Rural Hospital-Led Community EHR Project: Peaks and Valleys

1. Rural Hospital-Led Community EHR Project: Peaks and Valleys California State Rural Health Association Conference November, 2010

2. Rural Hospital-Led Community EHR • What motivation is there for a rural hospital to lead a community EHR project • How Greater Sierra Health Information Organization evolved • Peaks • Valleys • Getting Started

3. Case for Action • Multiple physicians leaving area to join large medical groups • Difficulty recruiting new Physicians despite competitive package • Increased competition for ancillary services • Strained relationship with local providers

4. Greater Sierra Health Information Organization (GSHIO) Vision • Our vision was to select a single ambulatory EHR system that would be available to allcommunity health providers at an affordable rate.

5. Cost Justification • Operational Efficiencies & Savings • Redesign Patient Experience • New Revenue Opportunities • Lost Charge Capture

6. GSHIO Vision

7. GSHIO Sustainability • Hospital Contribution • Physician ASP Fees • Future Grants • Service Provider Revenue

8. Community Case for EHR • Patient Experience: continuity of care experience (consents, documents, tests); improved & timely communication with provider • Provider Experience: patient referral process improved (patient health records) • Public Health reporting: beyond “reportable disease”  disease surveillance • Community disease and prevalence rates  more data leading to targeted and timely resource use within community

9. Patient Case for EHR • Access to electronic copy of patient records • Ability to communicate with provider via internet • Ability to view test results at home • Ability to complete forms, schedule appointments from home

10. Physician Office Case for EHR • Incentive payments (ARRA)  revenue enhancement • ePrescribe payments (CMS)  revenue enhancement • Quality measures reporting (PQRI)  revenue enhancement • Investment in practice (sale of practice) • Office efficiency  expense reduction • Training assistance goes beyond product training  exposure to “best practices” by trainers benefits office practice

11. Hospital Case for EHR • Community Leadership Opportunity  largest cost of uncoordinated care borne by hospitals • Physicians connected to hospital  leveraging of hospital resources (information, staff) to assist in physician office movement towards EHR implementation

12. GSHIO - Peaks • Funds to start project • PM/EMR product unanimously chosen • Support team formed • First offices implemented • Hospital interface with EHR • Hospital impact – insurance verification with orders; diagnosis codes with orders; demographics with orders • Addition of hospitalists/ED to move towards hospital “meaningful use”

13. GSHIO - Valleys • Delays due to contracting (physician participation agreement) • Office “wait and see” hesitation • Connectivity issues in rural areas • Economic conditions – practices under pressure • More interfaces to build to increase efficiency

14. GSHIO Meaningful Use Roadmap • Project Leadership – Steering Committee • Best Practices – teaching the community • Community Quality Project  prevalence rates, improved reporting, surveillance • Pilot for other communities (coordination of care  SNF, schools, correctional facilities) • Pre-Post implementation evaluation  metrics (A/R, ePrescribe $$, ARRA funding) • Move from SURVIVE to THRIVE

15. Getting Started … • Identify Physician Leadership • Internal (hospital) Champion • Hospital IT – current status, current interface requirements for community MU • Assessment – community EHR penetration rate, community physician EHR early adopters (Community clinics!) • HIT Information, Education, Grants champion • Get Involved with Rural HIT collaboratives • Develop Vision & Strategic Plan • Identify Community Partners • Leverage Community Resources!!!