Dorieanne BatiKatherine JoseJonathan Munar

EHR IMPLEMENTATION

CASE STUDY: DR CHRONO

Healthcare facilities are in the process to go paperless

Doctors inability to document notes right away

Ineffi ciency between staff members and Doctors

Better communication at the point of care

Enabling better patient education through visual aids

Elimination of hassle and potential inaccuracies of handwritten prescriptions

ABSTRACT

Government wants the healthcare industry to adopt electronic health records by 2014

Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009, to encourage the adoption of meaningful use of health information technology.

Enabled incentive payments through Medicare and Medicaid to clinicians and hospitals when they use HER to help improve in patient care delivery.

Incentive payments up to $27 bil l ion over 10 years, and as much as $44,000 (through Medicare) and $63,750 (through Medicaid)

EHR Implemention

INTRODUCTION

Healthcare is buried in paperwork

Many providers have been hesitant to take on the task of converting from the paper-based medical record system to the electronic health record

It costs nearly $250 bil l ion to process 30 bil l ion healthcare transactions each year

86% or mistakes made in the healthcare industry are administrative

Three of every 10 tests are reordered because results cannot be found

Patient charts cannot be found on 30% of visits

Providers need to fi ll out an average of 20,000 forms every year

THE PROBLEM

DR CHRONO uses the originality of the iPad to create the only Patient Care Platform that gives you what you need at the point of care

DR CHRONO vs. EMR Meaningful Use Certifi edMeaningful Use Introduction OnPatient appDR CHRONO vs EMR: Paper check-in clipboard Accurate medical speech-to-text

Custom forms and templates

Spend less do more (FREE)

Accessible anywhere

THE SITUATION

OPERATIONAL IMPACT

Paper fi ling Old-fashioned clipboard

Frustration Staff having to keep everything in their head (memorize) and

go back to desktop. Information lost.

Physician and Patient—limited time together DrChrono: triage notes, conducting history, physical down to

discharging patient and emailing a summary.

Variable consistency and accuracy of patient record

STRATEGIC IMPACT

Time involved in vendor selection process Nurses need to be involved (time conflicts). Dedication of “training time.” Lack of time and funding to cope with change.

Conversion not an upgrade Not an “easy fix.

Process reengineering Going from paper and pen to iPad. Change in workflow.

Short-sightedness EMR shouldn’t just measure today—it should measure

tomorrow.

CULTURAL IMPACT

People factors Personal characteristics and expectations

i.e. prior EMR experience Staff’s personal time investment in exchange for the benefits

expected from the system Shift in tasks (i.e. documentation by staff vs. physicians)

Could lead to role ambiguity and conflict

Staff participation Culture that support EMR adoption/use

There’s a huge unmet demand for acute care for minor injuries and ailments in the downtown area.

POLITICAL IMPACT

DrChronos adoption part of overall organizational vision and mission

Dr. Sonny Saggar Only senior health executive (St. Louis Urgent Cares)

Strong vision and awareness of strategies Must be able and ready to execute strategies to ensure that

any obstacles encountered during achieving the ultimate vision and mission.

Must be able to inspire staff, in turn be able to ultimately make a difference in transforming the HCO.

THE PROPOSED SOLUTION

DrChrono- a patient care platform that consists of an iPad based EHR, an iPad based patient portal (onboarding system) and a web based practice management and medical billing system. It’s like New York, London and Chicago without the big city

negatives. There are a lot of progressive and conservative people, simultaneously, and they have a healthy blending of science and technology without surrendering their traditional values.” –Dr. Sonny Saggar on St. Louis

The company released the fi rst Pad EHR system to be in accordance with ONC-ATCB stage 1 Meaningful Use criteria by Infogard Laboratories in June 2011.

Provides a number of free medical search engines: medical icd-9 search engine, electronic medical insurance payer search engine, and iPhone ICD-9 search engine. A place to ask questions about medical billing. 

OPERATIONAL IMPACT

“The main advantage of using electronic records on iPad is that it gives us complete access to everything that’s ever happened with each patient — in the current visit or previous ones.” Dr. Sonny Saggar, CEO, founder and medical director, St. Louis

Urgent Cares“iPad lets us spend more time with each patient and

less time typing.” Dr. Carol Ann Smith, staff physician, St. Louis Urgent Cares

STRATEGIC IMPACT

Customizable templates (clinical forms) Fits the needs of any practice, no matter the workflow

HCO is more effi cient overall Fanning and printing Legibility issues Documentation “in hand” for every patient

Expedites care Spending time taking care of patient Less time typing and document

Make life easier for patient In and out as quickly as possibly

Potential for surveys and taking suggestions from patients and neighboring businesses.

CULTURAL IMPACT

Enhanced communication between all staff in an HCO.Multimedia experience for both provider and patient

Notes in real-time, X-rays“Tap” through registration

Streamlined experience for allSt. Louis Urgent Care is able to provide care to more

“downtown” residents (with a 63101 area code) Satisfies the calling for more acute care in the downtown area There are no urgent care centers near the downtown area.

“They’re traveling 45 minutes to an hour out of the city to be seen for half an hour, and then go back.”

Others, he says, come by cab from other emergency rooms closer to the city. “When they get there, they see that they’re overflowing, so they come out here.”

POLITICAL IMPACT

Increased trust and respect of employees and partner physicians Help and allow subordinates work to the best of their abilities. Seek feedback from direct reports.

Meaningful Use certified platform Potential for tax breaks even with the small size of St. Louis

Downtown Urgent Care.Dr. Sonny Saggar wants to have an arrangement with

downtown business to make it financially easier for employees to come to the center.

“The demographics and market analysis say we’ll be seeing upwards of 100 patients a day,” he says. “But, in terms of revenue, I’m anticipating 25 people a day, at least at fi rst.” “Eventually, we want to be open 12 hours a day, seven days a

week,” he says.

PRE-IMPLEMENTATION Convince staff early

Create timeframe

Organization-wide assessment of basic iPad skills

Training

POST-IMPLEMENTATION Weekly meetings

Begin with one patient

Leadership support

ATTEMPT TO MITIGATE FORESEEABLE PROBLEMS (PRE-

IMPLEMENTATION)

CHALLENGESDR CHRONO vision

Lack of work flow and data analyses

Training from DR CHRONO

Strong investment

Support

ATTEMPT TO MITIGATE FORESEEABLE PROBLEMS

(CHALLENGES & SUCCESSES)

SUCCESSESClear process

Weekly meetings

One patient

Strong Investment

Support

ATTEMPT TO MITIGATE FORESEEABLE PROBLEMS

(CHALLENGES & SUCCESSES)