Challenges and Strategies When Challenges and Strategies When Implementing an Electronic Health Record Implementing an Electronic Health Record

(EHR): A(EHR): A Ground Level Perspective Ground Level Perspective

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Guillermo Diaz Jr, MDGuillermo Diaz Jr, MD

Chief Medical Information OfficerChief Medical Information Officer

QueensCare Family ClinicsQueensCare Family Clinics

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Warning hard work Warning hard work ahead!!!ahead!!!

• 6 clinical sites: ~ 215 FTE employees6 clinical sites: ~ 215 FTE employees• ~30,000 lives served/yr~30,000 lives served/yr• ~130,000 visits/yr~130,000 visits/yr• 33 FTE providers (MD/NP)33 FTE providers (MD/NP)• Services offered include:Services offered include:

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Family MedicineFamily Medicine CardiologyCardiology

PediatricsPediatrics PodiatryPodiatry

OptometryOptometry ObstetricsObstetrics

DentalDental

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• Current Practice Management SystemCurrent Practice Management System

- 10 years- 10 years

• Dictation System for Dictation System for

- 2yrs 2yrs –– FailedFailed

• Manual Disease registryManual Disease registry

• 3 years 3 years –– becoming out-dated becoming out-dated

• Electronic Health Record (EHR) Electronic Health Record (EHR)

- 2 years- 2 years

- 1.5 years - 1.5 years (Full (Full

implementation)implementation)

QCFC’s Health Information Technology QCFC’s Health Information Technology History:History:

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Implementation Financing:Implementation Financing:

$2.7 million to implement $2.7 million to implement

- California Health Financing - California Health Financing

Authority Grant Authority Grant ~$471,000~$471,000

- QueensCare Charitable - QueensCare Charitable

Foundation ~$550,000Foundation ~$550,000

- Remainder - Clinic budget- Remainder - Clinic budget

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Request For Proposal Defined:Request For Proposal Defined:

What do you want out of the system and what What do you want out of the system and what does the system have?does the system have?– 109 requirements 109 requirements –– 92%92% of criteria were met of criteria were met

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Create WorkflowsCreate Workflows

•Create the Create the As-Is WorkflowsAs-Is WorkflowsHow do you do what you do daily on How do you do what you do daily on

paper?paper?•Create the Create the To-Be WorkflowsTo-Be Workflows

How will you do what you do on How will you do what you do on computer?computer?

•Validate the To-be WorkflowsValidate the To-be WorkflowsEstablish Best PracticesEstablish Best Practices

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Create a System of SupportCreate a System of Support

• Created - Support DeskCreated - Support Desk - User Groups- User Groups

• Trained - TrainersTrained - Trainers - By Clinic- By Clinic - Work Type- Work Type - In Groups - In Groups - 1:1 sessions- 1:1 sessions - Online- Online

• Training continues today…Training continues today…

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Are providers satisfied?Are providers satisfied?

Provide Satisfaction w/ Electronic Charting

Very Satisfied43%

Somewhat Satisfied

19%

Not Satisfied5%

Satisfied33%

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Would providers go back to paper?Would providers go back to paper?

85%

10% 5%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

No Yes NA

Would you revert to a paper system?

Will Quality Improve (cont’d)?Will Quality Improve (cont’d)?

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Will productivity ever be the same?Will productivity ever be the same?

Visits Stats by Fiscal year

8000850090009500

10000105001100011500120001250013000

07-'08

06-'07

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Challenges & Lessons LearnedChallenges & Lessons Learned

• Have a predefined selection processHave a predefined selection process

• Be FlexibleBe Flexible

• Interfaces have inherent flawsInterfaces have inherent flaws

• Scan Today’s Work TodayScan Today’s Work Today

• Patience is a virtuePatience is a virtue

• Consider ROI (Return on Investment)Consider ROI (Return on Investment)

• Be willing to self-evaluate/obtain outside evaluationsBe willing to self-evaluate/obtain outside evaluations

• Communicate / be inclusiveCommunicate / be inclusive

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Thank You !!!Thank You !!!