A Case Study on EHR Selection & Implementation

Doc DeVore Director of Clinical Informatics & Industry Relations

• Together, Transforming the experience of aging

• Kendal Charitable Funds

• Kendal Outreach - offering creative solutions in health care.

• Advocacy ~ Education ~ Resources

• Broadening Kendal’s mission beyond Kendal’s walls

• Affiliates in 8 States: • Pennsylvania (3), New York (2), Ohio (2), New

Hampshire, Virginia, Massachusetts, Maryland and Illinois - July 2012.

Values and Practices

In carrying out our mission, our primary objective is to establish and maintain integrity and excellence in all aspects of our work.

• TO ENHANCE THE QUALITY OF LIFE AND VITALITY OF THOSE WE SERVE AND

• TO FOSTER A SENSE OF COMMUNITY

• TO PROMOTE AN ENVIRONMENT OF CONTINUING LEARNING • TO ENCOURAGE AND WELCOME ALL PEOPLE TO PROVIDE HIGH QUALITY WELLNESS PROGRAMS AND HEALTH CARE

SERVICES

• TO PROVIDE PHYSICAL SETTINGS THAT ARE SENSITIVE TO THE AGING PROCESS

• TO ENGAGE IN PRACTICES THAT SUSTAIN AND IMPROVE OUR ENVIRONMENTS

• TO EMPLOY FINANCIAL DESIGNS THAT CONTRIBUTE TO SECURITY AND SERVE OUR SOCIAL OBJECTIVES

• TO FOSTER A HIGH QUALITY WORK EXPERIENCE FOR STAFF • TO STRIVE FOR EXCELLENCE IN MANAGEMENT AND GOVERNANCE

• TO VALUE PARTICIPATION, TRANSPARENCY, AND CONSENSUS BUILDING • TO TAKE RESPONSIBILITY IN THE LARGER COMMUNITY

• TO CONTINUE TO GROW

• TO TAKE AN ACTIVE ROLE IN AGING ISSUES • TO FOSTER A CULTURE OF GENEROSITY

• TO MAINTAIN INTEGRITY AND HIGH ETHICAL STANDARDS

• 2002 Kendal Corp developed 10 year strategic plan

• Initiate an Electric Health Record in 2012

• 2007 – Kendal learned that current vendor would no longer support Clinical software

• Urgency to move up the process for implementing an electronic health record

• Evaluated 10 software vendors

• Narrowed down to 3 vendors

• Kendal Affiliate Staff did site visits to clients of 20 of the 3 selected vendors

• AOD (the 3rd vendor) made site visits to Kendal Affiliates to demo their system

• Dec. 2007 IT Steering Committee approved of AOD

• Jan 2008 Executive Directors approved

• Feb. 2008 Kickoff with all stakeholders

• Theme: Soaring to New Heights

• AnswersElite® Solutions gave Kendal “one throat to choke” for:

• Clinical (EHR) Solution

• Financial Solution • Payroll & HR Solution

• Marketing & Donor Development Solution

• Operations Management Solution

• Resident Management Solution

• Enterprise-Wide Solution • Point of Sale Solution

• Assisted Living Solution

• Home Health Solution

• Rehab Solution

• Physician's Office Solution

• Go Big Bang • Totally paperless • All modules • All at once

• Developed Schedule • Go Live Oct 2008 at first Affiliate • Go Live at another Affiliate every 2 months

• Not an IT Project • Needed subject matter experts (Super Users)

• In Health Service • In Finance • At Every Affiliate

• Not just automating a paper system

• Develop best practice processing

1. Which steps are really necessary

2. Who should do them

3. How should they be done

4. What do you need to do them

5. What results do you expect

6. How will the results be monitored

• From 'Leading Change' (1995) and the follow-up 'The Heart Of Change' (2002) by John Kotter

• Increase urgency - inspire people to move, make objectives real and relevant.

• Build the guiding team - get the right people in place with the right emotional commitment, and the right mix of skills and levels.

• Get the vision right - get the team to establish a simple vision and strategy, focus on emotional and creative aspects necessary to drive service and efficiency.

• Communicate for buy-in - Involve as many people as possible, communicate the essentials, simply, and to appeal and respond to people's needs. De-clutter communications - make technology work for you rather than against.

• Empower action - Remove obstacles, enable constructive feedback and lots of support from leaders - reward and recognize progress and achievements.

• Create short-term wins - Set aims that are easy to achieve - in bite-size chunks. Manageable numbers of initiatives. Finish current stages before starting new ones.

• Don't let up - Foster and encourage determination and persistence - ongoing change - encourage ongoing progress reporting - highlight achieved and future milestones.

• Make change stick - Reinforce the value of successful change via recruitment, promotion, new change leaders. Weave change into culture.

• Pain: Not having appropriate training materials from AOD

• Stop: Halted implementation schedule

• Re-assess our direction and time frame

• Gain: Creating our own documentation

• Intimately learning the system

• Became Super User of AOD

• And Developed a partnership with AOD

• Leadership is the key to success – • The DON has to be visibly involved.

• Not an IT project. • Affiliate needs to own the new system • Education ~ empowers front line staff

• Different learning styles • Computer literacy • Language not a barrier • Age not a barrier

• Education Alleviates Fears • Super Users/Champions

• Critical to success • Need to be identified for 24/7 support for go-live.

• State Regulations Differ • New York

• Board of Pharmacy – DAW box (Dispense as Written)

• Department of Health • Need approval for use of System in Adult Home & Enriched Housing

• Ohio • Board of Pharmacy

• 2nd factor identification

• Required wet signature

• Accreditation standards differ – • JCAHO National Patient Safety Goals

• Physician Acceptance

• Redesign processes to improve efficiency • Admissions process

• Month end re-cap process

• 24 hour chart check

• Care Plan process

• Availability of chart to interdisciplinary team

• Improved documentation • MDS trending

• CNA documentation for ADL’s and MDS look back

• Medication effectiveness

• Improved survey outcomes

• Staff satisfaction and retention

• Each implementation = new challenges and opportunities

• Client – Vendor partnership is key

• Preparation and planning for implementation is critical

• Ensuring staff understand the reason for change and are highly involved in the process

• Project champions critical to success from DON CNA

• Move to a paperless EHR can take place as a carefully orchestrated Go-Live “non-event”.

• Education yielded staff retention.

• Staff morale improved as evidenced in staff satisfaction surveys.

• It helps to have a Magic Wand.

THANK YOU!

doc@aodsoftware.com