# Presentation: 530433

- INDIAN HEALTH SERVICE
- EHR
- ELECTRONIC HEALTH RECORD

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## ONE SERVICE UNIT’S EXPERIENCE IN IMPLEMENTING THE INDIAN HEALTH SERVICE’S ELECTRONIC HEALTH RECORD

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Two Ambulatory Care Facilities About 25 Miles Apart In Rural Wyoming
IHS Service Unit-Not Contracted 
About 85,000 Visits Annually
Approximately 120 Employees
Physicians Admit To Local Community Hospital About 15 Miles Away
Busy, Understaffed, and Under Funded

- IHS Service Unit-Not Contracted
- About 85,000 Visits Annually
- Approximately 120 Employees
- Physicians Admit To Local Community Hospital About 15 Miles Away
- Busy, Understaffed, and Under Funded

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Decision?

- The Service Unit must make the decision as to whether they are ready to make the investment of resources toward the EHR.
-  There should be agreement throughout the Governing Body/Management Team that the EHR is worthy of the required resources.

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Consultation

- Tribal Council
- Patients
- Staff
- Area Office
- Other EHR Users

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## You Need Commitment!

- Like the pig-------------not like the chicken!

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Ham And EggsCommitment Vs Involvement

- IHS
- EHR

- WIND RIVER SERVICE UNIT

- Involved

- Committed

## Who Needs The Commitment?

- Resource Managers
- All Clinical Staff
- All Administrative Staff
- Information Technology Staff
- Area Office Consultants
- Everyone

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Getting Started

- Project Coordinator
- CAC – Clinical Activities Coordinator
- Service Unit EHR Team
- IT Infrastructure

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## EHR Project CoordinatorandClinical Activities Coordinator

- Interpersonal Skills
- Proactive and Helpful Nature
- Management Skills
- Facility Working Process Knowledge
- Computer Skills

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Service Unit EHR Team

- Enthusiastic Workers
- Representative Of All Services
- Managers
- Health Information Services
- Clinicians
- Information Technology

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## I

- WIND RIVER SERVICE UNIT

- H
- S
- E
- H
- R

- Note:  This Ex Highway Line Painter Now Works For IHS

## EHR Team Meetings

- Meet At Least Weekly
- Encourage Active Participation
- Develop Your Plan Early
- Promote Assignments Between Meetings
- You Are Developing Your SUPERUSERS
- Create EHR Ownership
- Keep Moving Even If It’s  Hard

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## IT Infrastructure

- Cachet
- PIMS
- Pharmacy 5.0/7.0
- Hardware

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Early Decisions

- Inpatient-Outpatient or Both
- Which Services?  Dental, PHN’s, Optometry.....
- And To What Extent?  Order Entry Only?
- Desktops, Laptops, or Tablets
- Hard Wired or Wireless Network And Where
- Equipment-Routers, Servers, Switches, Telephone Lines, Computers, Printers, Power Protection.....
- Facility Issues-Space, Wiring, Privacy, Flow.....
- Funding
- Promotional Activities

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Develop Your Implementation Plan

- Specific To Your Site And Your Staff
- Specific As To Timing
- Big Project-Don’t Get Overly Aggressive
- Implementation Tied To Training
- Lots of Training
- Stick To Plan -- Adjust If Necessary

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Implementation Timetable

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Training – Phase 1

- Demonstration By Knowledgeable User
- Limit to 1 Hour Or So
- Promote Discussion on How Certain Functions are Accomplished – EHR Capabilities
- Deal With Concerns—Allay Fears

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Training - Phase 2

- EHR Test System Loaded On All User’s Computers
- Set Up Proper Permissions for Everyone
- Promote Self Exploration of EHR
- Promote Lookup Of Demo Patient Info
- Newsletter

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Training – Phase 3

- Multiple Classroom Sessions
- Schedule Staff Appropriately
- Train Everyone – Not Necessarily Together
- Consider Departmental Trainings
- Train, Then Implement Promptly
- Have Hardware And Permissions Issues Resolved Before Classroom Trainings
- Use Knowledgeable Trainers
- One-On-One Training Also

- IHS
- EHR

- WIND RIVER SERVICE UNIT

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## More On Training

- About 2 Hour Sessions Away for Work Area
- Demonstrate for About 1 Hour
- Hands-On for About 1 Hour
- Have A Task List for Hands-On Session
- Competency Check List
- Again, Make Sure Equipment Is Functional and Permissions Are Correct Before Session

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## File Setup

- New User File – Provider File
- Hospital Location File**
- User Class File
- Document Class And Document Title Files
- Lab Files
- Radiology Files
- Medication Files**
- Pick Lists for Procedure And Diagnosis Codes

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Quick Orders

- Pharmacy
- Lab
- Radiology
- Nursing

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Business Rules

- Verbal Orders
- Protocol Orders
- Check In Procedures
- Queues
- Lab Results
- Pulling Charts
- Printing And Filing Chart Copies
- And On And On And On

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Note Templates

- Some Available From VA
- Alpha Sites are Developing Templates
- Can Be Exported And Shared
- Need a Template Specialist Trained At Each Service Unit
- Need A Basic Library of Templates To Get Started
- Develop More Personalized Templates After Using EHR For A Time

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Permissions and Keys

- Provider Key
- Order Keys
- BTRI Keys
- Screen _View_ Templates
- Visit Creation Parameter
- Co-Signature Parameter
- Electronic Signature Assignment

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Personal Preferences

- Progress Note Titles
- Personal Patient Lists
- Screen Views
- Establishing Teams
- Notifications
- Surrogates
- Order Check Criteria

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Final Equipment Details

- Live System Loaded, Tested & Retested
- Full Location Computer Availability
- Lab Order And Nurse Order Printers
- Chart Copy Printers
- Network Printer For Patient Information
- Recharging Equipment for Portable Units
- Stands, Carts, Space, Privacy Issues

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Going Live

- Stepwise
- Progressive
- IT Support
- Intense CAC Support
- Make Appropriate Scheduling Adjustments
- Coordinate Departments
- Back-up Plan

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Medical Records Issues

- Pulling Of Paper Chart?
- Filing In Paper Chart?
- Print And File Chart Copies? Batch Print?
- Release Of Information?
- Outside Paper?   Scanning?
- Incorrect Entries?
- Record Quality Assurance?

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Coding Issues

- No Longer An Encounter Form
- Daily Error Reports
- Non-Merged Lab and Pharmacy Visits
- No POV, E&M Code, Activity Time
- ICD Coding By Providers
- Duplicate Visit Creation
- Hospital Location File Issues

- IHS
- EHR

- WIND RIVER SERVICE UNIT

## Business Office Issues

- Services Pick List Development, Installation, And Training
- Missing E&M Codes
- No Hard Copy To Work With
- EHR Notes Are Legible
- Great Opportunity For Improved Provider Documentation & Increase Billing/Collections

- IHS
- EHR

- WIND RIVER SERVICE UNIT

- James (Bob) McKnight, CAPT, USPHS, Ret
- 18 Chambers Drive
- Lander, Wyoming, 82520
- Phone  (307) 332-7300 work
-            (307) 332-5682 home

- IHS
- EHR

- WIND RIVER SERVICE UNIT

- IHS
- EHR

- WIND RIVER SERVICE UNIT

- IHS
- EHR

- WIND RIVER SERVICE UNIT

- IHS
- EHR

- WIND RIVER SERVICE UNIT