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Seattle Indian Health Board Electronic Health Record Implementation.ppt

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					Seattle Indian Health Board
 Electronic Health Record
      Implementation




       Crystal Tetrick, MPH
        Associate Director
      Health Care Operations
                               1
Seattle Indian Health Board
 Founded in 1970
 Private non-profit
 Receive IHS Title V grant
 Receive BPHC 330 grant
 6,000 unduplicated users
 25,000 encounters
 55% AI/AN

                              2
Three Locations
 Leschi Center (611 12th Ave S):
     Health Care Services: Medical, Dental,
     WIC/Nutrition, Pharmacy, Lab, Family Practice
     Residency Program, Diabetes, Cardiovascular
     Disease Prevention Programs
     Community Services: Mental Health,
     Domestic Violence Advocacy, Youth Program,
     Elders Program




                                                     3
Thunderbird Treatment Center
(Renton Ave S.)
    96-bed residential facility
    Both intensive and long-term treatment
Outpatient Chemical Dependency
Treatment (12th & Jackson)
    Assessment and counseling




                                             4
Existing Systems
 Misys Script Practice Management
 (Late 80’s-2008)
 Benefits
     Scheduling & billing
 Disadvantage
     No EHR
     DOS application




                                    5
Existing Systems
 TARGET (Treatment and Report
 Generation Tool)
 – Benefits
     Patient registry
     Utilization reports
     Treatment outcomes
     Demographic reports
     Easy to use
 – Disadvantages
     Stand alone
     Required double-entry

                                6
Existing Systems
 CDEMS, WIC, Prenatal
 – Benefits
     Reporting
     Disease registry
 – Disadvantages
     Stand alone
     Required double-entry




                             7
Project Outline
Phase 1 2004-2007             Planning & Identifying a
                              System
Phase 2 May 2007-Oct 2007     Vision Practice
                              Management
                              Implementation
Phase 3 Nov 2007-July 2008    EHR Implementation

Phase 4 Jan 2009-April 2009   Dental Digital X-Ray


Phase 5 Jan 2010-March        Charge Passing
        2010
                                                         8
Phase 1: Planning & Identifying a System
         (2004-2007)
Key steps:
      Staff survey
      Vendor selection
      Hired consultant
      Signed contracts




                                           9
Why Misys?
 Upgrade of current system
 Multidisciplinary
 Cost




                             10
Estimated Cost
    Hardware           330,000
    Software           160,000
    Servers            110,000
    Wireless             30,000
    Consultants          95,000
    Training/Travel     160,000
    Temp Help            65,000
    Misc                 50,000
    TOTAL             1,000,000
                                  11
Phase 2: Vision Implementation
         (May 2007-October 2007)
Key Steps:
     Identify Project Management Team, Master File
     Builders and Super Users
     Set Up Training Room
     Operational Assessment




                                                     12
  Vision Implementation Timeline
May 14-16        Installation
May 17-18        Kick-off
June 4-8         Master file build training
June 11-15       Reports overview
June16-July 23   Master file building
June 25-30       Demographics conversion
July 30-Aug 10   Build testing
Aug 13-24        Develop training plan and documentation
Aug 27-Sept 28   Training
October 1        Go Live


                                                     13
Phase 3: EHR Implementation
         (Nov 2007-July 2008)
Key Steps:
     Process Review
     Template Design
     System Build
     Hardware Deployment
     System Test
     Training
     Go Live



                                14
Key Step: Process Review
Stage 1: Forms Review
Stage 2: Creating the Storyboard
Stage 3: Analysis
Stage 4: Recommendations




                                   15
Stage 1: Forms Review
 Collected all forms used in Health Care
 Services, Community Services and
 Chemical Dependency Treatment
 Services
 Form Inventory

 SIHB was using 600 different forms!


                                           16
Stage 2: Creating the
Storyboard
 3-day retreat with all departments
 Documented process
 Described process
 Identified pain points
 Identified improvement areas




                                      17
18
19
Stage 3: Analysis
 Translate storyboards into electronic
 diagrams for developing EHR templates
 and identifying documents to keep or toss
 Review diagram with each department




                                             20
21
Stage 4: Recommendations
 Planning Daily Operations: Proactive
 Planning & Anticipating Expectations
 Evaluating Patient Cycle Time
 Managing Change




                                        22
EHR Go Live
 Health Care Operations went live July 7, 2008.
 In-patient and Outpatient chemical dependency
 services went live July 21.
 Electronic LabCorp interface went live July 22.
 All providers went live at same time.
 Provider schedules reduced to 1 patient per
 hour.
    Dental schedules increased to full patient load within 20 days!

    Medical schedules increased to 3 per hour after 90 days!


                                                                      23
The World As It Was
 8 Records Staff
 3 staff dedicated to delivering charts
 15-20 minute wait for a chart
 Work flow driven by charts
 Manual chart audits




                                          24
The World Today
Benefits of EHR:
  6 Health Information Technology staff
  Instant access to chart
  Improved patient flow
  Remote access to charts from hospital
  Easy extraction of data from charts



                                          25
The World Today
New Challenges:
 Open charts
 Increased charting time by providers
 Quality of note
 Training new staff
 Remote access policies
 Evaluating patient cycle time
 Double-entry due to stand alone
 databases
                                        26
Things to Consider
 Communicate, Communicate, Communicate
 How will you support providers during transition
 Use a consulting group
 Conduct a process review
 Preload as much information as possible
 Double the training time
 Identify a dedicated EHR Specialist
 Have a plan for managing change after
 implementation

                    Good Luck!                      27
   Questions?
  Please call us!

     Crystal Tetrick
   crystalt@sihb.org

   Barbara Johnson,
Director of Finance & IT
   barbaraj@sihb.org

                           28

				
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