City of Austin Community Health Centers

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City of AustinCommunity Health Centers

• EMR Implementation

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City of Austin Community Health Centers

• Services
• Primary Care
• OB/GYN
• Pediatrics
• Dental
• Behavioral Health
• HIV
• Nutrition

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City of Austin Community Health Centers

• Size
• Over 200,000 visits per year.
• Over 100,000 patients.
• 20 locations.
• Over 200 providers, 60 residents.
• Over 400 users.

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City of Austin Community Health Centers

• Project History
• Needed to replace Practice Management System.
• In Oct. 2002, the Citys CIO the CHCs CEO
  co-funded a consultant to develop RFP, manage
  selection process, negotiate contract and oversee
  implementation of both Practice Mgt. and EMR.
• System selection process completed in mid 2003
  contracted with NextGen Healthcare Systems in
  late 2003.
• Funding for project from Capital Improvement
  Project Bond funds.

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City of Austin Community Health Centers

• Implementation Timeframe
• Practice Management System phased rollout in
  2004.
• EMR Design and Rollout beginning in 2005 with
  target completion in October 2006.

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City of Austin Community Health Centers

• EMR Team Composition
• 1 RN (Trainer, Nursing Coordinator, backup RN for
  go live support, clinical liaison)
• 1 RHIA/HIM Expert (SuperUser, Documents
  Developer, Trainer, Go Live Support)
• 1 Physician Champion (Provider coordinator,
  clinical UI designer, Provider Trainer)
• 1 Tech/Project Mgr (UI Builder, Interface
  Programmer, Report Builder, Project Leader)
• IS assistance on non-application requirements
  including hardware/network/security etc.

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City of Austin Community Health Centers

• EMR design approach
• Review and refine templates and documents with
  user group.
• Introduce with one specialty type at Pilot site.
• Refine specialty type and deploy to all providers
  at Pilot site.
• Refine remaining specialty types at Pilot site
  and enhance processes to speed up encounter..
• Finalize hardware configuration.

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City of Austin Community Health Centers

• EMR deployment approach
• One Clinic hallway every two weeks.
• All visit types introduced.
• Start off with two to three encounters per
  session.
• Target 100 adoption within 45 days.

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City of Austin Community Health Centers

• EMR hardware configuration
• Linux workstations with multi-simultaneous users
  (kiosk) capability running citrix client.
• Workstations in each exam room for History,
  Provider Charting and Discharging.
• Workstations placed in in-take room and mounted
  in hallways.
• Network Printers in Provider offices, hallways
  and Nurses area.
• Citrix farm.
• SQL Servers with EMC

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City of Austin Community Health Centers

• Challenges
• Technology
• Wireless network security requirements.
• Multi-user workstations configurations.
• Wireless network performance issues.
• Security restrictions on wireless
  tablets/labtops.
• Business
• Competing business needs pulling key resources
  for periods of time.
• Expectation management of encounter length of
  time.
• Training the residents.

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City of Austin Community Health Centers

• Successes
• 100 Provider Adoption.
• Fully charted encounters (no dictation).
• Electronic Lab Results.
• Continued Clinician enthusiasm.
• No hold ups on rollout schedule.
• Rollout approximately 50 completed.

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City of Austin Community Health Centers

• Next Steps
• Interface with indigent care collaboration to
  consolidate visit information into EMR from ER,
  Hospitals and indigent care clinics.
• Real time formulary management with RXHub and
  electronic prescription delivery to pharmacies
  using Surescript.

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City of Austin Community Health Centers

• Recommendations/lessons learned
• CEO Commitment.
• Bring in qualified consultant.
• Justify lengthy affordable deployment over one
  that is rushed and unaffordable.
• Try to tie it with a Practice mgt replacement
  effort to consolidate products under one cost.