Technology in the Clinical Practice Made Ridiculously

Transcription

1 1212 Technology in the Clinical Practice Made Ridiculously Making the Technology Work and Pay Off (EMR or any technology project) David Shulan, MD, FAAAAI

2 Disclosure : David Shulan I or my family own stock: GE IBM Apple Microsoft HP Google CISCO

3 Planning Technology Project (EMR is an example) Why are you doing it? Remain competitive. Required to stay in business. Improve patient care. Improve efficiency. Reduce costs In short term In long term

4 Planning Technology Project Costs Cost of original hardware Cost of original software Cost of training Figure in the cost/or benefit to productivity. Short term Long term Will you get paid to do it? Cost of acquisition and maintenance Hardware Software Obsolescence

5 Make sure the system is ready Before you or your colleagues are subjected to a new technology. Make sure your equipment is ready. Make it as stress free as possible for the user. If down time impacts your practice, do you have plans for proper PROMPT support? Do you have disaster plans.

6 Leadership (in any project) Who is going to lead the project? Champions Practice manager Physician Nurse Outside consultant Who is going to maintain the project after implementation?

7 Goals (in any project) Determine what you want to accomplish in the short term and what you wish to do in the long term. Make your goals achievable. Be prepared for changes in goals and timelines based on unforeseen circumstances.

8 Technology Changes In 1995 Word processing over telephone lines to a central server was impractical. Word processing on standalone PCs was the best choice. Interoffice networking was limited. Transfer files between offices via floppy disc 2000 offices networked via VPN over internet Files transferred over network 2007 higher speed connections allow running EMR and word processing on virtual desktops. Word processing over a central server was now practical. Today Virtual Machines are common.

9 Technology Changes Note any project needs reconsideration of previous workflows and practices. The best solutions will likely change over time. Be ready for this. Don t bet on a great technology that has not been tested. You do no want beta test in your practice. Can some of these new technologies save time? With a patient portal, pre-visit information can be given, patient can give required information.

10 Workflow redesign New technology often offers better solutions to old problems. They way we did it for 20 years may not be the best. Do not carry inefficient work flows into the new system. Be prepared to modify workflows before and after an implementation.

11 Old workflow for RX refills Call to office Pull chart Nurse review Send to Physician Send back to nurse to mail prescription if OK

12 New Workflow for RX Refills Patient receives message from secure portal. Nurse checks on EMR, if appropriate e- prescribes refill directly to pharmacy.

13 Roles What are the roles of staff preimplementation. What are the roles of staff during implementation? What are staff roles post implementation? Some roles may be eliminated. Some roles may transformed. Some new positions may be needed.

14 Preparing for a technology project- Expectations (EMR as an example) It is not going to be perfect from the beginning. It will get closer to perfection over time but expect an ongoing process. The new technology may do some actions in a way that is alien to you. Adjust the technology (if possible) Adjust your work flows. How long will the project take to get up to speed? The learning curve.

15 Assign Responsibility Select individuals or groups to complete task. Have them own their tasks. Identify those who need additional training. Identify individuals who are reluctant for the change and use their skills if possible to bring them into the process.

16 Planning There will be some in your staff who may not be able to make the change. What roles do people have today? What roles will they have after implementation? Plan for contingencies. Murphy s Law

17 Planning for the project Plan an implementation schedule Be flexible Decide on what features to implement at the beginning or at all. How to get existing patients into the system. Repopulate or add over time. Adjust schedules to accommodate training and implementation.

18 Planning Customization Will it be fine out the box? Example EMR templates How much customization do you need to do. Have others used the technology before? Can you use their solutions or adapt them? Sellers of equipment can give slick demonstrations, be sure to test the technology in real life scenarios.

19 Security and privacy (EMR example) You will be required to set up security and privacy protocols. For staff For patients For sending out records. You will need to maintain security updates on your system.

20 IMPLEMENTATION Train, train, train Consider timing of go live Evaluate, re-design, re-educate The process is continual!

21 CHECKLIST FOR PREPARING FOR IMPLEMENTATION (of an EMR) q Do you have a clinical lead and an administrative lead for the project? q Have you appointed a project manager? Does one of the "leads" have the time and skills to do this or do you need to hire a consultant? q Have you worked with your team to create a project plan, with tasks, timelines and a named individual responsible for each task? Is everyone in agreement with this plan, including the vendor? q Have you worked with your team to complete a process map for your practice and identify areas for improvement, e.g. where the EMR software will change how you work, where staff have different roles, where information and data flow differently?

22 CHECKLIST FOR PREPARING FOR IMPLEMENTATION q Have you developed privacy and security policies for your practice? Do all staff understand the policies? Are patients aware of the policies? q Have you established system management guidelines and a disaster recovery plan for the practice? Have you worked out implementation details with your vendor(s)? q If you are planning on meeting meaningful requirements. Are you prepared?

23 CONTACT INFORMATION DAVID J. SHULAN, MD Certified Allergy & Asthma Consultants 8 Southwoods Blvd. Albany, NY