Basically we are implementing one clinic on EPM and EHR simultaneously and another clinic just on EMR as they have already implemented EPM (a third clinic is slated for EHR later this year).
We chose to implement EPM and EHR for "Clinic 1" simultaneously because they were fairly small and very new.
We chose "Clinic 2" because of they had been successful in implementing and utilizing the EPM. They were eager to learn and had a good "project champion" at their site that we felt was necessary for achieving end user "buy-in".
We are also attempting to install a bi-directional lab interface with Quest at 4 of our clinics. We have successfully finished one of them and they are paperless. The choice for our first lab install at this particular site was due to the level of experience the users already had with EHR. The lab interface can add a level of complexity to the EHR that is not appropriate for newer less experienced users that are in the earlier stages of EHR adoption.
The following is a "status/summary" breakdown of our 2 current EHR implementation sites:
Clinic 1:
- Clinic 1 held initial meeting with board of directors, medical director & CRIHB to determine project implementation roles. A project “point person” was chosen along with goals and timelines being established.
- Setup weekly EMR implementation status teleconferences.
- A customized chart abstraction template was built to allow for quick and easy conversion from paper chart to electronic chart prior to EMR implementation.
- Front office and nurse training was conducted over 3 different sessions to assure proper understanding of the abstraction process. Once training was completed, chart abstraction was started.
- Elearning programs along with document and video trainings were made available via our corporate intranet. The training was broken down into 3 areas; front office, nursing and providers. Each area was designated with specific “self-learning” tasks to be completed before in-person and WebEx trainings begin. This allows for an introduction to the EMR workflow and template usage while cutting down on training costs.
- Initial nurse training was conducted via WebEx with our consultant. We went over basic workflow and template usage.
- We provided the nursing staff with sample patient data for practicing “real world” patient visits. The expectation is that they will be forced to do the visits entirely within the electronic system and to notate any issues/questions to be discussed in our next training session.
Clinic 2:
- ICS (scanning) was successfully set up and end users trained to allow for the initial first stages of converting patient charts to electronic charts via scanners.
- The customized abstraction template was also implemented at this clinic and training conducted so that scanning and data input could be done simultaneously.
- Customized lab interface templates were successfully imported and set up in Test to begin the bi-directional lab interface implementation with Quest.
- EPM and EMR training was done over a variety of sessions. Training was done on-site, via WebEx and some at the NextGen training facility.
- Follow up sessions were provided with our own consultants to help the providers/nurses with any issues and or questions they had involving the EMR workflow.
- Go-Live happened in early January (I will expand on this more in a separate blog).
2 comments:
Michael - Thanks so much for your informative post. I have lots of questions, but for now I'll stick to just one: when clinic 1 used the special chart abstraction template to prepopulate the electronic chart with information from the paper chart, what was the method used to do that? Was information entered as patients came in (I've seen people use the schedule to determine patients coming in that week and then enter those charts week-by-week or day-by-day), or was there some attempt to determine "active" patients and these were entered as part of one big effort. If it was the latter, how many charts were involved and how long did it take? Okay, I guess that's two questions.
First of all I'm sorry to take so long to get back to you. We can't get to this site as it is blocked at work so I have to do this from home and I thought I had selected to get comments in email(so I'd know I got a comment quickly) but I suppose I'm still learning how to use this.
Now to the questions. We are a bit unique I suspect in that for this particular situation we have a large population of diabetic patients so we chose to actually abstract all our diabetics first. This is our main chronic disease focus and we have various reporting requirements that also force us to focus initially on this set of patients. This of course is a "historical" abstraction process, meaning we weren't initially trying to abstract based on patients coming in rather just getting all diabetics. Beyond that, yes the idea was to next focus on active patients with the most visits in the past year. After that of course we would use the idea of a patient having a visit within the next week or so and try to abstract before the time of the visit.
In terms of numbers for this particular clinic, they aren't that large, probably close to 100 diabetics and for all patients I'd guess several hundred(in terms of visits within recent history).
Now to the most important part, we have by no means finished this process and have run into some issues which probably deserve a separate blog (I'll post that soon). While chart abstraction is a fairly slow and tedious process(even with our nice single template for abstraction) it definitely is hindered when the personnel you train leave and or are reassigned. This is the situation we are in. We have had to change our focus and go to plan 2. More to come on that later.
Hope that helps a little.
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