health IT • Vulnerabilities: Privacy and security risks

may exist and health center could be open to fines or grant conditions

Components of an HIT Assessment

1. System Infrastructure

2. System Governance

3.

Clinical Quality Management and

Reporting

Clinical Quality Management

and Reporting

• How HIT captures and reports quality of care

• HIT as a barrier/facilitator for CQI

Overview

• What are the critical data/quality

reporting programs; how CQI reports shared with staff; reporting capacity

Discussion

• MU reports (EPs and more); PCMH scores; common reports and reporting schedule; UDS report

Examples of CQM and Reporting

Issues

• Meaningful Use: Training EPs on MU

objectives, changing tools and work flows • PCMH: Making the necessary changes

for PCMH recognition and maintenance • Ad-hoc CQM reporting: Funders and

emergencies determine CQM reporting • Shifting UDS: Planning for UDS changes

Components of an HIT Assessment

1. System Infrastructure

2. System Governance

3. Clinical Quality Management and

Reporting

Health IT Work Flows

• Does HIT enhance or hinder work flows

• Work flows to take advantage of HIT

Overview

• Front desk/intake; PCMH processes; use of care teams; panel management; orders reconciliation

Discussion

• PM reports (access, productivity); MU objectives; open charts; order sets

Examples of Health IT Work

Flow Issues

• Exploding schedule: Dozens of

appointment types, frequent missed appts • MU frustration: High number of clicks to

capture MU information, poor rates • Care coordination: Building effective

teams to manage population health • Referrals!: Managing and tracking

Health Information Management

Committee

• Poor governance/communication at the root of most health IT issues

• Governance breaks down silos

• Allows for targeted allocation of resources • Aligns health IT priorities with larger

strategic plan

Health Information Management

Committee (cont.)

Q: What does an HIMC have in common with horseshoes and hand grenades?

HIMC Membership

• Cross-section of health center staff:

• Operations, financial, IT/IS, clinical staff

• Important voices related to: clinical work flows, expenditures, system integration, HIT strategic priorities

• System must be in place to track:

HIMC Membership

HIMC Roles HIMC Roles

Chair – leadership, manage meetings

Secretary – take notes, email group

Operations – clinic ops and staffing

Provider – clinical perspective, user

Compliance – privacy and security IT – systems, networking

IS – helpdesk support, training App Manager – development, change management

Finance – coding, budgeting QI/QA – CQM reporting, initiatives

HIMC Charter

Maintains HIMC focus and sets expectations 1. Guiding Principle

Timelines and Project Planning

projects to support planning

• Project planning allows prioritization in a world of constrained resources

• Projects:

• Adoption

2015 August Sept. Oct. Nov. Dec. Jan.

May June July

7/11 Clinician Mtg.

MU Training

7/18 Allscripts

MU2 package live

End of July: Pt. Portal:operational planning Mid Sept. Pt. Portal go-live Review MU dashboards with clinical teams and evaluate workflows/op

erations Begin MU2 365 capture ICD-10 planning; MU stage 2 365; new call center tools 12/31 end of 2014 MU reporting period Oct. 1 deadline to begin 90 d. MU capture; Send out reminder eblast to providers 6/13 or 6/20 Allscripts v.13 upgrade 2014-15 IT Budget review: kiosk, printers

Early June: Pt. portal

demo for HIMC

Early- mid Aug.

4-6 week portal implementation (instillation) HIMC planning for HIT updates

Project Planning

• Adoption:

• Identify new products going live

• Financial, staffing, networking implications

• Maintenance:

• Post go-live: what needs to be done?

• Training, ongoing staffing, system testing, eval

• Optimization:

Maintain HIMC Progress

• Maintain regular, weekly items for discussion

• Ongoing maintenance, not just new projects • Larger projects should be broken out to

sub-committees

• Clearly identify actionable items in notes • Rotate membership when necessary

Where can I find HIT

Optimization Services?

Sustainability provides free technical assistance services to health centers, regardless of FQHC status

• Levels of support:

• Multi-day onsite HIT assessment

• Guided HIT assessment conference call • Tools and templates to support

self-assessment

HIT Optimization Resources

• ONC EHR Implementation Resources

•

http://www.healthit.gov/providers-professionals/implementation-resources

• Many useful templates and guides, not just for those implementing

• Safety Net Medical Home Initiative

• http://www.safetynetmedicalhome.org/

Q&A

For More Information

Casey Alrich, MPH, CPHIMS

Health IT and Quality Improvement

[email protected]

(215) 731-2440