# Presentation: 026005

## Inpatient HIT Adoption Experiences

- James M. Walker, MD, FACP
- CMIO, Geisinger Health System
- Director, EHR Safety Institute

## Geisinger Overview

- 40 counties, 5 helicopters
- 4 hospitals; 30,000 discharges per year
- 41 clinic sites, 70 specialties
- 670 physicians
- HMO
- 2.4 million prescriptions per year

**CENTRE COMMUNITY HOSP.**

**LEWISTOWN HOSP.**

**MOSES TAYLOR HOSPTAIL**

**POTTSVILLE HOSPITAL**

**TYLER MEMORIAL HOSPITAL**

**LOCK HAVEN HOSP.**

**BLOOMSBURG HOSP.**

**SUNBURY COMM. HOSP.**

**GOOD SAMARITAN HOSP.**

**COMMUNITY MEDICAL CTR.**

**PHILLIP[SBURG AREA HOSP.**

**CLEARFIELD HOSPITAL**

**SHAMOKIN AREA HOSP.**

**MERCY HOSPITAL SCRANTON**

**Non-Geisinger Physicians with EHR access**

## Clinical Information Systems

- Outpatient EHR – all clinicians, all activities
- Inpatient EHR
- Results, ADT, Nursing Documentation, ED, OR
- 10/07 - Order Management, Physician Documentation

## Clinical Information Systems

- Outpatient EHR
- Inpatient EHR
- Patient EHR – 82,000 users
- Outreach EHR – 250,000 notes/year
- Regional Information Exchange
- Research – EHR benefits, information-optimized care processes

## Agenda

- A Goal worthy of the cost (ROI)
- Organizational capabilities
- Organization & user readiness
- The Operations/IT team
- Software matters
- Knowledge Management
- EHR Safety

## A Goal Worthy of the Cost

- Transform the way the organization provides care:
- Reimbursable performance
- High-touch patient experience
- Safe, effective processes
- Decreased unit-cost of care
- Employee satisfaction

## Organizational Capabilities

- Care-process transformation (continuous)
- Patient safety
- Incentives for clinicians and managers to use the EHR effectively
- Human-factors engineering
- Project management
- Experienced information-systems staff

## Organization & User Readiness

- Organizational strategy
- Organization-wide strategy teams
- Executive leadership

**Notes:**
Remember small hospitals and practices.

## Organization & User Readiness

- Organizational strategy
- Physician champions

**Notes:**
Remember small hospitals and practices.

## Physician Champions

- “Founding champion”
- CEO
- CMO
- Project champions
- Local champions (Domain Experts)

## Non-Physician Champions

- COO
- CFO
- Quality Improvement
- Patient Safety
- Managers
- Nursing

## Organization & User Readiness

- Organizational strategy
- Champions
- Inter-Disciplinary Implementation
- Implementation-strategy teams
- Control teams
- Inter-disciplinary feedback teams
- Optimization teams
- Scope-of-practice team

**Notes:**
Remember small hospitals and practices.

## EHR Scope-of-Practice Team

- Operations
- Clinicians
- Medical Records
- Education
- Legal
- Risk Management
- Information Security
- EHR Teams
- CMIO

## Organization & User Readiness

- Organizational Strategy
- Champions
- Inter-Disciplinary Implementation
- Positive experience of HIT
- Phased implementation
- Fit the EHR to the work.
- EHR use

**Notes:**
Remember small hospitals and practices.

## Fit the EHR to the work.

- Workflow analysis and re-design
- Specialized EHR tools (70 Specialties)
- Order sets
- Note templates
- Preference lists
- Alerts and reminders
- Pick lists

## Organization & User Readiness

- Organizational strategy
- Champions
- Inter-disciplinary implementation
- Positive experience of HIT
- Incentives

**Notes:**
Remember small hospitals and practices.

## Incentives

- Performance Assessment
- Financial (internal & external)
- Transformation Opportunities
- Recipients
- Care teams
- Individual clinicians
- Managers
- HIT teams

## Clinically Astute IT

- CIO
- Process engineering
- Business analysis
- Network management
- Uptime team
- Help Desk

**Notes:**
Kaiser, Mass General

## Operations-Led HIT

- Control teams (implementation)
- EHR-optimization teams
- Needs assessment
- Project prioritization
- Downtime plans
- Shared responsibilities with IT

## Software Matters

- Commercial Software
- Market discipline
- Community of users
- Vendor partnership
- HIT integration

## Software Matters

- HIT Integration
- Inpatient EHR (ED)
- Outpatient EHR
- Operating Rooms
- Patient Health Record (PHR)
- Outreach EHR

## Knowledge Management

- Scores of projects (groupware)
- Hundreds of team members
- Thousands of rules and tools (curation)
- Sub-optimal knowledge products
- Laborious input methodologies

## EHR Safety

- Focus on System-Safety Flaws
- (any characteristic of an EHR or its interactions with other healthcare systems that creates the potential for system malfunction and patient harm)

## EHR Safety Pyramid

- System Malfunctions

- System-Safety Flaws

- Adverse Events

- (incidents, near
- misses)

- (failed flaw
- mitigation)

## EHR Safety

- Focus on System-Safety Flaws
- Flaw Management
- Fix software (vendor or provider).
- Change the process.
- Omit the “feature”.
- Train users.
- Replace the software.
- Track flaws.

## EHR Safety

- Focus on System-Safety Flaws
- Flaw Management
- Look beyond CPOE (to integrated processes)
- Order Entry <–> Pharmacy <–> eMAR
- Inpatient <–> Outpatient

## EHR Safety

- Focus on System-Safety Flaws
- Flaw Management
- Look beyond CPOE (integrated processes)
- Implement safe, HIT-supported care processes
- Prospective Risk Analysis
- Usability Testing

## Summary

- A Goal worthy of the cost (ROI)
- Organizational capabilities
- Organization & user readiness
- The Operations/IT team
- Software matters
- Knowledge Management
- EHR Safety

## Discussion

- jmwalker@geisinger.edu