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Implementing EHR by Z5HN4T6E


									Hurdles in Adopting and Implementing
Integrated EHR in Community-based
Addiction Treatment Clinics

     Ron Jackson, M.S.W.
 Evergreen Treatment Services
         Seattle, WA
       Agency Description
   Private non-profit, founded 1973
   $7.7 M annual budget; staff of 110
   Clinical programs
     Opioid Treatment Programs (OTPS)
       • 1400 patients at three fixed sites (two in Seattle & one in
         Olympia) a mobile medication unit and a primary care-based
         program (both in Seattle)
     Intensive Case Management (REACH)
       • homeless, chronic public inebriates

   Research projects
      Why are we doing this?

   Better able to track staff productivity on
    contract and regulatory deliverables
   Easier access by staff to patient
   Clinic performance evaluations made
   Interoperability with other EHR systems,
    research and clinical
     Vital Considerations

   If you are not moving towards EHR you will
    be in a competitive disadvantage
   Do your homework; vendors must add
   Realize once you take the steps towards an
    EHR you must challenge the way you
    conduct your business
     A Paperless Approach

   Gather Patient Information
   Electronic forms
   Electronic & Digital signatures
   Organize Treatment plans and progress notes
   Manage doctor orders & medical notes
   Interface with toxicology labs
   Maintain medication inventories
   Bill 3rd party payers' and manage co-pays
Adoption Process
“What are we going to do and how are we going to do it?”

    What are we going to do?
      Limited EHR, e.g., medication dispensing?
      Complete EHR?
        • If complete are we going to try to enter all existing
          patient data or some subset?
    How are we going to do it?
      Vendor selection
        • Which staff are involved?
      Budgeting for the expense
        • Software
        • Hardware
        • IT staff at agency
      Incremental versus total immersion from Day 1
    Adoption Process
    Vendor selection
   What are the key elements?
     Specificity to agency’s services’ delivery
     Software’s history and acceptability to
      accreditation, regulatory and funding
     Training and on-going customer support
     References from current customers
       • Durability of software
       • Customer support
       • Staff and patient acceptance
            Price, while important, is less so than the above
     Implementation Process
     Before going “live”
   Selecting a core team and “champions”
   Examining the differences between EHR
    software and agency forms and processes
    What to change and what to keep
       • Iterative process between agency and vendor

   Staff training
    By vendor
    By champions
   Patient notification and support
       Implementation Process
       After going “live”
   Incremental versus total immersion
     If incremental, choosing order of element implementation
   Continuing the iterative process between agency
    and vendor on differences between EHR software
    and agency forms and processes – problem solving
     What to change and what to keep
   Monitoring performance
   Monitoring staff needs and morale
     “It’s all about relationships”
     Other EHR Concerns

   Management reports
    How to integrate into agency supervisory and
     administrative processes
   Data extraction for use in other databases
   Interoperability with other EHRs?
   Effect on patient outcomes?

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