INDIAN HEALTH SERVICE

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WIND RIVER SERVICE UNIT
IHS EHR

• INDIAN HEALTH SERVICE
• EHR
• ELECTRONIC HEALTH RECORD

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ONE SERVICE UNITS EXPERIENCE IN IMPLEMENTING THE
INDIAN HEALTH SERVICES ELECTRONIC HEALTH RECORD
WIND RIVER SERVICE UNIT
IHS EHR

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WIND RIVER SERVICE UNIT
IHS EHR

• Two Ambulatory Care Facilities About 25 Miles
  Apart In Rural Wyoming
• IHS Service Unit-Not Contracted
• About 85,000 Visits Annually
• Approximately 120 Employees
• Physicians Admit To Local Community Hospital
  About 15 Miles Away
• Busy, Understaffed, and Under Funded

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Decision?
WIND RIVER SERVICE UNIT
IHS EHR

• The Service Unit must make the decision as to
  whether they are ready to make the investment of
  resources toward the EHR.
• There should be agreement throughout the
  Governing Body/Management Team that the EHR is
  worthy of the required resources.

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Consultation
WIND RIVER SERVICE UNIT
IHS EHR

• Tribal Council
• Patients
• Staff
• Area Office
• Other EHR Users

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You Need Commitment!
WIND RIVER SERVICE UNIT
IHS EHR

• Like the pig-------------not like the chicken!

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Ham And EggsCommitment Vs Involvement
WIND RIVER SERVICE UNIT
IHS EHR
Involved

Committed
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Who Needs The Commitment?
WIND RIVER SERVICE UNIT
IHS EHR

• Resource Managers
• All Clinical Staff
• All Administrative Staff
• Information Technology Staff
• Area Office Consultants
• Everyone

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Getting Started
WIND RIVER SERVICE UNIT
IHS EHR

• Project Coordinator
• CAC Clinical Activities Coordinator
• Service Unit EHR Team
• IT Infrastructure

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EHR Project CoordinatorandClinical Activities
Coordinator
WIND RIVER SERVICE UNIT
IHS EHR

• Interpersonal Skills
• Proactive and Helpful Nature
• Management Skills
• Facility Working Process Knowledge
• Computer Skills

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Service Unit EHR Team
WIND RIVER SERVICE UNIT
IHS EHR

• Enthusiastic Workers
• Representative Of All Services
• Managers
• Health Information Services
• Clinicians
• Information Technology

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WIND RIVER SERVICE UNIT
I H S E H R
Note This Ex Highway Line Painter Now Works For
IHS
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EHR Team Meetings
WIND RIVER SERVICE UNIT
IHS EHR

• Meet At Least Weekly
• Encourage Active Participation
• Develop Your Plan Early
• Promote Assignments Between Meetings
• You Are Developing Your SUPERUSERS
• Create EHR Ownership
• Keep Moving Even If Its Hard

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IT Infrastructure
WIND RIVER SERVICE UNIT
IHS EHR

• Cachet
• PIMS
• Pharmacy 5.0/7.0
• Hardware

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Early Decisions
WIND RIVER SERVICE UNIT
IHS EHR

• Inpatient-Outpatient or Both
• Which Services? Dental, PHNs, Optometry..
• And To What Extent? Order Entry Only?
• Desktops, Laptops, or Tablets
• Hard Wired or Wireless Network And Where
• Equipment-Routers, Servers, Switches, Telephone
  Lines, Computers, Printers, Power Protection..
• Facility Issues-Space, Wiring, Privacy, Flow..
• Funding
• Promotional Activities

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Develop Your Implementation Plan
WIND RIVER SERVICE UNIT
IHS EHR

• Specific To Your Site And Your Staff
• Specific As To Timing
• Big Project-Dont Get Overly Aggressive
• Implementation Tied To Training
• Lots of Training
• Stick To Plan -- Adjust If Necessary

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Implementation Timetable
WIND RIVER SERVICE UNIT
IHS EHR

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Training Phase 1
WIND RIVER SERVICE UNIT
IHS EHR

• Demonstration By Knowledgeable User
• Limit to 1 Hour Or So
• Promote Discussion on How Certain Functions are
  Accomplished EHR Capabilities
• Deal With ConcernsAllay Fears

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Training - Phase 2
WIND RIVER SERVICE UNIT
IHS EHR

• EHR Test System Loaded On All Users Computers
• Set Up Proper Permissions for Everyone
• Promote Self Exploration of EHR
• Promote Lookup Of Demo Patient Info
• Newsletter

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Training Phase 3
WIND RIVER SERVICE UNIT
IHS EHR

• Multiple Classroom Sessions
• Schedule Staff Appropriately
• Train Everyone Not Necessarily Together
• Consider Departmental Trainings
• Train, Then Implement Promptly
• Have Hardware And Permissions Issues Resolved
  Before Classroom Trainings
• Use Knowledgeable Trainers
• One-On-One Training Also

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WIND RIVER SERVICE UNIT
IHS EHR

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More On Training
WIND RIVER SERVICE UNIT
IHS EHR

• About 2 Hour Sessions Away for Work Area
• Demonstrate for About 1 Hour
• Hands-On for About 1 Hour
• Have A Task List for Hands-On Session
• Competency Check List
• Again, Make Sure Equipment Is Functional and
  Permissions Are Correct Before Session

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File Setup
WIND RIVER SERVICE UNIT
IHS EHR

• New User File Provider File
• Hospital Location File
• User Class File
• Document Class And Document Title Files
• Lab Files
• Radiology Files
• Medication Files
• Pick Lists for Procedure And Diagnosis Codes

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Quick Orders
WIND RIVER SERVICE UNIT
IHS EHR

• Pharmacy
• Lab
• Radiology
• Nursing

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Business Rules
WIND RIVER SERVICE UNIT
IHS EHR

• Verbal Orders
• Protocol Orders
• Check In Procedures
• Queues
• Lab Results
• Pulling Charts
• Printing And Filing Chart Copies
• And On And On And On

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Note Templates
WIND RIVER SERVICE UNIT
IHS EHR

• Some Available From VA
• Alpha Sites are Developing Templates
• Can Be Exported And Shared
• Need a Template Specialist Trained At Each
  Service Unit
• Need A Basic Library of Templates To Get Started
• Develop More Personalized Templates After Using
  EHR For A Time

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Permissions and Keys
WIND RIVER SERVICE UNIT
IHS EHR

• Provider Key
• Order Keys
• BTRI Keys
• Screen View Templates
• Visit Creation Parameter
• Co-Signature Parameter
• Electronic Signature Assignment

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Personal Preferences
WIND RIVER SERVICE UNIT
IHS EHR

• Progress Note Titles
• Personal Patient Lists
• Screen Views
• Establishing Teams
• Notifications
• Surrogates
• Order Check Criteria

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Final Equipment Details
WIND RIVER SERVICE UNIT
IHS EHR

• Live System Loaded, Tested Retested
• Full Location Computer Availability
• Lab Order And Nurse Order Printers
• Chart Copy Printers
• Network Printer For Patient Information
• Recharging Equipment for Portable Units
• Stands, Carts, Space, Privacy Issues

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Going Live
WIND RIVER SERVICE UNIT
IHS EHR

• Stepwise
• Progressive
• IT Support
• Intense CAC Support
• Make Appropriate Scheduling Adjustments
• Coordinate Departments
• Back-up Plan

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Medical Records Issues
WIND RIVER SERVICE UNIT
IHS EHR

• Pulling Of Paper Chart?
• Filing In Paper Chart?
• Print And File Chart Copies? Batch Print?
• Release Of Information?
• Outside Paper? Scanning?
• Incorrect Entries?
• Record Quality Assurance?

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Coding Issues
WIND RIVER SERVICE UNIT
IHS EHR

• No Longer An Encounter Form
• Daily Error Reports
• Non-Merged Lab and Pharmacy Visits
• No POV, EM Code, Activity Time
• ICD Coding By Providers
• Duplicate Visit Creation
• Hospital Location File Issues

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Business Office Issues
WIND RIVER SERVICE UNIT
IHS EHR

• Services Pick List Development, Installation, And
  Training
• Missing EM Codes
• No Hard Copy To Work With
• EHR Notes Are Legible
• Great Opportunity For Improved Provider
  Documentation Increase Billing/Collections

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WIND RIVER SERVICE UNIT
IHS EHR

• James (Bob) McKnight, CAPT, USPHS, Ret
• 18 Chambers Drive
• Lander, Wyoming, 82520
• Phone [phone] work
• [phone] home

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WIND RIVER SERVICE UNIT
IHS EHR

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WIND RIVER SERVICE UNIT
IHS EHR

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WIND RIVER SERVICE UNIT
IHS EHR