# Presentation: 153395

## Rural Iowa Redesign of Care Delivery with EHR FunctionsMercy Medical Center – North IowaTrinity Health- NoviThe University of IowaMercy Medical Center – ClintonAHRQ – THQIT Implementation  #1 UC1HS015196-01 

- Jane M. Brokel, PhD, RN - Co-Principal Investigator
- Donald Crandall, MD – Principal Investigator
- Douglas Wakefield, PhD – Investigator
- Marcia M. Ward, PhD - Investigator

**Notes:**
1 minute project – hospital & clinic – all but physician progress notes, consents, tracings & photos

## Case Presentation- Rural

- Build the electronic health record
- Monitor the use
- Sustain the use
- Buy-in at Clinician Level
- Issues with integration, interoperability and sharing of data in rural settings

**Notes:**
Build- 
Monitor- 
Sustain Use-
Issues with integration, interoperability & sharing of data- 

## Clinical Practice Guidelines

- Built Form Screen Designs with Evidence-Based Content
- CDC criteria for Immunizations
- Scales –
- Glasgow Coma, NIHSS (stroke)
- Braden Assessment (skin), Morse Risk (falls),
- Aldretti 1 & 2 (post anesthesia),
- Use of Display Screens – pull the story
- Monitor - % completion
- Issues

**Notes:**
Build- 
Monitor- CDR analysis 
Sustain Use- What’s the information value of the data pulled together into a patient story
Issues with integration – Uniform languages
interoperability – the input of data impacts expert rules
& sharing of data- HIPAA – limited to those clinicians that need to know.
Other Need legal rights to use scales etc.

## Service Specific Order Sets

- Built Care Sets – Executable Knowledge
- Zynx Health Authorspace
- References for Multi-disciplinary Evidence
- Monitor – % of use & perceptions
- Sustain Use – value for all venues
- Issues - Operational Definitions – EHR
- Protocols
- Standing Orders
- Evidence-based Guideline
- Standard of Care/Practice

**Notes:**
Build- 
Monitor- 
Sustain Use-  covering admissions, discharges, peri-operative, outpatient, series
Issues with integration
interoperability – definitions associated with functions and the workflows
sharing of data- 

## Clinical Decision Support Rules

- Build Discern Expert Rules
- Evoke form a Clinical Event
- If-Then Conditional Logic – Evidence
- Action Responses – not just messages
- Monitor - Uniform Nomenclature; Use, Outcome
- Sustain Use - Evidence-Based Practice
- Citations
- Issues – controlled changes to the EHR

**Notes:**
Build- 
Monitor- 
Sustain Use-
Issues with integration, 
interoperability – controlled changes 
& sharing of data- 

## Integrated Role-based  Work Flow Charts

- Redesign processes - early
- Reduce variation among disciplines
- Increase understanding of redesigned care delivery
- Build in evidence-based practices in care delivery
- Monitor Pre and Post Activation
- Sustain Use - Life-cycle change/adaptation
- Issues – integration of roles and HIT systems

**Notes:**
Build- 
Monitor- 
Sustain Use-
Issues with integration, interoperability & sharing of data- 

## Implications

- Integrate processes for each role:  patient, nurses, physicians, clinical departments, health information record services,  registration/admitting & accounting departments
- Common terminology between and among disciplines and finance
- Orders catalog – is a clinical language not a financial coded term
- Focus on patient care being transformed, the EHR and other HIT just helps us do it.

**Notes:**
Build- 
Monitor- 
Sustain Use-
Issues with integration, interoperability & sharing of data- 

## Project

- Clinical Data Repository – 3+ years
- Easy Remote Access – 2 years
- Clinic EHR – 1+ year
- Hospital EHR Activation - July 8th
- Clinic Activation – November
- Clinic Activation -  May

**Notes:**
Build- 
Monitor- 
Sustain Use-
Issues with integration, interoperability & sharing of data-