December
2006 — Volume 1, No. 12
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Be Part of HIMSS Volunteer Effort in New Orleans -
Common Ground Health Clinic
HIMSS and its members will be putting the Society’s healthcare IT mission into action with the Common Ground Health Clinic in New Orleans. HIMSS has aligned with this free clinic in the Algiers section of the city to help provide needed supplies and technology as the Society comes to New Orleans Feb. 25-March 1, 2007, for the 2007 Annual HIMSS Conference & Exhibition. All donations to the clinic will be managed through the HIMSS Foundation, the philanthropic arm of HIMSS.
The main clinic is in the Algiers neighborhood, located on the West Bank of New Orleans. Additionally, the clinic operates, a Latino Outreach Health Project (LHOP) that goes out several days a week to provide services to Hispanic laborers and residents and occasional mobile clinics. The clinic also provides weekly, confidential HIV testing in partnership with the New Orleans Dept. of Health.
Since opening on Sept. 9, 2005, the clinic has had 20,000 patient visits and now sees about 200 patients each week. Most of the patients do not have health insurance. Visit the Common Ground Health Clinic Web site to read more about the clinic.
- Visit the HIMSS Web site for more information.
- If you have questions about donations of consulting hours, software, hardware, or other products, contact HIMSS Common Ground to find out more.
- View the Common Ground Health Clinic wish list.
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HIMSS07 – Hear from the Davies Award Recipients Putting the EMR into Action
Learn from recipients of the 2006 Davies Award of Excellence recipients at the 2007 Annual HIMSS Conference & Exhibition. Scheduled for Feb. 25-March 1, 2007, the conference will be held in New Orleans, La.
At the Davies Award sessions, attendees will find out just how the EMR works for these organizations, physician practices and public health systems.
 Here are the Davies Ambulatory Care Education Sessions at HIMSS07.
Davies Ambulatory Award Winner: Cardiology of Tulsa (education session #6)
Monday, February 26, 10-11 a.m.
Michael Spain, MD, MBA
President/CEO, Cardiology of Tulsa
This full-service cardiology practice began its search to achieve its technology vision in 1989. Its first implementation was not a success. This "learning organization" overcame its obstacles, utilizing motivational strategies such as "Project CHEARTBURN", now defining EMR success with immediate access to patient information, improved workflow, and revenue enhancement.
Davies Ambulatory Award Winner: Piedmont Physicians Group (education session #61)
Tuesday, February 27, 9:45-10:45 a.m.
William McClatchey
Piedmont Physicians Group
Architecturally unsafe from the weight of its paper medical records, this eight-physician physician practice in internal medicine used an industrial management firm to analyze its workflow, customizing its EMR to match the needs of its practice. Striving to utilize its EMR to drive clinical performance, PPG 775 is an example of a positive operational and financial investment in an EMR.
Davies Ambulatory Award Winner: Alpenglow Medical, PLLC (education session #97)
Tuesday, February 27, 2:15-3:15 p.m.
Daniel Griffin, MD
Alpenglow Medical, PLLC
Designed to use an EMR from the day it opened, this practice has been able to focus its energy on electronic efficiencies. The remarkable workflow leaves no pending information to be revisited in the patient's medical record at the end of the patient visit. This two-physician practice provides a model for the small practice to move to the decision point of adopting an EMR.
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Tips and Tricks from the Practice Manager’s Perspective
Tips for EMR Implementation
By Brenda Plunkett
Executive Administrator
Old Harding Pediatric Associates, Nashville, Tenn.
Recipient of the 2004 Davies Ambulatory Care Davies Award of Excellence
It’s a partnership with the EMR at Old Harding Pediatric Associates because both parent and physician can view and discuss the child’s health information.
You have purchased an electronic health record…Now what?
Implementation is the #1 success factor in the future use of your EMR. It can create excitement about the change or it can create chaos.
Once the contract is signed, you must create a roadmap to know what direction you are going.
- Pick your championship team to guide you through this process. Ask a manager or staff member from each department to serve on this team to assure all workflow areas are covered. Team members must be enthusiastic about change and must be willing to put extra effort into this project. The team needs to be cohesive and present themselves as one voice.
- Assess your current workflow so you can change any systems necessary before going live on the EMR. If new systems are needed, the staff can adapt to these changes before being challenged with the EMR.
Example: Currently you do not take co-pays at time of check-in. If you decide with the EMR that your workflow will be better taking the co-pays upon registration, then make that change now so that process is automatic when go-live date arrives.
- Customize if possible, if your software allows, assigning each physician templates on diseases that they have a special passion. They will be more eager to complete the task and they probably have more in-depth knowledge about a topic.
- Identify specific success criteria so you can objectively evaluate if you have met the goals you had set out to accomplish. Identify the risks involved in the implementation of an EMR. By identifying these risks, you are likely to find solutions before they happen.
- Know in detail the roles and responsibilities of the practice implementation team and the vendor implementation team. Agree on these before moving forward.
Going live with your EMR will only be as successful as the TRAINING you receive and provide to all staff. Provide two staff members with extensive training of the system and they can be your “super users.” They will be able to provide training in addition to what the vendor will provide.
You may do group training by classification of staff and then provide training per physician/nurse team. This training will help the teams to develop their flow within their area.
- Set goals for the EMR to be fully implemented within all areas of your practice immediately. If everyone is compliant with this goal, you will have the success you wanted to achieve when you purchased the EMR.
- Make “go-live” day a fun and exciting day. The champion team needs to be positive, encouraging and available to provide solutions. Buy lunch. This is probably one of the only days in your practice that everyone will be experiencing the same anxiety, the same fears, and the same exuberance at the end of that day.
If you have prepared and followed a thorough implementation process, your practice will be ready to move forward to providing better continuity of care and greater satisfaction for your patients. The staff feels rewarded that they have a system that will provide them the tools to effectively complete their daily tasks.
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Personal Health Records: Arriving at Your Office Soon
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Holly Miller, MBA, MD
Chair, HIMSS Personal Health Record Steering Committee |
JoAnn W. Klinedinst, CPHIMS, FHIMSS, PMP
HIMSS Staff Liaison to the HIMSS Personal Health Record Steering Committee |
Following is a paper providing an update and a timely review of personal health records. Read the introduction here and link to the complete paper.
Recent discussion on personal health records (PHRs) has focused on the basic question: Exactly what is a personal health record?
Unfortunately, there is no universal industry-accepted definition to date.
In the most basic form, a PHR is a collection of personal health-related information, such as an individual’s active medication list, a diary of finger stick glucose or blood pressure values, symptom-related journal entries, copies of results reports, prior patient instructions, and imaging studies. Indeed, this is frequently the kind of information that patients bring with them when they go to see their doctor.
An electronic PHR (ePHR) might include all of the above elements and additional electronic health tools, such as secure patient provider messaging, patient-specific and context-sensitive information, and e-services such as prescription renewal, appointment scheduling, and other applications.
Currently, the industry is at the crest of the wave of an eHealth transformation that will alter medicine as much as the Internet has affected other industries, including banking, travel and retail sales. Today, consumers may obtain a PHR from a variety of sources including providers, employers, health plans, the government, Internet “dot.com” sites, through pharmacies and pharmacy benefit managers, or device manufacturers. PHRs may
- Conform to an “untethered” model that is populated by the patient in a standalone environment (also known as “self-directed”)
- Conform to a “tethered” model by being integrated with an EMR (also known as a networked PHR)
- Be a combination of both
Ultimately, in a world where all providers are using interoperable EMRs, PHRs may represent the most complete lifetime health record maintained by the patient and current care providers and shared with new providers and others (e.g. payers) at the patient’s or patient designee’s behest.
Consumers do worry about the privacy and security of information in a PHR, secondary uses of their medical data and the digital divide in this information exchange. As a result, significant issues must be addressed before consumer adoption is widespread. Read the complete article.
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NEWS BRIEFS
Personal Health Record Update
Attendees at the Connecting Americans to Their Health Care: Empowered Consumers, Personal Health Records and Emerging Technologies held recently in Washington, DC, received numerous updates relating to industry developments for personal health records. The Markle Foundation’s David Lansky, PhD announced that eight grantee teams were selected out of a pool of 165 applicants to each receive an 18-month, $300,000 grant provided by Robert Wood Johnson Foundation's Project HealthDesign. The awards were made to help researchers develop PHR tools for a variety of purposes that will remind patients to take their medications, provide prompts for treatment of chronic illnesses, or transmit data to providers for various home-based biomonitoring devices.
Physician Lauds Online Continuing Medical Ed
On Nov. 17, Salvatore Volpe, MD appeared on the cover of Medical Economics magazine. Dr Volpe was interviewed on the benefits of using online continuing medical education. He continues to manage the HIT Blog and Healthcare Information Technology Forum to disseminate timely information on health information technology. Dr. Volpe serves on the Health Information Technology Committee for the Medical Society of the state of New York and lectures to physician groups throughout the state.
Nurses Use IT for Follow-Up Care
Read more about Crystal Run, a 120-physician group practice in Middleton, NY and its new “care manager” positions for registered nurses who use IT tools to manage care for patients.
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Important Links
WCBF’s 5rd Annual Six Sigma in Healthcare Conference
March 28-30, 2007, Las Vegas, Nev.
This conference focuses on practical
insights into what's working and what's not to address the unique challenges with Six Sigma implementation for healthcare organizations. Through a multi-streamed, multi-functional program, practitioners can apply and maximize the value of Six Sigma to their specific organization's needs.
Businesses Take the Lead on Personal Health Records - Read more about businesses such as Intel and Wal-Mart coming together to develop a database to house the personal health records of their more than 1 million employees.
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Terms & Definitions
PHR: Personal Health Record - Usually used when referring to the version of the health/medical record owned by the consumer/patient.
CCR: Continuity of Care Record – 1) A standard specification being developed jointly by ASTM International, the Massachusetts Medical Society (MMS), HIMSS, the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics. It is intended to foster and improve continuity of patient care, reduce medical errors, and assure at least a minimum standard of health information transportability when a patient is referred or transferred to, or is otherwise seen by another provider. 2) A new XML document standard for a summary of personal health information that clinicians can send when a patient is referred and that patients can carry with them to promote continuity, quality, and safety of care.
CDA: Clinical Decision Architecture - An XML-based document markup standard that specifies the structure and semantics of clinical documents for the purpose of exchange. Known earlier as the patient record architecture (PRA), CDA provides an exchange model for clinical documents such as discharge summaries and progress notes, and brings the healthcare industry closer to the realizations of an electronic medical record. By leveraging the use of XML, the HL7 Reference Information Model (RIM) and coded vocabularies, the CDA makes documents both machine-readable (so they are easily parsed and processed electronically) and human-readable so they can be easily retrieved and updated by the people who need them.
Chair of the HIMSS Enewsletter Task Force Chuck Parker puts these definitions into context: "CCD is a transition framework aligning the CCR within the context of the CDA."
Source: HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations. HIMSS. 2006
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Terms & Definitions Background Information
Continuity of Care Document (CCD) Standard on Ballot - Read more about a compatible standard for an electronic patient care summary. ASTM International and Health Level Seven both originally developed competing standards for this data compilation, but now, they have agreed to work together to develop a standard that is mutually compatible.
HIMSS Summit 2006 - Comparing the Continuity of Care Record and the Continuity of Care Document
Review this presentation from the HIMSS Summit 2006. An expert on each standard described the benefits of each approach and then discussed the collaborative project of HL7 and ASTM. This session looked at the collaboration on an HL7 CDA-compliant expression of the ASTM CCR called the "Continuity of Care Document" (CDA). It provided the implementer community two alternative frameworks for the CCR data set: the data model developed by ASTM and the HL7 RIM-based Clinical Document Architecture (CDA). The two approaches to interoperability differ in how they model data and in their stylistic approach to XML.
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Vendor Update
eClinical Works
Achieving ROI with EMR
Seven-Provider Practice Saves Around $200,000/year with EMR System
Glynn Medical Associates
Brunswick, Ga.
Glynn Medical Associates, comprised of four internists, two rheumatologists and a physician’s assistant, began using eClinicalWorks integrated EMR/PM system in February 2005 with every provider using the system as of the first day. Glynn had decided that maintaining dual systems and “phasing in” would defeat the purpose of changing from paper to EMR.
The first three months of going paperless were stressful; however, returns have proven the transition well worth it, with the practice saving approximately/conservatively $200,000/year. Also, one physician in the practice is seeing 33 percent more patients daily with the EMR system with increased patient satisfaction. Some of the quantitative benefits Glynn has received include:
- $120,000 of annual transcription costs disappeared almost immediately.
- Glynn has allowed attrition to reduce medical records personnel from 4.5 people to two at a conservative estimated savings of $50,000.
- Attrition has permitted the billing department to decrease from 5.5 people to three at an estimated savings of $50,000.
- With 500 charts a day not being transported and the diminution in personnel, Glynn realized that it had more space than needed. It downsized from 14,000 to 11,500 square feet, saving $47,500 per year. Some of these savings may be used by IT for now.
“Changing to an EMR system and making the office paperless required a significant learning curve but was well worth the effort,” says Dr. Erick Bournigal. “Aside from the financial rewards, there is the ability to work from home, to review labs, catch up on notes, access notes from the hospital that improve our quality of life and contribute to better patient care."
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Thinking About Implementing Health IT
Guide to the Electronic Medical Practice: Strategies to Succeed, Pitfalls to Avoid
Spend some time with this new book, Guide to the Electronic Medical Practice: Strategies to Suceed, Pitfalls to Avoid, from Steven L. Arnold MD, MS, CPE, Editor.
Written by physicians, nurses, and IT professionals, this book brings a hands-on perspective to the challenges and solutions of implementing the electronic health record in the medical practice. The book covers
- The political, societal and economic drivers for EHR implementation
- The costs and benefits of EHRs
- Getting stakeholder input and support
- Barriers to implementation and how to address them
The book also outlines the 10 phases of implementation:
- Achieving buy-in
- Analysis of business and technology needs
- Design and project planning
- Managing change
- Selection and procurement
- Installation and set-up
- Training
- Piloting and ‘go live’
- Maintenance and support
- Post-implementation strategies and enhancements
The book includes detailed descriptions of factors that drive both success and failure. Four case studies help illustrate how different practices have approached some of the more challenging issues with EHR implementation.
Order from the HIMSS store using order code #493 for Guide to the Electronic Medical Practice: Strategies to Succeed, Pitfalls to Avoid.
Regular price/$72 and HIMSS member price/$60.
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Already There…Implemented Health IT
See the “Tips and Tricks from the Practice Manager’s Perspective.”
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The HIT Dashboard
The latest information on over 500 state, federal, and private HIT initiatives
www.hitdashboard.com
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