MEDSTAR HEALTH

Centricity EHR Project Assessment/Optimization

Presented by: MedStar Health

Suzanne Carter, IS VP Customer Service

Dawn Richmond, IS Director Ambulatory EHR

Topics

•

Background–

MedStar Health-who are we?

–

Centricity EHR Implementation Stats and Status

•

Project Assessment/Optimization Project Overview

•

Project Assessment/Optimization Results

•

MedStar Response and Action Plan

3

MedStar Health

Nine hospitals in the Baltimore/District of Columbia region

•

Franklin Square Hospital•

Georgetown University Hospital•

Good Samaritan Hospital•

Harbor Hospital•

Montgomery General Hospital•

St. Mary’s Hospital•

Union Memorial Hospital•

Washington Hospital Center•

National Rehabilitation Hospital

•

$3.5 billion non-profit

•

26,000 employees and 5,000 affiliated physicians

•

3,100 beds

•

158,000 admissions

•

1.5 million outpatient visits

MedStar Centricity EHR Implementation Status

Today•

142 practices LIVE

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60+ specialties

•

1600 providers

•

2400+ support staff

•

50+ Interfaces

•

30 practices scheduled for go live Oct.-Jan.

In the pipeline•

80 practices to implement in FY11-12

•

500+ providers

•

800+ users

•

practice acquisitions planned for FY11

•

And…

9.5 upgrade, superbill

pilot, EMRLink, Clinical Informatics Beta

5 Health Systems121 Customers25 Employees

MedStar Initiative to Evaluate Implementation of GE Centricity

• MedStar engaged an outside consulting firm, Clinovations, to evaluate the Enterprise rollout of GE Centricity EMR to employed, ambulatory practices.

• Initiative started in February, 2010. Completed May, 2010.

Goals:

Evaluate functionality and usability of GE Centricity 

Improve customer satisfaction 

Determine if modifications to processes and resources are necessary

Clinovations

5 Health Systems121 Customers25 Employees

MedStar Initiative to Evaluate Implementation of GE Centricity EMR

Enterprise rollout of GE Centricity EMR to employed, ambulatory practices 

Initiative initiated in February, 2010.  Completed May, 2010.

Goals:

Evaluate functionality and usability of GE Centricity EHR

Improve customer satisfaction 

Determine if modifications to processes and resources are necessary

Total Focus Group and Individual Customer Interviews

MedStar Ambulatory Point of Care

Focus Group Participants

Additional Interviews

Total Customer Participants

Franklin Square Hospital 12 1 13

Good Samaritan Hospital 6 3 9

Georgetown University Hospital 20 6 26

Harbor Hospital 22 - 22

MedStar Physician Partners 18 2 20

Union Memorial Hospital 11 - 11

Washington Hospital Center 11 7 18

Other (Not Including Centricity Team)

2 2

TOTAL 121

Customers Find Many Benefits from Using Centricity

•

Available 24/7•

Remote access•

Never lost•

Legible

•

Patient 

communications

•

Provider  

coordination

•

Referrals

•

eRx

/ medication list•

Labs•

Compliance

Assessment Results Key Areas of Focus

1.

System Performance2.

Usability

3.

Support / Staffing4.

Communications

5.

Training6.

Leadership / Governance

10

1. System Performance

Customer Feedback

System freezing

System speed and responsiveness

11

1. System Performance

IS Response/PlanServers •

Increased physical memory •

Fine-tuned server configuration•

Migrated all scanned documents into new storage •

Moved to new server infrastructure and data center in Sept.

Desktops•

Remediated PCs and servers and installed new anti-virus software•

Verified desk top and network settings on all PCs

Reconfigured Citrix Farm•

Citrix technology platform has been reconfigured based upon revised vendor specifications and industry best practices.

Application•

EMR 9.2 service pack and patches applied–

Prevents system locks caused by closing sessions using the "x" button. –

Increased overall stability of the EMR application. –

Performance improvement when updating large problem and medication lists

12

2. Usability Customer Feedback

System intuitiveness

Within-record multitasking (i.e., two screens open at once)

Click count for common tasks

Provider access/ability to generate reports

Robustness/relevance of decision support

Redundancy/inaccuracy of entries in provider directory

Form complexity

Multiple logins

Dictation policies

13

2. Usability IS Response/Plan

System Intuitiveness

Centricity Informatics Enterprise Reporting Beta Project begin Sept, 2010.

Centricity v10 addresses multiple usability issues: multiple windows, action oriented documentation,

etc.

Enhanced Clinical Decision Support

Clinical Decision Support released in May/ June. CDS design for all specialties planned for FY11.

Focus on PQRI and Meaningful Use.

Table Maintenance

Provider directory and pharmacy clean-up to be done this summer

Form Complexity

Active Physician added to IS Centricity team to assist in addressing usability issues.

Medical Students EHR will test enhanced content for usability.

Multiple Logins

Improve access to data in other systems through the HIE

Explore ways to reduce multiple sign ons

Continue to expand voice recognition availability

14

3. Support Customer Feedback

Transition Timing / Practice Readiness

Practices transitioned to Post IA before they are ready

Dramatic shift in level of Post IA support

Post-Implementation Issue Resolution

Help Desk responsiveness & understanding

Process and point person for issue resolution

Documentation and support for content updates

Variability in use of local site-specific Centricity coordinators

Internal resources not fully leveraged

15

3. Support Customer Feedback-(cont.)

IS Analyst Resources

Presence “on site” vs. “in practice” and continuity of relationship with

practices

Level of operational and clinical expertise

Ability to support ongoing form development

Availability of post-implementation resources

Special project and application support responsibilities compete with

customer-facing needs

16

3. Support IS Response/Plan

Customer Preparedness for Go Live

Offer two implementation tracks -- Standard Content or Custom-- to insure customer

proficiency before introducing increased complexity in clinical content.

Move toward a ongoing point of contact for Centricity support

‘In Practice’ Support

Created customer workgroup to define superuser roles/responsibilities.

Enhancing the super user training program and establishing a superuser forum and

routine meeting schedule.

Documentation and support for content updates

Enhanced release documentation

Offer multiple webex presentations for each release

‘Rounding’ support

Promoting use of customer sharepoint site

17

3. Support IS Response/Plan-(cont.)

IS Onsite Support

Established routine onsite post implementation visits.

Moving Centricity team from data center to facilities

Revising Centricity application team organization to provide ongoing point of contact

for Centricity support regardless of implementation status.

Clinical Help Desk Support

Continuing to provide training to clinical support desk to address common issues that

can be resolved without call back.

Continuing to develop service desk scripts (guidelines for common problem

assessment/resolution)

18

4. Communications Customer Feedback

Frequency and urgency

Technical nature and simplicity

Rationale and implications for use

Methods (e.g., flags/alerts vs. emails)

19

Formation of a cross disciplinary work group to develop more effective communication strategies

20

4. Communications IS Response/Plan

5. Training Customer Feedback

Focus on functionality vs. clinical workflows

Sharing of best practices across practices/sites

Incorporation of best practices into training

Scope and value of eLearning content

Accessibility and time to complete

Timing and frequency

Conflicts with clinical responsibilities

Non-existent/consistent after implementation

Lack of proficiency testing

Effectiveness of super user training

New providers

Attendings / residents / medical students

21

Enhancing all training programs to insure the learning objectives focus on workflow and

best practices. Collect feedback via customer survey.

Developing physician training programs with focus on meeting criteria for ‘meaningful

use’.

Expanded before and after hours training offerings.

Developing post implementation ongoing training programs for physicians and support

staff.

Developing proficiency testing in all eLearning and classroom training.

Enhancing the super user training program and establish a superuser forum and routine

meeting schedule.

Utilizing physician support analysts to support new provider training.

22

5. Training IS Response/Plan

6. Leadership and Governance Customer Feedback

Alignment of practice goals and MedStar needs

Communication of benefits realization strategy

Expectations for, and amount of, practice involvement/responsibilities in

pre/post-implementation

Transparency of, rationale for, and customer involvement in, decision making

and processes

Empowerment of physician champions / superusers

23

Prepare communication plan describing current governance model

Define mechanisms for accessing or escalating issues to project leadership

Establish work group to delineate the site coordinators, physician champions,

superusers, IS roles

Establish new clinical governance group

24

6. Leadership and Governance IS Response/Plan

Integration / Interfaces

25

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Hospital lab results interface rollout to all facilities in progress and expected to complete November, 2010.

•

EMR Link kickoff August, 2010. LabCorp and Quest pilot project

to begin in October.

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Health Information Exchange (HIE) approved as FY11 project; vendor selection is in progress.

Questions?

Thank you