Implementing Electronic Medical RecordsAn Overview of Lessons Learned

2011 Rural Hospital ConferenceInn at Grand Glaze, Osage Beach

June 2, 2011

Presentation by;Jeff A. Tindle, MHA

Associate Administrator and CFOCarroll County Memorial Hospital

Who is CCMH?

25-Bed Critical Access Hospital in Carrollton, MO

6 Clinics, 5 Physicians, 1 P.A. and 2 N.P.

Current Services: Cardiac Rehab Emergency Room Standard Ancillary (Lab, Rad, Rx, PT, RT, Sleep, Nuc Med) Extensive OP Clinic (Cardiology, Ortho, GI, Surgery,

Podiatry, Urology, Pulmonology, etc.) Home Health

Planned Expansion/Renovation Summer 2011; adding new CT, MRI, complete renovation of

E.R., renovate and relocate Lab and relocate Medical Records

CCMH EMR Timeline

January 1, 2010 HIMSS ENRAM score of 1.7 Running on HMS, purchased in early 1990s

Original Pat. Acct. software, no department integration No CPOE

Added Omnicell Med Dispensing in mid-2009

EMR RFP’s out in January 2010 Site visits in late January, early February Presentation to Board in late February Cerner selected

Implementation Begins March 2010Go Live September 1, 2010HIMSS Stage 6 Designation, February 2011Certification of Meaningful Use Started February 2011

Records

Our Decision-Making Process

Why Purchase a new EMR? Completion of gaps in current system Take advantage of stimulus incentives Improve patient care, quality and workforce efficiency Desire to be an “early adaptor”

Why Cerner? Compliments our mission statement and strategic goals Software as a Service (SaaS) model (Remote Hosted) Implementation approach Trusted they would be certified for Meaningful Use,

confidence in their ability to keep up with changing criteria Good partner

Cerner Partnership

Partnered with Cerner in March 2010Cerner Solutions: Registration/Scheduling CPOE/ePrescribing Nursing and Physician Documentation Inpatient Pharmacy General Laboratory Device Connectivity Ambulatory EMR and Practice Management eMAR with Medication Bar-coding Emergency Department Radiology Patient Accounting EDI Transaction Services Oracle EBS – General Financials

Benefits of the Cerner Model

Years of Experience Project planning and implementation Always on latest code and content releases Cerner handled a large portion of implementation and

training, freeing up our staff to focus on patient care and operations

SaaS Reduces our Dependency on In-House IT We contract out IT – network, PC’s, etc Cerner handles hosting of Cerner Millennium and Oracle

Financials SLA for performance standards Predictable TCO

Upgrades are included Hardware costs are included Application management and help desk support is included

Our Implementation Process

Select internal implementation teamPrepare for Kick-OffAgree to communication planTake pulse of organization Culture Assess comfort of staff with technology

Decide what is negotiableFind your “cheerleaders”Essentially build your StrategyHowever, “Culture Eats Strategy for Lunch Every Day”

Key Lessons Learned

Communication is Key Communicate plans with staff

upfront Executive sponsorship Training Set staff expectations

Doing your Homework Master File clean-up (charge master, formulary, etc) Examine current practices and policies Departmental data collection Identify Subject Matter Experts and Super Users Validate build models against workflow requirements Test, test, test

Key Lessons Learned (cont)

More upfront work = better outcomes Accurate and thorough data collection leads to a build that

imitates your actual workflow, process, and expectations Verify all build and then conduct end user training

Know your staff Culture It’s not personal, it’s business Be prepared for a wide range of comfort levels with

technologyBe prepared for… Appointing a project manager

Do it yourself or appoint someone else

Entering a continuing partnership with your vendor (Cerner)

Additional staffing - mainly nursing during go live Added challenges in maintaining files/accounts for short

period of time Learning more about your organization along the way

Key Benefits

Imperative: Improved Quality of Care Increased Documentation of Pain Assessment  Increased % of Allergies Documented On-line Reduction in Medication Variances (Adverse Drug Events & Adverse Drug

Reaction) Increased % of Orders Placed Online by Providers Decreased Incidence of Falls Increased Medication Reconciliation at Each Change of Level of Care Decrease Time to Access Patient Chart Reduce the Number of Missed Doses of Medication Increased Accuracy and Speed in Obtaining Medication History

Imperative: Operational Efficiency Increased Coding Efficiencies Reduced Printing Costs Decrease Time to Access Patient Results (EMR) Reduction in Paper and Form Expenses Reduced Time Spent Managing Prescription Renewal Requests

Meaningful Use – 2011 Planned Attestation

Partnering with Cerner’s Regulatory Compliance team Focused effort and drive to help with attainment of Meaningful UseExposure to what is occurring in the various policy and standards committee and workgroup meetingsReporting and Monitoring of key objectives

Summary Observations

Limit your Vendor analysis to 3-4Remember you are choosing a Partner for the next 5+ yearsSoftware is software, make sure your Vendor can make it work in your Hospital and with your unique Interface needsStrongly consider the pro/con of using a single solution for both the Hospital and ClinicsYour Organization can handle more than you thinkReasonable Implementation time frame is 9-12 monthsCommunicate, Communicate, CommunicateConsider a Vendor that has had success with HIMSS and Meaningful Use AttestationWe over-purchased our peripheral support equipment, COWS, Scanners, etc. Basic will do just fine.You must be Committed to the End Result. It will be Rough Ride

Questions