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WELCOME. Attendees and telehealth participants to the National EHR Incentive Program Event. WELCOME Rita Luongo, Marketing Director. Attendees and telehealth participants to the National EHR Incentive Program Event.

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  • Attendees and telehealth participants to the National EHR Incentive Program Event

Welcome rita luongo marketing director
WELCOMERita Luongo, Marketing Director

Attendees and telehealth participants to the National EHR Incentive Program Event

Thayer county health services presentation for national ehr incentive program registration event

Thayer County Health Services Presentation for National EHR Incentive Program Registration Event

The Road to Successful EHR Implementation

Joyce Beck, LPN, MHA January 13, 2011

Objective of presentation
Objective of Presentation Incentive Program Registration Event

  • Illustrate TCHS commitment to quality of care through the use of health information technology

  • Support national efforts promote EHR adoption

  • Outline step by step methods used for EHR implementation and obtaining meaningful use

Background of tchs ehr implementation
Background of TCHS EHR implementation Incentive Program Registration Event

  • As a result of CAH-HIT $1.5M grant TCHS implemented EHR in 2008

  • Communication was established with long term care, pharmacy, assisted living, EMT’s and tertiary hospital

  • As a result, Southeast Nebraska Health Information Exchange was formed

  • Nationwide interoperability obtained through NHIN

The road to successful ehr implementation
The Road to Successful EHR Implementation Incentive Program Registration Event

  • Have a commitment to patient safety-you have to want it

  • Examine culture and address issues

  • Determine the vision

  • Evaluation of financial options

  • Formation of EHR project team

  • Vendor selection process

  • Develop timeline with accountability for deadlines

Commitment to patient safety
Commitment to Patient Safety Incentive Program Registration Event

  • There has to be a driving force in the facility to create a safe environment for the patient-you have to want it

  • In everything you do patient safety has to come first

  • What are your commitments to patient safety?

Commitment to patient safety through education
Commitment to Patient Safety Through Education Incentive Program Registration Event

  • Hardwiring Excellence

  • Practicing Excellence

  • The 7 Habits of Highly Effective People

  • If Disney Ran Your Hospital

  • How Full is Your Bucket

  • Customer Service in Health Care

  • Flight of the Buffalo

Commitment to patient safety through process improvement tools
Commitment to Patient Safety Through Process Improvement Tools

  • TeamSTEPPS

  • Lean

  • Balanced Scorecard

Examine culture and address issues
Examine Culture and Address Issues Tools

  • Culture must be a just culture:

  • Culture in facility must be open and fair

  • Culture must be one of learning

  • Culture must design safe systems

  • Culture must manage behavior choices

Behavior standards
Behavior Standards Tools

  • Based off the book Hardwiring Excellence

  • Developed by employees

  • They are part of annual review and count equally with job performance

  • Scores are calculated from peer review

  • A score of 80 or below requires employee to be on probation

  • If, in 90 days a repeat peer review does not score higher than 80 they are terminated

Determine the vision
Determine the Vision implementation of EHR

Once vision determined next step
Once vision determined-next step implementation of EHR

  • Perform a gap analysis

  • What do you currently have in place and is it working for you?

  • What systems do we need to meet MU?

  • What other systems do you want in place for patient safety?

  • What resources do you need to meet goal?

Evaluation of financial options michael pracheil cfo
Evaluation of Financial Options implementation of EHR Michael Pracheil CFO

  • What capital is needed?

  • Considerations should include software, hardware, training, travel, data migration

  • Disaster recovery costs

  • Fire suppression and data protection

Financing implementation of EHR

  • Is there enough cash on hand for project?

  • Lease options?

  • Donations and grant available?

  • What resources are available through Medicare and Medicaid?

Medicare share
Medicare Share implementation of EHR

  • “Reasonable cost” is based on cost incurred for purchase of certified EHR system during the cost reporting period and similarly incurred cost from previous cost reporting period

  • Includes acquisition costs for the purchase of depreciated assets such as computers and hardware and software

Example implementation of EHR

  • CAH A incurred reasonable cost of $500,000 for purchase of certified EHR during previous cost reporting period. The CAH depreciates $100,000 in previous cost report leaving $400,000 of undepreciated costs

Calculation for medicare reimbursement
Calculation for Medicare Reimbursement implementation of EHR

Formula for calculating Medicare Share:

__ #IP Part A Days + #IP Part C Days___ + 20%

Total IP Days x Total Charges - Charity Care

Total Charges

Cah a information
CAH A Information implementation of EHR

CAH A had 300 Part A IP days and 400 Part C IP days, total inpatient days were 1,000, total charges excluding charity care were $2.0M, total charges were $2.2M

Results for cah a
Results for CAH A implementation of EHR


1,000 x _$2.0 M__ +20%

$2.2 M Equals 97% Preliminary Incentive Payment of $388,000

Incentive payment
Incentive Payment implementation of EHR

  • The best advice concerning incentive payment is: KEEP UP

    Changes can occur all the time. What you learn

    today may not apply tomorrow!

Formulation of ehr implementation team
Formulation of EHR Implementation Team implementation of EHR

  • Team should have representation from all departments

  • Open communication vital for success of team

  • All members of the team do not need to agree

  • Set goals and meet those goals

  • Total team commitment to get project completed

  • Regular meetings are important

Vendor selection process
Vendor selection process implementation of EHR

Develop timeline for project
Develop Timeline for Project implementation of EHR

  • Numerous methods available to use for timeline

  • Identify tasks and mark the tasks that are mission critical

  • Set start and stop dates

  • Identify people in charge of tasks

  • Hold people accountable for tasks and deadlines

Timeline example
Timeline example implementation of EHR

Accountability for project
Accountability for project implementation of EHR

  • Strong leadership must be in place to ensure timelines are met

  • Accountability can be obtained through the use of just culture and behavior standards

Success of project
Success of Project implementation of EHR

  • Success can be judged by employees and physicians who are satisfied with the system and patients see a positive outcome from implementation

An interoperability option dan engle cio

An Interoperability Option implementation of EHRDan Engle CIO

Nationwide health information exchange

Nationwide Health Information Exchange implementation of EHR

The Nationwide Health Information Network (NHIN) is being developed to provide a secure, nationwide, interoperable health information infrastructure that will connect providers, consumers, and others involved in supporting health and healthcare. This critical part of the national health IT agenda will enable health information to follow the consumer, be available for clinical decision making, and support appropriate use of healthcare information beyond direct patient care so as to improve health.

Challenges implementation of EHR

  • Few rural existing examples

  • Lack of information about options

  • Broadband cost and availabilities

  • Legal barriers

Tchs demonstration
TCHS demonstration! implementation of EHR

Thayer county chose mirth mux option
Thayer County Chose Mirth MUX option implementation of EHR

  • MUX ( Meaningful Use eXchange )

  • National or Global vs. Statewide

  • Cost

  • Minimal bandwidth requirements

  • Non-EHR specific

CONNECT implementation of EHR

  • CONNECT gateway ( open source )

  • 2 step request for information

  • Health Care facilities that have an agreement

  • Patients data that is requested displays

Interoperability demonstration reason for demonstration
Interoperability demonstration-Reason for demonstration implementation of EHR

Information Technology said it would work

Test data had only been sent on the NHIN between facilities

There were doubts from other HIE’s in Nebraska about NHIN

If NHIN was to be endorsed I had to see it myself

If our actions do not help a patient than all is for nothing

Joyce Beck CEO

Wellness check began in tchs in hebron nebraska
Wellness Check Began in TCHS in Hebron, Nebraska implementation of EHR

Dr. Bryan Hubl ordered lab test in Hebron for wellness check

Lab results obtained and placed in EHR in Hebron

Lab results then made available to Redwood MedNet in California for actual wellness exam

Information also available on USB to fulfill meaningful use

Second step of trip was travel to healdsburg california for wellness and radiology exam
Second Step of Trip was Travel to Healdsburg, California for Wellness and Radiology Exam

Wellness exam completed by Dr. Jeff Meckler at Alliance Medical Center, Healdsburg, California

Lab results from Thayer County retrieved by Redwood MedNet via CONNECT gateway

Healdsburg california
Healdsburg, California Wellness and Radiology Exam

Results of labs and x-ray of left hip taken in Healdsburg placed in Alliance Medical Center EHR

Results could be placed on USB bracelet or card at patient request

This product available through 911 Medical ID or Zaptag

Final step
Final Step Wellness and Radiology Exam

Returned to Thayer County Health Services to be seen by Dr. Hubl

Wellness exam as well as results of lab work was available to Dr. Hubl via the NHIN therefore no duplication of testing necessary

Dr. Hubl was able to recommend treatment based on information gathered in both Hebron, Nebraska and Healdsburg, California

Interoperability is a part of mu
Interoperability is a part of MU Wellness and Radiology Exam

Dan Engle CIO

  • Ask questions

  • Talk to vendors

  • Don’t accept one solution options

“Don’t Worry about Interoperability, Wellness and Radiology Exam

Until you are Operable!”

References Wellness and Radiology Exam


Seim Johnson Accounting Firm

CUSP Consultants

Questions? Wellness and Radiology Exam

Contact information
Contact Information Wellness and Radiology Exam