EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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EHR Requires You to Reconsider Your Workflow

EHR Requires You to Reconsider Your Workflow | EHR and Health IT Consulting | Scoop.it

Despite many EHR vendors best efforts to tell you otherwise, an EHR requires every organization to reconsider their workflow. Sure, many of them can be customized to match your unique clinical needs, but the reality is that implementing an EHR requires change. All of us resist change to different degrees, but I have yet to see an EHR implementation that didn’t require change.

What many people don’t like to admit is that sometimes change can be great. As humans, we seem to focus too much on the down side to change and have a hard time recognizing when things are better too. A change in workflow in your office thanks to an EHR might be the best thing that can happen to you and your organization.

One problem I’ve seen with many EHRs is that they do a one off EHR implementation and then stop there. While the EHR implementation is an important one time event, a quality EHR implementation requires you to reconsider your workflow and how you use your EHR on an ongoing basis. Sometimes this means implementing new features that came through an upgrade to an EHR. Other times, your organization is just in a new place where it’s ready to accept a change that it wasn’t ready to accept before. This ongoing evaluation of your current EHR processes and workflow will provide an opportunity for your organization to see what they can do better. We’re all so busy, it’s amazing how valuable sitting down and talking about improvement can be.

I recently was talking with someone who’d been the EHR expert for her organization. However, her organization had just decided to switch EHR software vendors. Before the switch, she was regularly visited by her colleagues to ask her questions about the EHR software. With the new EHR, she wasn’t getting those calls anymore (might say something good about the new EHR or bad about the old EHR). She then confided in me that she was a little concerned about what this would mean for her career. She’d kind of moved up in the organization on the back of her EHR expertise and now she was afraid she wouldn’t be needed in that capacity.

While this was a somewhat unique position, I assured her that there would still be plenty of need for her, but that she’d have to approach it in a little different manner. Instead of being the EHR configuration guru, she should becoming the EHR optimization guru. This would mean that instead of fighting fires, her new task would be to understand the various EHR updates that came out and then communicate how those updates were going to impact the organization.

Last night I had dinner with an EHR vendor who told me that they thought that users generally only used about 50% of the features of their EHR. That other 50% of EHR features presents an opportunity for every organization to get more value out of their EHR software. Whether you tap into these and newly added EHR features through regular EHR workflow assessments, an in house EHR expert who’s constantly evaluating things, or hiring an outside EHR consultant, every organization needs to find a way to regularly evaluate and optimize their EHR workflow.


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Lessons learned from an award-winning EHR system replacement | Healthcare IT News

Lessons learned from an award-winning EHR system replacement | Healthcare IT News | EHR and Health IT Consulting | Scoop.it
In 2012, ARcare undertook a fast-paced transition to a next-generation electronic health record system. Less than two years later, ARcare was nationally recognized, receiving HIMSS Analytics' Stage 7 Ambulatory Award, the highest HIMSS honor for EHR adoption.

[See also: Cleveland Clinic scores Stage 7 ambulatory award from HIMSS Analytics]

ARcare, a private, non-profit corporation providing primary care in rural Arkansas and Kentucky through a network of clinics, pharmacies and wellness centers, is the first Federally Qualified Health Center – and was one of only two ambulatory practices not connected with a hospital – to receive a Stage 7 ambulatory award.

On the way to a successful implementation, ARcare learned a great deal about the relationship between ongoing physician involvement and final clinical training – information that may help our peers who are moving forward with similarly ambitious systems replacements.
Managing change during the transition

ARcare’s system replacement involved moving from comparatively basic EHR use to a more comprehensive system with clinical event functionality that would enable us to better manage patient conditions across multiple care venues. A primary goal was to have the system drive orders and events rather than merely document clinical activity.

Migrating to next-generation technology across an enterprise requires significant IT resources, training, management support and workflow changes. Our strategy was to tie these elements together with a carefully constructed change-management plan, in which a highly experienced, multi-disciplinary team with C-level support facilitated all aspects of system adoption. The change-management team was tasked with creating a continuum of sustained change with a primary focus on improved patient care, stripping away governance of information silos. In this spirit of change management, each identified issue was relevant to the team – rather than individual roles – without regard to reporting structures.
The importance of keeping physicians in the change-management loop

Although ARcare achieved significant success in the arena of change management from an IT perspective, and within an aggressive timeframe, we also found in hindsight that keeping physicians in the loop throughout the transition can simplify clinical training during the final stages of implementation.

While ARcare actively sought input and buy-in from physicians on the front end of the transition, our sensitivity to the demands on physicians’ available time led us to remove most of them from the actual transition process, preserving involvement to a select few clinical staff members as physician representatives. While physicians remained involved to provide input to the new standardized workflows required by the new system, most of them had minimal exposure to the new system prior to clinical training.

[See also: Rip and Replace: Atlanta Thrasher Fans Feel Providers' Pain]

The scheduled training sessions involved the clinical staff who were part of the change-management team performing training duty: nurse practitioners training other nurse practitioners and physicians training other physicians. We had anticipated this to be one of the easier tasks of implementation, and hadn’t fully accounted for the learning needs of clinical staff.

Although our physician leadership group requested they be the trainers, it soon became apparent that many healthcare professionals are simply uncomfortable voicing the need for additional help, especially to their peers. We also learned that having select clinical staff involved in the overall process didn’t necessarily translate directly to building teaching skills; the ability to understand complex technology and to teach its use are quite different. We decided to revisit training with the assistance of our own KMS – knowledge management systems – education team.
Getting clinical training back on track

Together with the KMS education team and led by four top instructors, we created a new, three-day program that integrated training for physicians, nurses and physician assistants.

Working in small groups, clinical staff participated in the training program, which was rolled out across facilities in series. Feedback gathered at the end of each training session helped to improve each subsequent session. Satisfaction increased quickly and steadily, and ARcare has continued to provide training updates on a regular basis to ensure continued optimal performance.
Well worth the effort

Five months after going live with our new system, ARcare became the first ambulatory practice that was not part of a hospital to achieve Stage 6 on the HIMSS Analytics EMR Adoption Model. One year later, we became the first FQHC to achieve the highest level of EHR usage, Stage 7.

The overall experience helped the organization recognize and develop an appreciation for the fact that change can and should be a positive experience. ARcare has developed a level of confidence across the organization where employees are less reluctant or fearful of change, and where learning from failure produced valuable outcome – not just in successful training, but in the successful adoption of a new Greenway Health EHR that brought with it substantial benefits, including:

Improved patient management with better information access for providers and clinical event management that drives events and orders, computerized provider order entry and closed-loop medication administration, and other advanced functions that improve patient care
The ability to exchange data directly with the state health department
Streamlined access to patient records across the network of primary care clinics, dental clinics, pharmacies and wellness centers

During the transition to the new system, ARcare successfully converted more than 17.2 million records, including clinical notes, images and test results. Now, when ARcare identifies and secures a new clinic site, the new site can be completely operational from an IT perspective in 30 days or less thanks to advanced system capabilities for scalability and extremely fast implementations. As of today, the system provides paperless charting and order entry for 37 ARcare clinics.

In all, it’s been a very satisfying transition in which the gains were well worth the pain – pain that can be avoided by following the lessons learned in ARcare’s approach and re-working of clinical training. In short: It’s all about identifying an effective training team.
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