Transcript presentation ( format)

Integrating IT and Clinical Practice
for
Implementation and Support of
Electronic Health Records
at
The University of Texas at Austin
May 30, 2013
Presenters:

Theresa Spalding, MD


Robert Reed


Medical Director
Assistant Director, Health Information Management Services
Sherry Guyton, FNP

Advanced Practice Clinician & Informaticist
Objectives:

Identify obstacles to the efficient support and
implementation of an electronic health record
(EHR)

Discuss the strategies UT employed to address
some of these obstacles from an IT standpoint

Explain the benefits of having a clinical provider
in the IT department
Overview

Background on UT and University Health Services
History of IT at UHS
Problems with a traditional IT model
Finding a solution
Informaticist’s experience

Time for Q&A
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UT info
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350-acre main campus
17 colleges and schools
more than 50,000 students and
about 24,000 faculty and staff,
UHS Info
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Funding
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Student Activity Fee —
•
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lump sum divided among all Student Services
Billing and Insurance revenue
Student Services Building
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UHS
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Counseling and Mental Health Center
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Services for Students with Disabilities
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Dean of Students
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Financial Aid
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Pharmacy
UHS Info
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Medical Provider Staff
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17 MDs
6 FNP/PA
4 WH NP
27
= 11.7 FTE
= 3.9 FTE
= 2.9 FTE
18.5 FTEs
Nursing staff = 40
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RNs
LVNs
MAs
UHS Clinics
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3 General Medicine Clinics
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Women’s Health Clinic
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Colposcopy
Sports Medicine Clinic
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Medical providers
Integrated Health counselors
2 fellowship trained SM MDs
Orthopedic consultant
Urgent Care
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Open til 5:30 weekdays and 11-3 on Saturdays
UHS Ancillary Services
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Allergy and Immunizations
Registered Dietitian
Physical Therapy
Laboratory
Digital radiology
Pharmacy
A Little History…
The Beginning
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Mainframe Terminals
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HCSCHED
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HCBILL
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•
Scheduling
Billing
Email
Web Browsing
First Attempt (1998-2009)
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In 1997, UHS went out on bid for a Practice
Management System.
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Scheduling
Billing
The product was installed in 1998.
ITS in UHS begins to change…
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So we were slinging computers like any other ITS shop
on campus, but then….
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Could somebody figure out a way to request a paper
chart based on a phone message, have the chart arrive
in the clinic with an explanation, and track all patient
contact?
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HITS was “born”! Now we were directly supporting the
mission of UHS and not just the computers.
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How can we securely message our patients
so that their protected health data was not
sent in a plain email?
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E-Messaging was born
Further Implementation of an EHR
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Step-wise approach to implementation of
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Laboratory and radiology orders,
Documenting medications and allergies
Laboratory results viewed on computer
Vendor evolving into a full Electronic Medical Record
(EMR), with the ability to edit templates
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But who is going to create and edit all of the templates we
needed?
Technology Evolves…
• Lack understanding
of clinical processes
• Lack understanding
of complexities of IT
• Lack a common
language with
clinicians
• Lack the time to
clearly explain what
they need
• Different priorities
• Clinical staff even
busier due to new
technology
Result = Frustration for both IT and Clinical staff
Brainstorming the Solution
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Initially discussed using an RN but went with
FNP. (No particular reason at the time).
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Funding
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Joint appointment with Medical Staff and HITS
Joint supervision
Creating job description
Results
Building understanding
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IT begins to understand clinical priorities and
workflows
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Clinicians understand that not all processes
can be replicated electronically and why!
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Debate reshaped
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Initially had been EHR makes things faster
(obviously not true)
Now EHR makes patient data more available
Results for IT
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Clinician has more time to work with IT and understand the information
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Clinician can then take time to distill (translate?) this to peers.
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Clinician brings understanding of the clinical process
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Clinician can better communicate issues to our vendors.
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Better communication between IT and clinical staff
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Increased satisfaction with the process
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Clinicians know that somebody in IT is using the solution and not just
pushing it out.
EHR-2
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With experience gained by Clinical
Informaticist (CI) coupled with staff
frustration, we decided to seek out new
vendor for EHR
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Implemented EHR-2 on Aug 4, 2009
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CI was crucial in working with vendor
implementation team to develop and adapt
EHR to our needs
CLINICIAN / INFORMATICIST
Typical EHR Development/Training responsibilities include:
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acting as a liaison between providers/users and Health
Information Technology Services (HITS);
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communicating with associate medical director and HITS
manager as needed for priorities related to EHR issues;
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collaborating closely with HITS staff in the development, testing,
training and/or implementation of technologies related to the
EHR;
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training new providers on the use of the EHR and other
technologies that may facilitate its use;
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collaborating with other departments within UHS that are
impacted by EHR changes and use (Pharmacy, Lab, Radiology,
Cashier/Insurance, Health Information Management).
Experience for the
Clinician/Informaticist Role
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Experience
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No formal IT experience
had background in training & education
UHS medical staff member
Training for the Clinician/Informaticist Role
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On-the-Job Training
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workshop by original EHR vendor on
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template building structures,
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linking codes, and
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building coding dictionaries.
webinars by EHR-2 vendor on
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set up of all dictionaries,
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designing templates,
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creating links between clinical templates and coding and billing,
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secure messaging,
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patient portal.
Training for the Clinician/Informaticist Role
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HIT-Pro Certification Program
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Training as Clinician Practitioner Consultant
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In-depth education on
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basic IT history,
IT terminology,
IT security related to healthcare
Implementation strategies
Clinical duties
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Set schedule during long semesters (3-4
sessions/week)
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Fill in during unexpected provider absences
or increased pt volume
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Identify things that need to be corrected or
added into the EHR
UHS Acceptance of CI
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Both sides seeing her as representing their
best interests
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Broader exposure--
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member of Clinic Management Team,
member of Coding and Charges Committee
Member of EHR Committee
ad hoc committees on clinic flow
Accomplishments
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Building templates
Triage Guidelines
Editing process
Clinical flow brainstorming
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Prescription refills
PVNs
Setting up flow sheets for such recurrent visits as INH
treatments, EDAST, concussions….
Trainer of all new employees on the EHR
One-on-one training of new providers
Kudos from new staff member
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I also wanted to say a special thanks to
Sherry for spending so much time and effort
training me on the EHR and for helping to
develop all of my templates. You are directly
responsible for helping make my job so much
easier, not to mention assuring effective
communication between disciplines,
accuracy, and compliance, etc.
Customer Satisfaction

It’s very helpful having someone with clinical experience
representing our needs and creating templates and reports that
maximize clinic efficiency. In a few minutes or less I can explain to
Sherry what tool I need in PnC, whereas it often takes multiple
conversations with an IT staff member (even one who works in a
healthcare setting) to convey the same information. It also makes it
very easy to brainstorm solutions to challenges when the person you
are working with understands the clinic perspective.
• Mary Ann Dolph, RN
• Nurse Triage Manager
Presenters:

Theresa Spalding, MD


Robert Reed


[email protected]
[email protected]
Sherry Guyton, FNP

[email protected]