Transcript Challenges and Lessons Learned in Implementing Comprehensive

Implementing an Electronic
Health Records System in
Corrections
By
George Wells
Tom Donahue
In the Beginning
• $1.2 million from Medical Cost Reduction
• Provide health care services to an increasing
inmate population in the face of annual industry
medical inflation rates of 17% for health care in
general and 22% for pharmaceuticals. ( source:
Arlen Group Employee Benefits).
• 15-year old Unix Pharmacy Application
• Multiple Paper Records
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Dental
Medical
Mental Health
Optometry
Substance Abuse
Problems with old Process
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Appointment scheduling.
Cross-discipline coordination.
Duplicate information.
On-call care provider did not have inmate chart.
Hand written chart entries.
Unable to identify trends/similarities.
Chart entries not always timely.
Non-standard terminology.
Lack of chart integration across disciplines.
Pharmacy application was inefficient.
Requirements
• New Pharmacy system needed.
• Electronic Health Records to replace reliance on paper
records.
• Enhanced communication across all health services
disciplines.
• Electronic interfaces with medical equipment.
• Telemedicine capability.
• Color GUI body, dental, and eye charts.
• Support Windows 2000/XP, MS SQL, and MS Office 2000
and 2003.
• Comply with Federal healthcare regulations such as HIPAA
and provide available accurate info.
• Standardize clinical protocols in all NDCS facilities to
improve medical record documentation.
Requirements
• Active and Archived Searchable Databases.
• Retain records as active for 5 years after
discharge; then move to archive database.
• Medical Terminology Dictionary.
• Application security based on user profile.
• Interface with Corrections Tracking System,
Substance Abuse Treatment Program, Medical
Surveillance Database, Medcom’s Laboratory
Information System, and Mug Shot Database.
• ODBC and ADO/OLE DB Compliant.
Requirements
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Support NTFS and Active Directory.
HIPAA Compliant.
Permanent record of chart entries.
Maintain security log of all user activity.
Handle 4,500 initial records and 15% annual
growth.
• Support XML meta data interchange standard.
• Extended use of drop down menus and
WYSIWYG.
• Import/export data to/from SPSS, SAS, MS
Office.
Requirements
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Chart Sharing concepts with Patient Flow
Electronic Forms Management
Medication and Pharmacy Management
Employ the Inmate ID Card to bring up
the correct chart.
• State Statute requires NDCS to provide
inmates health care that is equal to what
is available in the local community.
• Enhance fiscal management and data
reporting.
Revised Requirements
• Reduced interfaces to just CTS and Mug
Shot databases.
• Eliminated interfaces to medical
instruments.
Vendor Selection
• Selection team comprised of business and
technical staff.
• Three qualified vendors.
• Lowest price vendor also highest technical score.
• Contract signed July 2005.
• Start date was August 24, 2005.
• Site setup/“Live” Testing May 15-June 2, 2006.
• Test Evaluation and Review May 22-26, 2006.
• NDCS-wide “Go Live” June 12-14, 2006.
• Final Review and Acceptance July 17-28, 2006.
Implementation Challenges
• Additional network infrastructure needed.
• Care providers needed to access charts of
inmates at all locations.
• Standardize Health Services processes/forms.
• IT support staff overloaded; no new FTEs.
– 3 desktop support, 4 network/server support, 1
database programmer, 2 help desk, and IT manager.
– 1200+ PCs, 200 laptops, 43 servers, 650+ printers, 25
scanners, and 30 digital cameras.
– 20 locations across Nebraska.
Obstacles Overcome
• Word 2000 different than 2003.
• Windows 2000 Pro support reduced by Microsoft;
needed to upgrade PCs to XP Pro.
• Database Architecture altered to fit NDCS need.
• Contracted with the Office of the CIO for staffing
assistance.
• Employed tablet PCs with docking stations in
office areas in lieu of networked PCs in the exam
rooms.
• Scan bar code on inmate ID card to bring up
correct chart.
Obstacles Overcome
• Obtained additional funds to support
purchase of additional Tablets and PCs for
staff efficiency.
• Trained Super Users first, Key Personnel,
and finally all other staff by discipline.
• Change from vendor’s on-site Project
Manager to one located at vendor’s
corporate office mid-implementation.
Architecture
QuickMed - WA
NCCW
NCYF
OCC/
DEC/
CCC-O
LCC
Central
Office
Pharmacy/
CCC-L
WEC
TSCI
NSP
Spare
Lessons Learned
• Reissue of RFP came at a cost; reduced
time to implement system.
• Keep vendor and implementation teams
focused on requirements and timeline took
more effort than planned.
• Don’t try to do more than one major
implementation at a time; we had three!
• Don’t fool yourself to believe that
everything that could go wrong has been
planned for.
Lessons Learned
• Realistic Time Frame
• Communication Challenges
• Integrate the delivery of health care
services seamlessly across the
department’ s multiple facilities and health
care disciplines.
• The electronic health record will require
significant IT Support both during and
post implementation
Delivery Enhancements
• Significantly improved medical record quality legibility and completeness with substantial
reduction in provider, nurse and administrative
clerk time dedicated to charting, filing, and
searching for medical record documentation.
• Improved performance in all steps in managing
medications.
• Continuity of care will be enhanced. An average
offender is moved every few years to a different
facility approximately 58% are on medication of
some kind; continuity of care will be affected
when provider-patient relationship is interrupted.
• Paper records can be misplaced and lost.
Enhancements continued
• Providers and nurses now spend approximately
40% of time charting encounters and patient
episodes. Medical Records charting accounts for
50% of overtime charged by medical staff. With
an EHR cost will decrease if managed properly.
• Accuracy and timeliness of management
reporting will improve. Reporting systems are
only as good as the data entered. Electronic
Health Record system supports data entry
processes concurrent with workflow and
incorporates standards ensuring the quality and
timeliness of management reports.
Questions?