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Guaranteeing successful EHR implementations EHRs implementations are difficult, don’t go it alone Shahid N. Shah, CEO

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NETSPECTIVE 2 Who is Shahid? • 20+ years of software engineering and multi- site healthcare system deployment experience • 12+ years of healthcare IT and medical devices experience (blog at • 15+ years of technology management experience (government, non-profit, commercial) • 10+ years as architect, engineer, and implementation manager on various EMR and EHR initiatives (commercial and non- profit) Author of Chapter 13, “You’re the CIO of your Own Office”

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NETSPECTIVE 3 Why listen to me? Do you have a well thought-out EHR implementation plan that will guarantee success? Pat yourself on the back and try not to make fun of the rest of us mere mortals. YES! Tell your boss this is the best EHR presentation you’ve ever been to. Adopt the EHR implementation ideas I’m proposing Stay and tell me why I’m wrong or nod your head in agreement. No

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NETSPECTIVE 4 We can help your project today • EHR implementations are very difficult and you will probably need help. Your EHR vendor will not be enough. • If you like what I presented, we are available to help with your EHR implementation efforts, especially where technology and clinical / business folks must communicate better. • Our contact information is at the end of this deck.

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NETSPECTIVE 5 Why are you implementing an EHR? Most obvious, dangerous Most noise, least attention Most promising

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NETSPECTIVE 6 Where are you in your journey? Made the decision to go to an EHR Created the leadership team • IT, Clinical, and Business participation is required Created the selection team Created the implementation team Implementation planned and ready to execute

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NETSPECTIVE 7 How do you know you’re successful? Adoption • What are staff and physician usage metrics? Cost Savings • Did you define reduction in tests, staff, malpractice insurance, data entry, etc.? Quality of care • What quality metrics have been defined?? Service Performance • Have you defined how much faster /better clinical services will be provided? Demand success metrics early on

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NETSPECTIVE 8 EHRs are NOT IT projects Non-IT Leadership Clinical & Business IT & Systems EHR Project PMO Governance Decisions Software Hardware Network Storage Interfacing Workflow Documents Imaging

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NETSPECTIVE 9 Staff Involvement Guidelines 10% 35% 35% 20% Successful EHR Projects Leadership Business Clinical IT 2% 19% 10% 69% Typical (usually unsuccessful) Leadership Business Clinical IT

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NETSPECTIVE 10 Implementation Roadmap Evaluate the current workflow Define documents that will be electronic vs. paper Figure out whether care standardization is possible Redefine and plan for new EHR workflows Evaluate whether staff and physicians are ready for culture shock

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NETSPECTIVE 11 Resist the “big bang” approach Phased approach Your EHR implementation will not be “born” all at once and must be implemented in stages. First, do no harm The EHR is a tool to care for patients and the initial implementation should be as minimal as possible so that it can be see as a success without harming patient care or causing staff revolts. Plan for change There is a beginning for your EHR project but probably no end – assume and plan for routine reconfiguration as the organization adapts to the system (don’t let people create manual workarounds for system problems).

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NETSPECTIVE 12 Transforming workflow before EHR EHR implementation is a perfect opportunity to optimize your clinical and business processes. Do not try to change processes and simultaneously try to deploy a new system and configure it “on the fly”. Always repeat a process manually before you attempt to automate it. If the first time you try out a new workflow process is after you install an EHR then the EHR will get all the blame and it will take longer to implement the change. Reduce culture shock by doing the “human centered” work before technology implementation

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NETSPECTIVE 13 IT Implementation Roadmap Visit existing sites serviced by EHR vendor Define the staff to hardware ratios and usage patterns Plan network bandwidth, wireless / wired networking upgrades Plan data interfacing and data storage (NAS, SAN, etc.) upgrades Plan hardware upgrades (clients, servers, scanners, etc.)

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NETSPECTIVE 14 Practical IT Considerations User to hardware ratio Hardware types flexibility Mobile access System downtime and DR Interfacing & integration How do you get out of a system?

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NETSPECTIVE 15 Paperless document management All paper charts •This is pre-EHR for some •Even after EHR for others Mostly paper charts •Even after EHR, charts are printed before handling •Staff task management and email help here Some paper charts •Most charts are eliminated but without CPOE not all can be •Need nursing automation tools •Physician documentation tools No paper charts •Signed documents, faxes, correspondence are still tricky so scanning is the only option Create a matrix of every document you work with to see how it should be handled

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NETSPECTIVE 16 Ancillary Software Considerations E-mail integration E-Prescribing Microsoft Office and Google Apps (scheduling, document sharing) Clinical groupware Patient registry and CCR bulletin boards Document imaging and scanning Health Information Exchange (HIE) Physician Communications Clinical content repository Hospital website and portal integration Electronic lab reporting Electronic transcriptions Speech recognition EHRs aren’t enough

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NETSPECTIVE 17 Hardware Considerations • If you’re going paperless, you’ll need much more hardware than you think • Regular desktops on the existing cabinetry (which may not have room for the desktops • Laptops on the existing cabinetry • Tablets • Mobile devices • COW carts with desktops or laptops • Wall mounted or pole mounted computers/monitors or laptop stations Workstations Servers Printers Scanners Barcode wands Cameras Biometrics Touch- screens Input devices Wall displays Handhelds

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NETSPECTIVE 18 Network Considerations Wired • Does every room with a device have a network drop? • Consider bandwidth and wall jack locations Wireless on Campus • Can WiFi be used for securely for business- and safety- critical work? • Consider bandwidth, coverage, etc. Wireless off Campus • Is the EHR securely and easily available on cellular networks? • Consider size of data and app UX (screens, etc.) Med Device Connectivity • Will medical devices feed into the EHR?

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NETSPECTIVE 19 Data storage considerations Structured data Coded data Semi- structured data Unstructured data Electronic images Scanned images Faxes Audio Video Chat logs E-mail logs Audit logs Storage isn’t just about hard drives. It’s really about all the different kinds of data and how you will collect, store, extract, interface, retain, and manage it. Define Collect Validate Store Online Extract / Transform Interface Retain? Store Offline

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NETSPECTIVE 20 Consider Virtualization • Before moving into EHRs, consider virtualization: – Servers – Desktops (VDI) – Storage – Networks

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NETSPECTIVE 21 Mobile & Wireless Devices Your EHR implementation must support remote devices, BYOD and mHealth

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NETSPECTIVE 22 EHR Security Considerations Role-based access control to patients, encounters, and documents “VIP” patients and encounters Patient and encounter aliasing Restricting patient records to caregivers assigned to case Restricting caregiver access to specific areas of a chart Redaction of certain data when releasing information Your EHR MUST support all of the following

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NETSPECTIVE 23 IT Security goes beyond encryption • What level of access do technical staff—both internal staff and vendor— need to support the system? • Does system support require access to the application database where patient data are stored? • Can all sensitive information be blocked from support staff’s view and access? • Can troubleshooting be achieved through the use of test data rather than live records? • What means are used for remote support? • For systems hosted by vendors, what audit trails are in place to monitor vendor staff activity? Does the vendor provide access to these logs? • Are audit trails of routine maintenance available?

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NETSPECTIVE 24 Confronting EHR Myths Broken processes are automatically fixed by an EHR. You won’t need to reconcile charts anymore. You will never lose charts again. Loose reports are no longer a problem. EHRs will eliminate staff. You don’t need to store records anymore.

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Thank You. Hire us. Visit E-mail [email protected] Follow @ShahidNShah Call 202-713-5409