EHR Institute - Ask an Expert

Migrating from paper to EMR

Fay Naj — Sat, 24 Mar 2012 16:58:36 GMT

Hello, my biggest concern about migrating from paper to EMR would be converting records to EMR. I've been looking at Open-EMR for some time now and am wondering what would be the easiest and most unchallenging way for a physician who's been operating for 5yrs and has in excess of 200 patients, to transfer all his paper based records to EMR.

How can my agency ready itself to capitalize on available funds?

Lindsay Young — Tue, 06 Apr 2010 18:24:01 GMT

There have been many news articles lately about increases in state funding and national initiatives so that organizations will have a better ability to acquire and "meaningfully use" electronic health record systems.

What steps can my organization take to ready itself to capitalize on available funds and soon-to-be available funds? Where does behavioral health fit into this puzzle?

RE: What is a realistic timeline for a project of this magnitude?

Glen Marshall — Tue, 06 Apr 2010 16:19:01 GMT

The tip that comes readily to mind is forming an end-user advisory panel. This group will stay with the project through implementation and is charged to bring honest advice and feedback as the project moves forward. It is good to do a Myers-Briggs test, or similar, for the end-user advisory panel members and then openly discuss each others' results and what they mean in the context of working together. A lot of resistance arises from people not understanding where each-other is coming from.

Outside of the team, the key reason for resistance is that many people dislike change, and much of that is irrational. Your primary tactics are friendly communication and seminar-style education as the project progresses. You will also need some formal classroom instruction for the users who must use the system day-to-day plus thorough online help and FAQs for users to use as they start using the system.

RE: What is a realistic timeline for a project of this magnitude?

Vince Collier — Tue, 06 Apr 2010 16:00:29 GMT

These are all great tips. The involvement of end-users seems like it could be a challenge in and of itself. Do you - or anyone - have any tips on how to prepare an organization for this change? What reasons for resistance should I expect?

RE: What is a realistic timeline for a project of this magnitude?

Glen Marshall — Tue, 06 Apr 2010 15:24:02 GMT

Before going any further, ask yourself some key questions:

Have you involved your end-users with decisions about presentation, easy of use, pro/con on modifications to current workflow, privacy and security, and usefulness of EHR data to healthcare consumers? In other words, will they enthusiastically use it?
What about ensuring that CMS's meaningful use criteria can be supported?
Does the current project plan and schedule support affirmative answers to the above two questions?
Does the project staff concur with the schedule and do they have meaningful incentives to realize it and consequences if they don't?
Does the project manager have the authority and strength of character to deflect disruptive tampering with project objectives and resources from people who are not direct project stakeholders?
If you have vendors or consultants on the project team, do they have iincentives for on-time on-budget performance and penalties for failures?

RE: Should we hire a consultant for EHR project?

Patrick Gauthier — Mon, 05 Apr 2010 18:30:18 GMT

I agree with others in that "it depends" but would expand the answer in the following way:

A. These projects have several key phases so you have to begin with a bit of a breakdown. Some consultants are experts in one or another area. Some of your needs may be very specific to one or another area. Sometimes, you need a consultant who is equipped to take you through the entire life-cycle of the project. This is a safe breakdown:

Strategic Planning
Needs Assessment and Gap Analysis
Business Process Analysis
Requirements Documentation
Vendor Identification and Evaluation
Vendor Contracting
Implementation Oversight

B. The steps above involve quite different skill sets and subject matter expertise (emphasis? expertise!):

Facilitation
Deep understanding of behavioral health operations and administration
Deep knowledge of clinical operations
knowledge of payer operations and process
knowledge of electronic data interchange or EDI requirements
knowledge of HIPAA security and privacy
knowledge of CCHIT certification requirements
knowledge of interoperability requirements
system architecture and infrastructure requirements (hardware, software and networking)
Vendor contracting (maintenance, support, help-desk, upgrades, disaster recovery, ASP options, "patches" and new releases, etc.)
Training
Project Management

C. Projects of this sort also require consultants with demonstrable:

Approaches
Methodology
Tools
References

The notion here is to understand what you need by understanding where you are in the "adoption curve" and being realistic about internal competencies and resources as well as budget. You can pay way too much and you can try to skimp and throw your money away.

Best advice? Ask those who have gone ahead of you. Ask for real references via word of mouth. Ask your local clinic, primary care doc, or hospital for references to PROVEN consultants they know and trust. They'll help you!

How is the debate over meaningful use affecting your organizational readiness?

Amanda Benfield — Mon, 05 Apr 2010 18:13:35 GMT

Has CMS' discussion over "meaningful use" criteria affected any organization's readiness in its search for an EHR software solution? Has this stalled your progress, or has this made you more excited about automating your systems?

If anyone is following, much of the funding/incentives hinge on these meaningful use standards, so this has the attention of many in the health care industry who want to implement an EHR soon. I wonder how closely people are following this development.

RE: What is a realistic timeline for a project of this magnitude?

Charles Budd — Mon, 05 Apr 2010 17:32:42 GMT

There is no "standard" timeline for implementing an EHR, though it can easily take from 3 months to a year or more depending on several factors:

Did you go through all your documents, forms, and communication flows and standardize them before starting the implementation or is that part of the implementation time?
Are you going to accept standard forms and screens from a supplier or will you need customization? How much customization?
Are your records already in some electronic form?
Are you going to convert all existing records or start everything new?
How do you plan to get current demographic client data into the system?
Have you set realistic expectations for your staff or are you going to experience resistance during training?
How many staff will use the system intially?
Do you have dedicated personnel for the project?
There are many more items that need to be covered during your discovery efforts before even selecting an EHR system.

Sometimes, a pause and revisit of the project baseline or a rededication for the effort is in order.

Charles

What is a realistic timeline for a project of this magnitude?

Scott Sutherland — Mon, 05 Apr 2010 16:40:49 GMT

We are in the beginning stages of organizing an EHR implementation project for our rehabilitation clinic. We are finding that we are using much more time than was originally allotted for this, and I'd like to get other people's takes on how theirs is going. What are your expectations? How quickly or slowly do you plan to move through this process?

One more question

Oprea Catalin Gabriel — Wed, 06 Jan 2010 07:54:10 GMT

5) How much space should be statisticaly reserved for health care recording of each person (patient) in EHR?

Is 1 MB/1 person/1 year enough or is it to small for the purpose of EHR and for nowadays technology?

Best regards,

Catalin Gabriel Oprea

coprea@ccss.ro
http://www.fly.to/catalin/

Disaster Recovery

Oprea Catalin Gabriel — Tue, 05 Jan 2010 10:24:52 GMT

Dear all,

I am quite new in this aria and I have 4 very important questions for you as follows.

For a national EHR system including all medical areas in a country where broadband Internet is in the childhood age and the population is about of 25 milions:

1) How critical is a disater recovery solution if the original site is cluster balanced in an active-active mode? (Please explain the reasoning.)

2) How fast must be the swiching between the production site and the disaster recovery site? (2 seconds, 2 minutes, 2 hours, 2 days etc. Please explain the reasoning.)

3) For a country with let's suppose of 25 milion inhabitants where every person can see its own medical record via Internet browser and where let's say 100 000 medical parcticioners are working every day in EHR how many concurent connections and instant access to the production site should be designed as minimum?

Off course that not everybody is quering or uploading/downloading data in the sistem second by second but statisticaly they are logged into the Main National EHR system (the production site).

How many concurent connections should be provided as minimum in the configuration of a national EHR?

4) How many employers should work in a callcenter(medical related questions) & helpdesk (IT related questions)?

Are 25 persons enough for a population of 25 milions?

I am looking forward for your profesional views and reply.

Please give me also a reasoning for your answers (and some links to pdf/html/doc documentation will be more than wellcome and appreciated)

Thank you very much!

Best regards,

Catalin Gabriel Oprea

coprea@ccss.ro
http://www.fly.to/catalin/

RE: Should we hire a consultant for EHR project?

Colleen McNulty — Thu, 22 Oct 2009 17:57:08 GMT

This was a question I was wondering as well. There are both pros and cons for hiring a consultant to help with an EHR project, but one thing is certain - it should not be a decision an organization makes hastily.

As I see it, a consultant’s experience and expertise provide a good framework for gathering requirements, but he also does not fully understand the organization. In addition to paying consulting fees, this requires a lot of work and time on the organization’s end.

EHR projects are a huge endeavor that some organizations are either unprepared for or do not know how to ask for the right components. I see this as another reason to enlist the help of a consultant. He can make sure all ideas are brought to the table and then help sort out needs and wants.

I think it is also important to note that a consultant should not take the place of an in-house champion for the project. Whether or not an agency hires a consultant to help with the project, everyone still has to be on board with the consultant and be willing to put in the same thorough effort as the consultant to achieve the best possible results. Consultants may know the best way to negotiate a strong contract or how to stick to timelines, but only staff members know the ins and outs of their organization. They are the ones who will have the ultimate say on the application, and they are the ultimate users of the system.

RE: Should we hire a consultant for EHR project?

Charles Penoi — Wed, 21 Oct 2009 17:57:42 GMT

It is much easier to find some firm who will help you do an RFP process in the grande manner than someone who will make sure you get where you should. The rolodex gets very thin on that end of the continuum. All you need do to get confirmation of this is to google "behavioral healthcare consulting". Pickings are slim, but such as they are, real.

RE: Should we hire a consultant for EHR project?

Lindsay Young — Wed, 21 Oct 2009 13:27:08 GMT

Thanks for your response, Charles. I agree that it depends entirely on the organization - what its goals are, how it is structured, its financial situation, etc. Some organizations seem to take on this project without the help of a consultant and do fine, but others do the same and do not achieve the results they wanted. It all seems to come down to the preparedness of the agency as a whole.

Also, you bring up a good point that consultants should be chosen based on the organization's needs. I would imagine there are thousands of them out there. Do you - or anyone else - have any tips on finding the right one?

RE: Should we hire a consultant for EHR project?

Charles Penoi — Tue, 20 Oct 2009 22:10:45 GMT

The most direct response would be "who's asking?". The magnitude of value that follows from an EHR implementation is mostly determined by the qualities of the organization undertaking it rather than on the product itself. An organization that finds a way to be successful at those things that are asked of it will do well with an EHR. An organization that managed to get in its own way in nearly everything it does can come close to a major lapse of organizational continuity during an EHR implementation. So, you have to ask different things of your consultant depending on the strengths and shortfalls you have going in. If you have a good staff and good cash flow, your emphasis is likely to be on how to multiply the advantages of an EHR. You will be giving your forward looking staff who are ambitious for your success the tools to take a step up in providing services. An organization that is having trouble putting a legacy of 'making do' in the past will have a different agenda. An organization cluttered with rework badly needs for things to 'just work'. The consultant for that engagement would need to deal decisively with distractions to hold focus on the opportunity an EHR provides. If that is your need, attend to the consultant's problem solving skills and then select a product that your organization can handle. Most EHR vendors do well with companies that are successful and forward looking. Fewer do well with customers who are going to have to work hard to preserve the opportunity an EHR represents. Choose your partners accordingly.

Should we hire a consultant for EHR project?

Lindsay Young — Tue, 20 Oct 2009 15:59:55 GMT

Is it advisable to hire an IT/EHR consultant while going through the selection process for an electronic health record system? I'm thinking of this question in terms of practicality, legal aspects, and financial constraints.

RE: When will mental health get at the table?

Charles Penoi — Fri, 21 Aug 2009 16:26:01 GMT

The National Coordinator of Health Information Technology, Dr. David Blumental, announced yesterday that two Stimulus HITECH Priority Grants were being rolled out. The first establishes grants for regionall EMR 'extension centers' that will provide eduation and support to providers seeking to acquire an EMR. It also includes a national center to coordinate sharing among the centers and facilitates their efforts. The second grant supports the establishent of state policies and methods to exchange health information within and between states. These grant programs are preliminary steps laying the groundwork for widespread EMR use. They create resources which should help you define what you need. Expect to see other grand programs coming on-line in the near future that could potentially provide the kind of direct aide you are seeking.

Read about the grants at this .gov site. http://tinyurl.com/m6zyaq.

Good Luck!

RE: When will mental health get at the table?

Birge Whitmore — Thu, 20 Aug 2009 22:41:02 GMT

We are a small 13-person outpatient clinic with one part-time psychiatrist. We have meager cash flow to invest in EHR technology, that is why the incentives are critical to entry.

We'l like to know the best place to put our oar in the water to raise at least a small voice.

We are involved in the Wisconsin STAR-SI and NIATx initiatives that use rapid cycle testing to improve access and the quality of care to mental health and AODA patients.

RE: When will mental health get at the table?

Ron — Tue, 18 Aug 2009 13:51:30 GMT

Mental health is at the table.

We achieved a victory with the reduction in the Medicare Part B co-pay from 50% to 20%. That same legislation increases payments for social workers by 5%.

We also are at the table of National Health Reform. See the eight policy papers of the Whole Health Campaign at: http://www.acmha.org/library/current_events.cfm.

We need more persons from the behavioral health fields to be active in the national debate. This national debate includes our role in EHRs and PHRs.

Are you active?

Ron Manderscheid

RE: When will mental health get at the table?

Charles Penoi — Tue, 18 Aug 2009 01:09:07 GMT

I guess we should begin by asking the question "which table are the doctors who can get incentive pay sitting at?" It is the table of meaningful use of an EMR/EHR. "What the heck does that mean?" you ask. Well, what matters to the Health Information Technology (HIT) Policy Committe established by the Stimulus legislation is whether you are tracking indicators of risk for chronic illness. The money being paid out for EMRs to doctors has to earn its way as part of healthcare reform by helping to reduce the incidence of chronic illness. Are there equivalent criteria for chronic illness in behavioral healthcare? I think the answer is 'yes'. The one that would come to my mind would be indicators of efforts to keep family intact for children. However, that is just an idea that does not command universal accent. The current draft measures of meaningful use are universally acknowledged to the degree that no one bothers to ask why they were chosen. That is rather amazing when you think of it. The guru of standards that the HIT Policy committee likes to use is the National Institute of Standards and Technology (NIST). Does NIST have something ready to go for behavioral healthcare? No, they don't. The National Council for Community Behavioral Healthcare is making the lack of a 'seat at the table' a focus of congressional lobbying. I think it is important to note that the Stimulus bill set the rules and the rule making for EMR incentives. A good deal of the mojo for shaping the future of technology in healthcare was allocated by the legislation to the HIT Policy Committee and the Office of the National Coordinator for Health Information Technology, the ONC. Now if the ONC doesn't want to 'go there' when it comes to behavioral healthcare, it isn't likely to happen no matter how much lobbying there is on the Hill. The best course would be to camp out at NIST rather than thel Hill if you want to see this changed. There are state level grants that behavioral healthcare has access to. That is a topic for another day.

When will mental health get at the table?

Birge Whitmore — Mon, 17 Aug 2009 22:20:09 GMT

Only non-MD providers are currently eligible for the Medicare and Medicaid incentives. Is anything significant being done to include PHD's and LCSW's as eligible providers?

RE: 42 CFR

Jennifer Daniels — Fri, 07 Aug 2009 16:45:26 GMT

As you know, the Public Health Service Act and its implementing regulation at 42 CFR Part 2 govern the confidentiality of substance abuse records maintained by federally assisted drug and alcohol abuse programs. These restrictions are still in place, as are all of the state-level drug and alcohol abuse privacy laws. I am not aware of any plans to undermine these existing protections through future legislation. That said, I’m not sure how many EHR systems and processes comply with these varying, higher standards for particularly sensitive health information (some of which would require limiting access even by other health care providers to the information). Privacy advocates have argued for higher penalties for failing to comply with those laws, to encourage compliance in the EHR environment. We will see how things develop.

RE: 42 CFR

Reba Architzel — Thu, 06 Aug 2009 16:11:54 GMT

Sorry!
For those with an alcohol or drug dependency, 42 CFR affords a higher level of protection re: confidentiality than is required under HIPPAA. OASAS has been concerned that, with EHR advancing, these protections will no longer be as powerful.

My question is whether or not this forum has dealt with the issue of confidentiality in EHR for those accepting treatment for alcohol or drug use.

Thanks.

RE: 42 CFR

Jennifer Daniels — Thu, 06 Aug 2009 14:24:53 GMT

Hello Reba,
Can you clarify what area of 42 CFR or what topic you're interested in? 42 CFR refers to the entire section of the Code of Federal Regulations that covers Medicare and Medicaid. For example, the anti-kickback and Stark regulations are included within 42 CFR, but so are many others. So, if there is a particular area in which you are interested, I can try to give you some information.

Regards,
Jennifer Daniels

Welcome!

Jeffrey Erb — Thu, 11 Jun 2009 19:14:07 GMT

Welcome to the EHR Institute Discussion Forum! We hope that you find this site a useful resource for gaining insight and understanding on all of the latest news on electronic health records and their implementation. Please feel free to network and communicate with your peers in order to help gain a clear picture with regards to how EHR can best benefit your organization.