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
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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
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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
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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
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Questions and Discussion
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