MINISTRY OF HEALTH ELECTRONIC MEDICAL RECORDS

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(1)

MINISTRY OF HEALTH

ELECTRONIC MEDICAL RECORDS

MEXICO CITY

(2)

OVERVIEW

Why Electronic Medical Records (EMR)?

Planning, Implementation & Challenges

Observed Outcomes

(3)

EMR US ADOPTION RATES (Nov ’09)

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 90% of Hospitals have no functional comprehensive EMR  Mostly large hospitals and teaching hospitals do

 Top Barriers to EMR Adoption  inadequate capital (73%),

 maintenance costs (44%) and  physician resistance (36%)

(4)

US GOVERNMENT REQUIREMENTS

Regulatory Compliance

HR 3590 – Patient Protection and Affordable Care

Act passed March 21, 2010 requires EMR

implemented in hospitals by 2015

Required for Medicare reimbursement

Reimbursement for Quality (Core Measures &

(5)

WHY ELECTRONIC MEDICAL RECORD?

(EMR)

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Primary Goals of EMR

Improve Communication

Quality & Patient Safety

Operational Excellence & Efficiency

Analysis of Aggregate Data

(6)

QUALITY & PATIENT SAFETY

Communication between clinicians

Timely accurate information

Ability to create clinical decision alerts

Positive Patient Identification (PPID)

(7)

IMPACT OPPORTUNITY EXAMPLE

(8)

OPERATIONAL EFFICIENCY & EFFECTIVENESS

Allow greater information for Cost Accounting

Systems & Inventory Systems

Case Cost for Top 10 Clinical Diagnosis

Signing of Verbal Orders

Timely transfer of information from results

reporting and decrease in lost information and

duplication

(9)

ANALYSIS OF AGGREGATE DATA

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Clinical Trends

Population Characteristics

Research Opportunities

Data Extraction

(10)

PEOPLE, PROCESSES & TECHNOLOGY

• Installation

is

hard

, and mainly technical

• Implementation

is

really hard

, and mainly

organizational

• Transition

(lasting change) is

incredibly hard

and

purely human

• Transformation

is a state of profound new

personal and enterprise thought and behavior

which accompanies the strategic

acceptance

(11)

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PLANNING, IMPLEMENTATION &

CHALLENGES

(12)

GUIDING PRINCIPLES

PLANNING

 EMR is not a financial system

 EMR is not just an IT system

 EMR is an organization-wide CHANGE initiative to:

 Improve processes

 Put best practices and clinical guidelines into action

(13)

PROJECT KEYS TO SUCCESS

PLANNING

12 • Involved governance structure

• Demonstrate strong executive support • Educate clinicians about benefits

• Define and manage goals and expectations

LEADERSHIP

• Create cultural shift; quality trumps autonomy

• Train and support with cultural sensitivity • Manage resistance at every step

• Communicate frequently and often

CULTURE

COMMUNICATION COLLABORATION

• Focus on process solutions • Involve pertinent stakeholders • Indentify, evaluate all workflows • Standardized nomenclature

• No sacred cows…we ALL must comply

SAFE & OPTONAL DESIGN

(14)

STRATEGIC DECISION STEPS

PLANNING

Visioning Preparing Go-live Optimizing

• Identify the major quality & operational drivers for adoption • Position for Success • Identify if physician

usage % should be mandated by

physician leadership • Understand the work

required to be successful

• Physician

leadership approval • Identify executive

sponsor, steering committee and workgroup,

physician leadership model

• Complete process labs, order set assessments to prepare clinical operations

• Effective go live support from experts, resident coaches, IT and EMR teams • Monitor & report

compliance with usage of EMR • Regular

communication of benefits

• Confirm support model after go-live • Execs monitors

usage metrics with IT

Status reporting Process improving

• Ongoing training and education of updates

(15)

GOVERNANCE STRUCTURE

PLANNING

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Steering Committee

COO, CPCO, CMO, COO-CMMH, ICU-MD Staff: IT Dept

Team Lead Readiness Team Directors, Managers Team Lead Readiness Team Directors, Managers

Taskforces - PRN

Team Lead Readiness Team

Directors, Managers

OR ICU MD

Strategic, Resources, Scorecard

Operational, Bi-weekly, Decisions

Executive Committee

(16)

FINANCIAL COSTS

PLANNING

Software

Wireless

Computers On Wheels

Customized Software

Staff Training

(17)

REACHING THE GOAL

PLANNING 16 Results Database Lab, Pharmacy, Radiology 100% paper Basic Clinical Documentatio n 50% paper, 50% electronic Critical Care Tools, Clinical Alerts, Data Sharing

10% paper, 90% electronic Evidence-based, Bar Coding Meds with Patient POE 100% electronic

(18)

IMPLEMENTATION TIMELINE

Category 2001 - 2005 2006 - 2010 2010 - Future

Orders • All ancillary

orders

including Lab, Rad,

Pharmacy, Patient Care

• Order Sentences to support

Physician Order Entry

• Evidence-based order sets

• Electronic

• Electronic Ordering for the Enterprise

(19)

IMPLEMENTATION TIMELINE

18 Category 2001 - 2005 2006 - 2010 2010 - Future

Clinical Documen tation

• EMR

• Vital Signs & I&O • Pain Scores

• Clinical Nutrition • Respiratory

• Clinical Notes • Physician

Documentation • Results

Reporting

• Evidence Based Medicine Database • Clinical Decision

Support

• Care Planning Tools • Clinical Documentation • Interactive Flowsheet with ICU integration • Physician Documentation • Clinical Documentation • Procedural department documentation • Clinical Data

(20)

FACILITY COMMUNICATION PLAN

IMPLEMENTATION

Who What

Leadership Presentation

Physicians Presentation

Clinical Staff Presentation, Flyers,

Downtime Procedures

(21)

METHODS OF TRAINING

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 One-on-One training

 Classroom and group training  Web based training

 How-to flyers on key subjects and processes

 Videos available to walk users through functions  Future Web Based Training Course Development

 One course takes approximately 60 hrs to create from build

(22)

CHALLENGES & MANAGEMENT

Challenges

Management

Staff turnover increases Training, communication, leadership support

Physician adoption Training, communication, leadership support

Productivity decreases Workflow analysis, training

Poor implementation Governance, planning, support, scorecard

(23)

OBSERVED OUTCOMES

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Clinical Quality Value

Physician Benefits

(24)

CLINICAL QUALITY VALUE

Information from all sources is coordinated

and presented in a single clinical document

Computing ability of the system assists the

clinical staff with decision making and

minimizing errors

Documentation is immediately available to all

care providers

(25)

CLINICAL QUALITY VALUE

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Physician and Clinical Staff documentation

becomes specific to patient conditions

 Documentation template is generated for anticipated

level of care in conjunction with evidence based medicine

 Content is designed to enhance quality of care and

efficiency

(26)

PHYSICIAN BENEFITS

Physicians will be able to view and include the

patient specific data gathered by other care

providers

 Chief Complaint, Vital Signs, Allergy, Medication History,

Family History, Past Medical History, Lab results, etc.

Monitoring of the patient and documentation

can be completed episodically in real time or

remotely

(27)

BUSINESS VALUE

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 Documentation enabling semi-automated professional

coding

 Documentation utilizes structured clinical content and

feeds professional coding based on CMS guidelines

 Enhances coders ability to accurately and efficiently

code

 improve documentation and charge capture

 Creates a structured documentation system to teach

medical students, residents and new staff

(28)

VALUABLE LESSONS

Physicians on board

Focus on quality over finance

Role of leadership

Figure

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