Implementing EHR in Health Care May 30, 2012 Tim Thompson Sr. Vice President & CIO 1 Title: Senior Vice President and CIO Bio: Tim Thompson currently serves as Senior Vice President and Chief Information Officer for BayCare Health System (BayCare) in Clearwater, Florida. His responsibilities include leadership of the technology planning and operations for the system-wide Information Services operation. Mr. Thompson has over 30 years of experience in health care administration and information technology. Prior to joining BayCare in 2010, he most recently served as Senior Vice President and Chief Information Officer for The Methodist Hospital System in Houston, Texas. Prior to working at Methodist, Tim was the CIO and Senior Vice President at both Adventist Health System in Orlando and Palmetto Health in Columbia, South Carolina. In addition he held senior management positions at The Cleveland Clinic, Dynamic Healthcare Technologies, Inc., and Proctor Healthcare Incorporated. Tim earned a bachelor’s degree in management from the University of Illinois. He is a member of the College of Healthcare Management Executives (CHIME) and Healthcare Information and Management System Society (HIMSS). 2 Why are Hospitals Implementing Electronic Health Record (EHR) Systems? 3 Federal EHR Strategy •President Bush’s goal in 2004 – “… an Electronic Health Record for every American by the year 2014. By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” State of the Union address, Jan. 20, 2004 •President Barack Obama announces an audacious plan – “Computerize all health records within five years.” - during a speech at George Mason University on January 12, 2009 •February 17, 2009 – the American Reinvestment and Recovery Act (ARRA – Stimulus Bill) is signed into law – HITECH component of ARRA provides a $19B incentive program to stimulate the adoption and use of HIT, especially EHR’s – Dr. David Blumenthal appointed the new National Coordinator 4 Meaningful Use Overview • WHAT is Meaningful Use? – Meaningful Use (MU) means providers must demonstrate they are using certified Electronic Health Record (EHR) technology in ways that can be measured significantly in quality and in quantity – Achieving MU determines whether an organization will receive payments from the Federal government under the Medicare EHR Incentive Program, Medicaid EHR Incentive Program, or both 5 Defining Meaningful Use (MU) • In a health information technology (HIT) context, there are three main components of Meaningful Use: 1. The use of a certified EHR in a meaningful manner, such as ePrescribing 2. The use of certified EHR technology for electronic exchange of health information to improve quality and coordination of health care 3. The use of certified EHR technology to submit Clinical Quality and other measures • Achieving Meaningful Use determines whether an organization will receive payments from the federal government under either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program or both. 6 Meaningful Use Overview, continued The REAL Bottom Line … • WHY is Meaningful Use (MU) so Important to Our Patients? – Improves the quality, safety, efficiency, and coordination of patient care – Provides patients and their families with timely access to data, knowledge, and tools to make informed decisions and to manage their health across the care continuum – Ensures privacy and security protections for confidential medical information – Enables patients to promptly access their own Personal Health Information (PHI) 7 BayCare EHR Implementation Strategy 8 BayCare BEACON 7-Year $236M Clinical Transformation Project The vehicle BayCare is using to drive toward practicing to a clinical standard It is not only driving clinical practice change enabled by technology, but also driving evidenced-based standardization 9 BayCare BEACON EMR Journey Home Health Cardiology ED CPOE & Phys Doc Clinical Doc Hospital-based SNF Lab Anesthesia (RT, PT, OT, Speech, Rehab) Scheduling eMAR Physician Portal Women’s Health Inpatient CPOE Critical Care RAD PACs Phase II Skilled Nursing Phase I Internal HIE Pre-Phase I CarePlans Device Integration Nursing Doc Orders Therapies E-Prescribing Phase III Oncology Behavioral Health ASC Closed-Loop Med Admin Future Physician Doc Real-time Decision Support eSig Results Viewing Dictation Evidencebased Practice Surgery Demographic HIM Pharmacy Clinical Scanning ED Triage Tracking Foundational Applications (Financial, Materials and Clinical) “High-Availability” Infrastructure and Skills 10 BEACON Timeline 2008 April SAH June NBH July MPH Aug MH 2009 Sep SFB 2010 2011 2012 2013 Oct SJ MPNB Phase I Go-Live Phase II Design/Build SJHN Current State Future State Phase II Rollout Phase III Design/Build Proof of Concept Build & Validation Integration Testing Phase III Rollout Build & Validate Training Phase 1 - 19 Months Design and Build Phase 2 - 24 Months Design and Build Upgrade Phase 3 - 14 Months Design and Build 11 Phase II Roll-Out Schedule 2009 Q3 MPNB SJHN 2010 Q4 Q1 Q2 2011 Q3 Q4 Q1 Q2 2012 Q3 Q4 Q1 Oct Feb MPNB Psych Facility SJH,SJC, SJW SAH SJHN May Aug Aug * Oct Feb April MCH, MDH, BAH June MPH Clin. Doc. with ED CPOE, eMAR, Orders, Messaging Inbox to sign orders Phase III SFBH ED Physician Documentation * FirstNet at SJH, SJC, SJW BEACON Innovation PowerPlans & Problem Lists 12 BEACON Phase III Activation Schedule SJHN PCM Jan 2012 MCH PCM Jul 2012 SFB PCM Mar 2012 SJHN SFB Jan 2012 Mar 2012 2012 Q1 2012 SJW PCM May 2012 SJH, SJC, SJW Jun 2012 Q2 MPH PCM Sep 2012 MPH MCH, MDH Aug 2012 Oct 2012 Q3 Q4 MPNB Jan 2013 Q1 2013 SAH Apr 2013 Q2 2013 Today Phase III includes: Inpatient Computerized Provider Order Entry (CPOE), PowerNote Documentation for Inpatient Physician’s with Dragon, Computerized Anesthesia Documentation, Interdisciplinary Plans of Care (IPOC), Quality Plans (Lighthouse), Stage I Meaningful Use Readiness, and PowerChart Maternity with FetaLink (PCM) PowerChart Maternity (PCM) Go-Lives 13 BEACON Implementation Methodology • Clinical transformation is at the core of the entire project • It’s all about adoption • Early involvement by senior leadership in making key strategic design decisions is critical 14 BEACON Methodology BayCare BEACON Methodology Executive / Clinical Leadership BEACON Day Three Go / No Go BEACON Day Two BEACON Day One CSSC Kickoff Strategic and Change Management Policies and Procedures Planning and Preparation Conduct Current State Assessment Analyze Options, Scenarios, Key Decisions Finalize Future State Facility Preparedness Identify Metrics Capture Localized Baseline Metrics Optimization Planning Implement and Measure Optimization Assessment Optimization Analysis Roles and Responsibilities Clinical Transformation Complete Preliminary Workflow Assessment (PWA) and Onsite Workflow Assessment (OWA) Define Standards Complete Design Decision Matrix (DDM) Validate Current and High Level Future State Identify Gaps Develop Standard Training and Testing Manuals Conduct Training Conversion Validate Proof of Concept Build Conduct Integration Testing System Build Conduct System and Design Review FRAME THE FUTURE Complete Preliminary Design Session Complete Proof of Concept Build Complete Additional Build BUILD THE FUTURE Complete Unit and System Testing Conduct Conversion Readiness REFINE AND ADOPT OPTIMIZE 15 The Importance Of Decision Making Major Impact High Level Decisions ~ 10% of decisions Moderate Impact Clinical Systems Steering Committee (CSSC) What will be done? Who will do it? Mid Level Decisions ~ 25% of decisions Clinical Standards Committee (CSC) Physician Advisory Council (PACo) How will it be done? Subject Matter Experts (SME) Less Impact Detailed Decisions Design the details ~ 65% of decisions 16 Phase II BEACON Day 1 – Decisions Summary Executives Voting on Key Decisions 17 Phase I BEACON Day 1Decisions Summary Phase I BD1 Decision Description 1 BayCare physicians will have remote access to Phase I functionality. 2 BayCare will practice to a standard for clinical documentation. 3 BayCare will practice to a standard for forms format. 4 BayCare will practice to a standard for bar-coded patient identification across all facilities. 5 Where results are available electronically, BayCare will discontinue placement of those results in the paper chart. 6 BayCare will mandate electronic signature (signatures, completion, edits and corrections) by physicians for record completion via the Inbox. 7 BayCare will consider the electronic record the legal medical record. 18 Phase II BEACON Day 1Decisions Summary Phase II BD1 Decision Description 1 Computerized Physician Order Entry (CPOE) will be the standard across BayCare. 2 Order Sets will be standardized and required in all BayCare Emergency Departments. 3 Physicians will use the BEACON Inbox (Message Center) to sign all verbal and telephone orders (Inbound Messaging). 4 Physicians will have availability to (but not be required to use) BEACON Messaging / Inbox (Message Center) to communicate with each other (Outbound Messaging). 5 All orders will be placed in BEACON. 6 All medications will be documented in BEACON. 7 All non-physician interdisciplinary clinical documentation will be captured in BEACON, with the exception of OB. 19 Phase III BEACON Day 1Decisions Summary Phase III Decision Description 1 Evidence based practice supported by standardized order sets will be implemented across all BayCare facilities. 2 A physician documented diagnosis and problem in BEACON will be the BayCare standard. 3 Interdisciplinary plans of care (IPOC) will be the standard for BayCare and will be documented in BEACON. 4 All anesthesia documentation will be captured in BEACON. 5 Physician documentation will be captured primarily using structured documentation tools in BEACON. 6 BEACON will be the source of truth for acute care clinical data. 7 Closed-loop bar-coded medication administration will be the standard for BayCare. 8 E-prescribing will be standardized and required in all BayCare facilities. 9 All medical device information will be captured in BEACON. 10 All OB documentation will be captured using structured documentation tools in BEACON. 20 Approach Communications – BEACON Communications will deliver simple specific targeted messages early and often and through various mediums – Improve peer-to-peer communication using SuperUsers, SMEs and Physician Informaticists to deliver messages Change Management / Adoption – Show organization that BEACON was designed, built, and validated by clinicians and physicians – Conduct standardization assessments at local level and change readiness surveys Training – 75% of BEACON solution training will be web-based, available online or facilitated in a classroom setting – 25% of BEACON solution training will be “Day in the Life” classroom training, focusing on role based technology enabled process 21 Workflow Localization – What is it? A disciplined and structured approach to standardizing the future state workflows and facilitating change management throughout the organization – Workflow Localization assists each facility in creating a strategy for implementing critical clinical and operational workflows – Workflow Localization assists in evaluating BEACON future state processes and driving necessary practice change to support BEACON best practices 22 23 Ways We Communicate Videos Videos of of team team members members Leadership Leadership e-mails e-mails Web Web sites sites E-Newsletters E-Newsletters (intranet (intranet and and internet) internet) Bulletin Bulletin board board flyers flyers Hospital Hospital Signage Signage Meetings Meetings Leadership Leadership voicemails voicemails PowerPoint PowerPoint presentations presentations One-on-one Training through FBEs, Trainers, Change Management, Readiness Rounds, etc http://www.baycare.org/BEACON 24 24 Effective Process-Oriented Governance Structures 25 25 Project Governance Board of Trustees Executive Oversight Board Clinical Systems Governance BEACON Governance Physician Advisory Governance Office of the President (BEACON) CIO Council Clinical Systems Steering Committee (BEACON Executive Steering Team) Documentation Task Force BEACON Project Steering Team BayCare Clinical Standards Committee (BEACON) BEACON PACo (Physician Advisory Council) Clinical Practice Council Medical Imaging Sub-committee Pharmacy Informatics Workgroup = Nursing = Information Services Medication Administration Workgroup Peds Collaborative Workgroup Legend = BEACON CIC = Physician * = Workgroups ** = Workgroup Launching 9/09 Launching 1/10 (Clinical Informatics Council) OB Collaborative Workgroup Cardiology Workgroup OB Workgroup Peds Workgroup CDS Workgroup Neurology Workgroup** Facility PACS Adult Med Workgroup NICU/PICU Workgroup Surgery Workgroup* Oncology Workgroup ED Workgroup Beh. Health Workgroup* ICU Workgroup Critical Care Workgroup 26 Questions and Discussion 27