Overview: HIMSS Nicholas E' Davies Award of Excellence

1

• Overview HIMSS Nicholas E. Davies Award of
  Excellence
• Friday, October 12, 2007
• Joan Duke, FHIMSS
• Davies Organizational Committee Member
• Managing Principal, HCIC, LLC

2
Davies Awards of Excellence

• Named in honor of Dr. Nicholas E. Davies, an
  Atlanta-based practice physician committed to the
  ideal of improving patient care through better
  health information management
• Encourages and recognizes excellence in the
  implementation and use of EMR-EHR systems
• Strategy
• Planning
• Governance
• Implementation
• Project Management
• Value ROI

3

• The program's objectives are to
• Promote the vision of EHR systems through
  concrete examples
• Understand, encourage, and share documented value
  of EHR systems
• Provide visibility and recognition for
  high-impact EHR system
• Share successful EHR implementation strategies
• Awards
• 1995 First Organizational Awards - 25
  recognized to date
• 2003 First Ambulatory Awards -15 recognized
  to date
• 2004 First Public Health Awards - 9 recognized
  to date

4

• Application Process
• Applications are reviewed by independent peer
  group including industry leaders and previous
  award winners
• Applications scored based on established
  objective criteria updated regularly reflecting
  EHR adoption stages
• For organizational applicants a shorter Threshold
  application is reviewed to determine if applicant
  meets initial screens
• If threshold is met, Full application is
  submitted for evaluation
• Committee scores and discusses each site to
  determine final candidates
• Site visit conducted to confirm applications of
  those determined to be candidates for the award
• http//www.himss.org/asp/davies_application.asp

5

• Resources
• Past recipients applications
• http//www.himss.org/asp/daviesAward.asp
• Davies Fact sheetshttp//www.himss.org/ASP/davies
  _factsheets.asp
• Davies White Paper series
• http//www.himss.org/ASP/davies_whitepapers.asp
• Davies book
• Improving Quality and Reducing Cost with
  Electronic Health Records Case Studies from the
  Nicholas E. Davies Awardshttp//marketplace.himss
  .org/acct618b/Default.aspx?tabid39actionTargs
  EHR
• HIMSS08
• Presentations by 07 recipients across all three
  Award types

6

• Application Due Dates
• Organizational Award Mon, March 31
• Ambulatory Award Wed, April 30
•  
• Public Health Award Fri, March 14
• Community Health Organization (CHO) Award
• - To be launched in January - Application due
  date TBD
• For additional information
• David Collins
• HIMSS, Davies Awards Manager
• dcollins_at_himss.org or 703-562-8817

7
Toward Quality Care

• Dr. Jim Morrow
• North Fulton Family Medicine, P.C.
• Cumming, Georgia

8
The value of a network increases as the square
of the number of users on it.
Metcalfs Law
Robert MetcalfeInventor of the Ethernet
9
The plan
Skate to where the puck is going not to where
it is.
Wayne Gretzky
10
(No Transcript)
11
You can move from this
12
To this
13
And from this
14
To this
15
North Fulton Family Medicine
2006
1998
2 4 0 1 0 0 1 100
Offices Physicians Mid-Level (PA-C) Registered
Nurses Administrator Business Manager Office
Managers Daily Encounters
4 11 11 2 1 1 4 400
16
Staffing Requirements
2001-'06
1998
4.7
2.8
FTEs
per provider
17
How Do You Succeed?

• A strong physician desire to initiate change
• A need to bring costs under control
• A good implementation team
• An implementation specialist who cared about our
  needs
• A company who puts service above everything else

18
What About ROI?
Return On Investment
19
Our ROI

• Chart handling 100 charts managed/day 625 mins
  _at_11/hr 29,791/yr
• New chart formation 19.6/day _at_ 10 mins per
  chart 196 mins _at_ 11/hr 9,342/yr

Based on 100 patients per day
20
Our ROI

• Chart searches 330 mins/day _at_ 11/hr
  16,456/yr
• Transcription transcribing, filing, managing
  20 lines per note _at_ 0.10/line 110,000/yr

21
Our ROI

• Lab Results _at_ 45 draws/day 315 min _at_ 12/hr
  16,380/yr
• Referral Letters dictation and transcription
  32,640/yr
• Chart Supplies forms, notes, lab sheets, history
  forms, problem lists 24,480/yr

22
Our ROI

• Represents a savings of 44 hours per day or
  11,440 billable staff hours per year
• Total saved (year) 239,089 (at 100 patients
  per day)
• At 450 patients per day the savings REAL
  MONEY

23
The Bottom LineCost Per Patient Visit
Paper
EHR
112. 47
79.32
Savings
33.15/visit
24
So What About

• Quality
• Access
• Connectivity

25
Access Access Access

• Allows patients to
• Message us securely, quickly
• View lab results
• View medication lists
• View problem lists
• Request refills, referrals, appointments
• Participate in their care

26
(No Transcript)
27
Limiting Access/Securing PHI

• Data is secured
• Three levels of passwords
• Passwords change regularly
• Never a pre-determined password
• Firewall/Antivirus/Backup

28
What Does AllThis HIT Do For Us and Our Patients?
29
Outcomes Are The Real Rewards

• We can now affect and track quality of care at an
  outcomes level
• Track HgbA1cs, LFTs, PTs, PSAs, cholesterol,
  blood pressure levels
• Monitor compliance with routine screenings
  (colonoscopy, mammography, bone density,
  exercise stress testing, etc)

30
Visual Reinforcement
31
External Connectivity

• Now we receive reports
• securely
• electronically
• legibly, and
• much more quickly

32
Connected
33
Tracking Tests / Procedures

• Ability to monitor results
• Search for labs not yet resulted or reviewed
• Search for procedures not yet resulted or reviewed

34
How Do YouDo This?
35
All at Once

• Successful implementations are done as a group.
• Dont separate providers in a single office
• Try to bring like systems/processes on line
  simultaneously.
• Resist those who advocate individual
  implementations.

36
Mandatory

• Most important declaration of all.
• Absolutely positively MUST use the EMR.
• Might not be the elder statesman that resists you.

37
Templates

• Physical Exam templates
• Enough to get started
• Review of System templates
• Basic system orientation
• Include negatives only

38
Electronic Superbill

• Create an electronic version of your paper
  superbill
• Categorized as your paper version is today for
  ease of locating codes

39
Training

• Failed implementations LACK adequate training
• Failed implementations LACK adequate training
• Failed implementations LACK adequate training
• Failed implementations LACK adequate training

40
The Champion

• Probably should be a physician
• Could be a staff member, with a lot of physician
  support
• Computer knowledge a plus, not essential
• A vocal member of the group

41
Paper to Paperless

• Piece-meal approach worked for us
• Complete chart conversion by the third visit
• Scanning of graphics, reports, consults
• Select most pertinent and recent items

42
Old Records

• Ongoing issue
• Select pertinent items and scan them
• Return to patient for storage

43
Wiring

• CAT-5 cable runs
• Workstation design
• Printers and locations
• Server room
• Millwork changes
• Millwork design

44
Wireless

• What size and type
• Laptop, Tablet PC, PDA ???
• Where will the triage process occur and be
  documented?
• Who to buy what hardware for
• Access points/signal strength

45
A Hybrid

• Wireless and Wired
• Tablet PCs for providers
• Desktops at nurses stations
• PDA for off-site use

46
VPN

• Ability to access the EMR off site
• Easy access to software and network
• Requires VPN agent on distant computer
• Secure access
• This is a thing of beauty!

47
Other Off-Site Access

• GoToMyPC.com / LogMeIn.com
• Allows secure access from anywhere in the world
  with internet access
• Monthly cost
• Speed can be an issue
• Access is worldwide

48
IT Support

• A local company
• Check references
• Check them again
• Two or more quotes
• On-site survey of your facility
• Communicate with the vendor
• Get it ALL in writing!!

49
Antivirus Software

• Keep it updated. Spend money on it.
• Have one person (CIO?) liaise with the IT company
• Keep a log

50
Backup

• To tape
• To separate server
• To distant server
• To vendors disaster recovery system
• Check the saved data for restorability
• It is not there until you prove it is there!

51
Firewall

• Keeping others out of your server
• Again, spend money on this
• Update it
• Check it
• Check it again!

52
Dress Rehearsal

• Twas the Night Before Go Live
• Separate into actors and staff
• Start with check-in
• Triage
• Old records
• Physician encounter
• Lab orders/collection
• Procedure entry
• Visit documentation
• Prescription printing
• Check out

53
Now what???

• Go !!

54
Conclusion

• Success depends on you
• The evolution of IT and healthcare is upon us now
• The return on your investment can be measured in
  real dollars
• The ultimate ROI is job satisfaction, a sense of
  accomplishment, and success in todays changing
  world

55
Toward Quality Care
Dr. Jim Morrow North Fulton Family Medicine,
P.C. Cumming, Georgia drmorrow_at_nffm.md