Implementing an Electronic Medical Record System at OK Care Hospital

Transcription

1 Implementing an Electronic Medical Record System at OK Care Hospital Medical Informatics 404-DL Fall 2009 Group 5 Tammy Gray, Beena Joy, Emad Osman, Joseph Ryan, Natalie Schwartz

2 PROJECT OVERVIEW To implement a fully integrated patient-centered EMR in a 250 bed medical surgical hospital Institutional Goals To improve the quality of patient care To improve patient outcomes To improve patient safety To improve organizational efficiency and productivity To effect cost reduction To improve service and satisfaction to our patients, providers, and staff

3 HOSPITAL SYSTEM OVERVIEW General Medical Floors 155 beds, 5 floors, 15 double and 1 single occupancy rooms/ floor General Surgical Floors 60 beds, 2 floors, 15 double occupancy rooms/ floor Medical ICU/ CCU 16 beds Medical Step-Down Unit 6 beds Surgical ICU 8 beds Surgical Step-Down Unit 5 beds Labor and Delivery Unit Operating Rooms and Delivery Suites Emergency Department 15 beds Pharmacy Department Laboratory Department Radiology Department Outpatient Clinic 300 staff physicians Voluntary & hospital-employed

4 STRATEGIC PLAN: CURRENT STATE CURRENT SOFTWARE ADT/ PATIENT REGISTRATION Siemens PACS GE Healthcare CURRENT HARDWARE Terminals in the Admitting Department, Patient Registration, Emergency Department, Billing Department, Pharmacy, Laboratory, Radiology, Outpatient Center Terminals at each central nursing station 2 terminals at each central nursing station (retrieval) 6 terminals in radiology dept. for retrieval and MD reading

5 STRATEGIC PLAN: FUTURE STATE ACTIVE, PATIENT-CENTERED EMR COMPONENTS AND FUNCTIONALITY: Health care information and data- anytime, anywhere access Full Integration of test results and management- laboratory, PACS CPOE and e-prescribing Barcode-enabled point of care- medication administration Decision-Support systems- evidence-based standards of care Electronic communication/ connectivity- , Intranet, Internet Clinical Reporting- Accrediting agencies, insurance, audits Clinical Research and Trials Chronic Disease Management (includes Case Mgt.) Data-Mining Fully integrated with ADT and Patient Registration Systems Other administrative processes- insurance verification, preauthorizations

6 STRATEGIC PLAN: FUTURE STATE ACTIVE, PATIENT-CENTERED EMR CPOE: Improved patient outcomes Reduction in medical errors Reduction in adverse drug events Improved adherence to clinical protocols Decision-support tools- alerts, reminders, call-backs Cost savings Reduction in medication errors and adverse events prevent unnecessary hospital days, reduced liability More cost-effective choice of medications Improved Revenue Improved accuracy and timely billing Increased transaction processing rates Reduced LOS Improved compliance with core measurements

7 NEEDS ASSESSMENT (1) Strong commitment from senior level healthcare administrators Physician Champion- passionate, respected, strong communication skills, strong leadership ties to medical community Provider buy-in and adequate representation in the design and implementation of the system Strong and committed leadership from major hospital departments Search for qualified vendors- vet organizational and financial stability, track record for service and response, pricing, upgrades, system expandability Formalize a contract with selected vendor(s) Develop a business plan- define capital and operating costs, costs of upgrades, organizational financing, government stimulus funding, ROI Identify the sources of data and systems that need to be integrated Identify storage space, electrical requirements (power, shielding, ventilation), physical space of clinical and IT activities, present and future capacity

8 NEEDS ASSESSMENT (2) Determine information system architecture- integrated platforms and IT infrastructure (servers, operating systems, networks) Develop solid and reliable administrative, physical, and technical safeguards for 24/7-365 days/year operability Solid disaster recovery plan Human resources analysis Create a strong and dedicated IT Team, including a CIO, CTO, CSO, CMIO, CNO, system analysts, programmers, database administrators, network administrator, telecommunications specialist, in-house IT staff to establish connections, load and test applications, troubleshoot, staff help desk, training, upgrades Workflow Analysis- determine # and location of workstations, space requirements, re-design of work areas Identify training staff and provide dedicated training time Develop a practical timeline for implementation across the hospital

9 CRITICAL NEED: IT ALIGNMENT AND STRATEGIC PLANNING Ensure a strong and clear alignment between IT decisions/ investments and the hospital s overall strategies, goals, and objectives Use IT to support the momentum of the hospital s vision, not to create the vision Strong senior leadership and understanding of the benefits and limitations of the IT initiatives to achieving organizational goals Strong IT governance

10 CRITICAL NEED: PHYSICIAN BUY-IN WE NEED TO MAKE THE PHYSICIANS PART OF THE SOLUTION, NOT PART OF THE PROBLEM!!!

11 Need to Convince Physicians of the Personal Value of a Hospital EMR Must align the value of a hospital EMR with the value to physician practices!!! Physician complaints: Need benefits to outweigh MD complaints: My handwriting is legible None of my patients have had medication errors Why do I need to change my practice to benefit the hospital? Remote access to hospitalized patient data Can track their patients across the hospital Time for classroom or one-on-one training not reimbursed Can use CPOE from any site- within the hospital/ office Learning curve (may be steep for older MD s) Cost of installing office technology for hospital linkage difficult in current economy and reimbursement environment Problems remembering multiple or single UserID s/ Passwords No more searching/ waiting for charts to enter notes (e.g. chart is being used for nursing rounds, by case manager, or another MD; taken off the floor for testing) Reduction in medication errors and physician liability Increased patient satisfaction with more integrated hospital services and efficiency Can sign discharge summaries and operative reports from their offices Improved patient billing services- fewer complaints

12 PROJECT STEERING COMMITTEE Project Sponsor: CIO Physician Champion: CMO Physician Advisory Subcommittee: Chairmen, Departments of Medicine, Surgery, Ob/Gyn, Laboratory, Radiology, Emergency Room Respected representatives of the full-time and voluntary medical staff must be involved from the ground up and at every key decision point! Director: Admitting Department Director: Risk Management Director: Medical Records Department Project Manager: Consultant/IT Liaison IT Advisory Subcommittee Nursing Champion: CNO Nursing Advisory Subcommittee: Nursing Supervisor, Nurse Manager (Medicine, Surgery, ER, L&D, OR) Director: Quality Improvement Director: Billing Department

13 PROJECT STEERING COMMITTEE Each department representative within the steering committee must: Perform a Stakeholder Analysis of their department Develop a list of CTQ s ( Critical to Quality ) Perform a Workflow Analysis of their development Become the project champion for that area

14 Stakeholder SWOT Analysis Short Term Long Term Threat Patient safety events Satisfaction of MDs, patients, and staff continued delayed treatment potential in LOS Loss of patients/business reputation and credibility Possible in liability, susceptibility to litigation Financial impact resulting in $$ Opportunity Meet strategic goals Meet/exceed customer expectations more often errors, delays in treatment and LOS bed availability Enhanced patient outcomes business community reputation

15 SOFTWARE SPECIFICATIONS RFI - VENDOR SELECTION CRITERIA

16 MEDICAL STAFF PERSPECTIVE: VENDOR SELECTION REQUIREMENTS CPOE capable Usability User-friendly GUI Order placing is intuitive (includes e-prescribing) Buttons, dials, links, etc., are logically placed Minimum number of mouse clicks per function Information display is useful and not confusing ( no wall of numbers ) Specialty modules in development Private practice connectivity Customizable order sets Voice recognition integration Decision support capable Alerts appear in summary to reduce fatigue Linkage to citations Value added Improves safety Enhances, not hinders, productivity and efficiency

17 VENDOR SELECTION REQUIREMENTS ADMINISTRATION AND NURSING ADMINISTRATION PERSPECTIVE: Willing to partner and grow with us- scalability Has an ongoing plan for moving us from A to B Accepts accountability for assisting the organization in the reengineering of all workflows Education plan includes ongoing support Demonstrated implementation satisfaction with other like organizations High level dashboard report capability for key indicators linked to strategic goals Evidence that vendor s EMR acquisition results in the improved patient outcomes and cost savings over time Reporting is turn-key and non-proprietary

18 NURSING STAFF PERSPECTIVE: VENDOR SELECTION REQUIREMENTS Workflow promotes optimal face time with patients and real time documentation GUI is intuitive and views customizable by user preference Terminology is dynamic Medication barcoding is integrated

19 VENDOR SELECTION REQUIREMENTS PHARMACY PERSPECTIVE: Medications and dosages are discreet fields Smooth transition of orders from ER to inpatient Alerts with decision support Requires justification Alert overrides Non-formulary meds Reporting is turn-key CPOE e-prescribing e-mar

20 VENDOR SELECTION REQUIREMENTS QUALITY PERSPECTIVE: Core Measures abstraction is automated Reporting is turn-key All data are reportable and easily accessed through ODBC connection Proprietary tools are not required Links with Laboratory, PACS, Pharmacy, both internal and external

21 VENDOR SELECTION INFORMATION TECHNOLOGY PERSPECTIVE: REQUIREMENTS Full integration with all other disparate clinical & non-clinical systems within the organization Scalable Roll-based access Audit trails

22 BUDGET RETURN ON INVESTMENT

23 Current Key Costs Medical Records Clinician Costs Other One Year Salary & Benefits for Medical Records $ 70, # of Medical Records Staff 30 Chart Creation Cost $ 2.00 # of Charts Created a Year 10% of Patients # of new patient a physician sees 220 Cost of Chart Storage $ 2,000, Rx Pads $ 77, # of Physicians 300 Transcription Costs $ 1,000, Coding Errors/Missing Charges $ 1,200, Billing Turn Around Time 4 weeks Misc Office Expenses 50,000 Cost Per Year $ 6,559,220.00

24 Return On Investment (ROI) Current Key Costs Medical Records One Year Percent Savings Current After Saving Salary & Benefits for Medical Records $ 70, % $ 2,100, $ 1,197, # of Medical Records Staff 30 Chart Creation Cost $ % $ 132, $ 13, # of Charts Created a Year 10% of Patients # of new patient a physician sees 220 Cost of Chart Storage $ 2,000, % $ 2,000, $ 500, Clinician Costs One Year Percent Savings Current After Saving Rx Pads $ 77, % $ 77, $ 7, # of Physicians 300 Transcription Costs $ 1,000, % $ 1,000, $ 100, Other One Year Percent Savings Current After Saving Coding Errors/Missing Charges $ 1,200, % $ 1,200, $ 600, Billing Turn Around Time 4 weeks 1 week Misc Office Expenses 50,000 50% 50,000 $ 25, Cost Per Year $ 6,559, $ 6,559, $ 2,442, Projected Savings $ 4,116,298.00

25 ROI 2 Day to Day Actions Current After Implementation Medication to Patients (Hours) Order Entry of Radiology to Completion of Procedure (Hours) 7:37 4:21 Length of Stay Lab (from Order to Completion) Chemistry Tests Urinalysis Microbiology Serious Medication Errors Preventable Medication Errors (PME) 30.4% Reduction 48.9% Decrease 41.6% Decrease 40.6% decrease 55% decrease 17% decrease Cost per PME $ 4, Average PME Cost for 300 Bed $1.2 Million $ 996, Medication Decision support could identify up to beneficial changes in treatment 41,000 Repayments to payers for non-compliant documentation or ineligible services $25, $ Admissions/registration Patient Satisfaction 63% 80% Overall Patient Satisfaction 75% 80% Physician Satisfaction 73% 80% Staff Satisfaction 69% 78% Physician Patient Load Increase 4-8 Net Savings Over a Five year Period $2.5 to $5 million

26 Implementation Costs Hardware Personal Software Cost Servers $ 50, Tablets 1500 $ 600, Computer Stations 25 * 500 $ 12, Installation (wifi, routers, wiring, etc) $ 30, Yearly Maintance 15% $ 103, Cost Analyst 75,000 $ 300, Director 80,000 $ 80, Consultant Fees $ 100, Cost Interfaces $ 50, License Fee $ 6,000, Implementation Cost $ 6,742, Yearly Cost $ 583,875.00

27 Five Year Project $15,000, $10,000, $5,000, $- $(5,000,000.00) Year No EHR Costs Savings from EMR $(10,000,000.00)

28 Facility Implementation Physician Engagement Leadership Support & Collaboration Engaging the Clinical Staff Real-time Training

29 Phasing Plan PHASE 1 Clinical Foundation PHASE 2 Clinical Enhancement PHASE 3 Outcomes Optimization Clinical Viewer EMR Results Reviewing HIM / Doc Imaging Surgery Surgery Pharmacy Pharmacy Alerts ADE, Prevention Alerts Medication Profile Medication Reconciliation Patient Care Orders Management Nursing Documentation Ancillary Documentation emar Interactive View for ICU ED ED Tracking Board and Triage Physican Documentation (ED) CPOE for ED Care of the Patient in the Physician Office 57 YEARS Years CPOE Evidence-Based Alerts at Provider Order Nursing Care Plans Advanced Laboratory Laboratory POC Solutions Surgery Expansion Anesthesia

30 The Importance Of Decision Making Major Impact High Level Decisions ~ 10% of decisions What will be done? Who will do it? Clinical Systems Steering Committee (CSSC) Moderate Impact Mid Level Decisions ~ 25% of decisions Clinical Standards Committee (CSC) Physician Advisory Council (PACo) How will it be done? Less Impact Detailed Decisions Subject Matter Experts (SME) Design the details ~ 65% of decisions

31 Timeline Design/Build P# 1 Rollout Design/Build P# 2 Rollout Design/Build P# 3 Rollout Phase 1-19 Months Design and Build Phase 2-24 Months Design and Build Phase 3-14 Months Design and Build Go / No Go Decision

32 Timeline Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Plan Current State Assessment Future State Design Proof of Concept Build & Validation Integration Testing Production Build, Validate Conversion Prep Refine & Validate Training Facility Rollout Validation and Sign Off Steps Go / No-go Decision

33 Change Adoption Curve SUSTAIN Make It Stick 7. Don t Let Up 8. Create a New Culture ENGAGE Make It Happen 4. Communicate for Buy-In 5. Empower/Enable Others to Act 6. Create Short-Term Wins PREPARE Set the Stage & Decide What to Do 1. Create a Sense of Urgency 2. Pull Together the Guiding Team 3. Develop the Change Vision and Strategy Reference: Our Iceberg Is Melting. Eight Step Process for Successful Change. Author, John Kotter, Page

34 Critical Success Factors These critical success factors apply to all areas impacted by the project. Critical Success Factor The project is completed on budget. The process solutions identified in the project scope were implemented in each of the facilities according to the plan. Project milestone dates and deliverables were achieved with less than 10% variance. Current state analysis completed and signed off. Future state analysis completed and signed off 45 days prior to the first activation. Proof of Concept demonstrated through a partial system build to validate the future state workflow and system functionality with approval from the appropriate stakeholders. Measurement Process Project expenses are monitored and tracked to stay within budget. This is a multi-year project and will be measured on an annual basis. Validation of new care delivery processes activated in each facility based on the final scope document and/or governance approval. Track and manage project plan dates and deliverables as defined in the approved project plan baseline. Baseline date to be determined. 90% of the Phase II teams meet all milestone dates and deliverables. Require signatures from department teams interviewed for current state. Require signatures from members of the Clinical Standards Committee for future state design. Require signatures from SMEs and Clinical Standards Committee for future state workflows and partial build.

35 Critical Success Factors Critical Success Factor Measurement Process System functionality was adequately tested to identify and resolve software and workflow issues prior to conversion. Training team received design documentation and new care delivery workflows with adequate lead time to prepare training and competency testing programs. Appropriate staff attended training prior to activation (only those with excused absence from appropriate director will be allowed to take training at a later time). Staff members who attended training passed competency test. The "C" suite at each facility participated in the facility preparation and conversion activities. Corporate compliance will audit integration testing and provide feedback. Training materials, scenarios and policies were available for training of staff. Training attendance tracked to ensure at least 95% of appropriate staff attended training. Training competency scores tracked to ensure at least 98% of staff pass competency test with score 80% or higher. Participation in facility preparation meetings and support of new care delivery processes.

36 Project Standards Rules of Engagement Key criteria that must be met to support the project s success Defining a Project What specifically is a project and what is not a project Tools The tools that are used to manage projects and document project activity Project Roles and Responsibilities What is expected of participating team members Project Governance/Organization Structure Identification of Teams within the project Customer Responsibilities What is needed from the customer to maximize success Project Levels and Complexities Identification of the levels of complexities and how each is treated in terms of documentation, communication, and involvement Project Documentation Standard documentation naming conventions and storage locations Communication Management Standard methods and styles of communication designed to provide consistency for the teams and customers Meeting Management Establishes standard meetings and updates with efficient Planning, Facilitating, and Documenting Vendor Management Defines how to manage vendors and service professionals; includes contracts, Corporate Compliance, and standardized Change Management Risk Management Defines how project risks are identified, managed, and mitigated

37 Project Organization CEO CIO Chief Medical Informatics Officer Clinical Transformation VP Physician Executive EMR Director (Nursing) EMR Director (Ancillary) Vendor Executive PM Integration Technical Project Mgr. PM Testing PM Interfaces

38 EMR Governance Structure Board of Trustees Office of the President Quality Committee EMR Executive Oversight Board Clinical Systems Steering Committee EMR Project Steering Committee Physician Advisory Council Clinical Standards Committee

39 By Beena Joy, RN BSN EDUCATION, TRAINING & COMMUNICATION STRATEGY

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46 Summary of Recommendations Approval to solicit RFI Approval to distribute RFPs based on vendor responses Support organizational efforts to improve care and safety, streamline processes, increase satisfaction, and decrease costs and waste through EMR implementation Play an integral role in changing our reputation and our name from OK Care Hospital to Exceptional Care Hospital

47 Questions?

48 Facility Implementation 1. Reference: Our Iceberg Is Melting.Eight Step Process for Successful Change. Author, John Kotter, Page Budget and Return on Investment 2. Benchmark Data Source: American Journal of Medicine, April 2003 Issue ($5 Cost per paper chart) 3. Benchmark Data Source: CDC Advance Data Aiugust,2003(1 in 10 visits are new patients) 4. 2/jorg=journal&source=MI&sp=&sid=/N/622195/s014p0029.pdf?issn= pdf 6. Benchmark Data Source: RxSecurityUSA, RxPads.com, FileRx, AmericanSecurity Rx EMR Education & Training 9. Communication mentation%20success.pdf %20Plan.pdf