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Thayer County Health Services Presentation for Indiana Rural Health Association. The Road to Successful EHR Implementation Joyce Beck, LPN, MHA December 1, 2010. Objective of Presentation.

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Thayer County Health Services Presentation for Indiana Rural Health Association

The Road to Successful EHR Implementation

Joyce Beck, LPN, MHA December 1, 2010


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Objective of Presentation Health Association

  • Background of Thayer County Health Services EHR Implementation and formation of Southeast Nebraska Health Information Exchange

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


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Background of TCHS EHR implementation Health Association

  • 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


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The Road to Successful EHR Implementation Health Association

  • 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


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Commitment to Patient Safety Health Association

  • 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?


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Commitment to Patient Safety Through Education Health Association

  • 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


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Commitment to Patient Safety Through Process Improvement Tools

  • TeamSTEPPS

  • Lean

  • Balanced Scorecard



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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


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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



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Determine the Vision implementation of EHR


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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?


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Evaluation of Financial Options implementation of EHR

  • What capital is needed?

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

  • Disaster recovery costs

  • Fire suppression and data protection


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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?


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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


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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


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Calculation for Medicare Reimbursement implementation of EHR

Formula for calculating Medicare Share:

#IP Part A Days + #IP Part C Days

Total IP Days x [Total Charges-Charity Care]+20%

Total Charges


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CAH A Information implementation of EHR

  • CAH A had 300 Part A IP days and 400 Part C IP days, total inpatient days were 1000, total charges excluding charity care were $2M, total charges were $2.2M


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Results for CAH A implementation of EHR

_____700______

1,000 x [__$2 M__]

[ $2.2 M ] +20% Equals 97% Preliminary Incentive Payment of $388,000


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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!


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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


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Vendor selection process implementation of EHR


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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


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Timeline example implementation of EHR


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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


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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


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References implementation of EHR

  • http://www.csm.gov/EHRIncentivePrograms

  • Seim Johnson Accounting Firm

  • CUSP Consultants



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