Supporting Health Care Delivery to Americas Military

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Second AHLTA Users ConferenceAfter Action Report
Implementation and Integration IPT 12 December
2006
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Overview

• Conference Objectives
• Attendees
• Main Concerns
• Leadership
• Communication
• Training
• Operational Impacts
• Policy Issues
• Next Steps

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Conference Objectives

• Provide Updates from May Super User Conference
• Improve customer satisfaction
• Recognize Centers of Excellence
• LT Steve Steffensen The Pensacola Experience
• Naval Medical Center San Diego Business Process
  Re-engineering
• Group Forums for AHLTA Users
• Clinical Operations
• Discussion of Clinical and Policy Impediments to
  Adoption of AHLTA
• Communications Forum
• Discuss improving avenues of communication
• Training Forum
• Recommended corrections in training of AHLTA
• Focus Group
• End User Relations Website and Online Forum

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Attendees

• Welcoming Remarks
• Dr. Winkenwerder
• CAPT David Tam, Deputy Commander NMCSD
• Mr. Hendricks
• Attendees
• Services Selected 57
• Army 11
• Navy 23
• Air Force 23
• 2 Invited Guests from California Health Care
  Foundation

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Common Themes 1st and 2nd Conferences

• Leadership
• Communication
• Training
• Operational Impacts
• Policy

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Leadership

• Leadership Support Successful Adoption
• Embrace Business Process Re-engineering
• Empower users to implement solutions
• What do you want?
• Access to care?
• Note quality and AHLTA use decreases
• Emphasis on RVUs?
• Provide Coding Training
• Emphasize document quality not node count
• AHLTA Use?
• Support Training needs
• Adjust appointment times to allow for AHLTA note
  completion

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Leadership

• EHR not yet part of the culture
• Identify Head or Cranium for MHS, Services
• Lack of or inconsistent AHLTA policy
• Leads to multiple approaches to document the same
  data, and confounds later AHLTA usage
• Ex Scanning to Clinical Notes - What header
  should be used for what type of scanned document?

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Communication

• Vital information not reaching end users
  Failures breed contempt
• Need to disseminate release notes for new builds
  and lessons learned across MHS
• Prevent sites going through the same problems
  over and over with new patches/builds
• Use redundant means of information dissemination
• Ex. Very few users knew of the CITPO scanning
  guidance from May 2006
• One stop shop for everything AHLTA

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Communication

• Create banner notification in AHLTA for
  clinically-relevant information
• Failure of Lab Interoperability
• Family History Autocite Errors
• Break IT/Clinical Barriers for Communications
• Not getting feedback or questions once trouble
  tickets are submitted
• Services now have clinical champion groups to
  represent user community
• Organizational focus is on future development
• Users want AHLTA to work well dont dangle new
  functions in front of us

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Training

• Train right from the initial usage of AHLTA
• Providers train providers, specialists train
  specialists
• Sustainment trainers dont understand provider
  workflows
• Give users the tools for success, then teach them
  to use the tools
• New users need adequate training- depends on MTF
  leadership support
• Refresher training must be frequent and include
  CME credit
• Train optimum documentation, not tool usage
• Focus on coding
• Provide a method for review and feedback
• Coding trainers at facilities, available to
  providers

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Operational Impacts

• Staffing Issues
• Frequent deployments and staff turnovers
• Inadequate support staff ratios
• Not all support staff trained to use AHLTA, i.e.
  admin
• Facility Issues
• Computer is seen as an obstacle to
  patient-provider interaction
• Clinics not designed for optimum EUD distribution
• Security Issues
• Must share EUDs - conflicts with current login
  procedures
• Create unapproved workarounds to defeat security
  obstacles

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Operational Impacts

• Performance and Stability Issues
• More workarounds.
• Decreased quality of note peer reviewers excuse
  poor documentation in AHLTA
• Print blank SF 600s to write note and enter into
  AHLTA later
• Free text in Word and scan into encounter
• Increased use of transcription services
• Site specific workarounds
• Expensive and wasteful
• May affect system performance i.e. scanning
• May have unknown security and legal implications

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Common Themes

• No guidance to mesh AHLTA Functionality to
• JCAHO and other regulatory agencies
• Patient Safety, Documentation Quality
• Readiness
• Need a minimum standards set for templates,
  forms, MEDCIN term use, etc
• AHLTA does not support the forms needed for
  non-clinical entities
• Who control forms as Forms Committees do now?
• Dont preach new functionality

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Next Steps

• IM will work with Clinical and Program Policy
  staff to help develop policies addressing
  concerns of AHLTA users
• Create one-stop shop for AHLTA information
• - Create virtual online forum for
  communication and training
• - Monitor and facilitate End-User
  Relations Site
• Provide regular updates to conference attendees
• Plan next conference now!

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Backup Slides
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Meeting Comments

• More opportunities should be given to highlight
  best practices. Many other people would have
  like to present.
• Folks - you have had the survey results for
  months and heard the same things from us. Did we
  yell louder this time? Survey the angry mob
  will only work once.
• Great start - the morale of the users rides on
  response from leadership.
• The conference was too short. We should be able
  to get CME's for the conference. Good job!
• Smaller focus groups - 'group think" often
  develops quickly, so a larger number of groups
  likely will broaden representation of concerns.
• Give pre-conference questionnaires via e-mail to
  identify top issues before conference.
• Last minute setting up of conference. Poor
  communications regarding who is going.

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NHP Has Leadership Support!