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Rolling Out Centricity EMR To A LargeMulti-Specialty PracticePresented ByThe Robert Wood JohnsonMedical Group &GE Healthcare
ImplementationOverviewF rank A. Sonnenberg, MD, FACP, FACMIMedical Director of Clinical Information SystemsRobert Wood Johnson Medical Group
Robert Wood Johnson Medical Group(RWJMG) Faculty practice of the UMDNJ Robert Wood JohnsonMedical School Located in Central New Jersey 500 physicians; 300 ambulatory providers 16 clinical departments 42 distinct specialty practices 8 clinical institutes 20 affiliated hospitals 243,300 annual ambulatory visits in 2010
History of RWJMGGE Centricity Implementation1995 – Clinicalogic installed at NJMS – Newark, Department ofMedicine2000 – Logician implementation extended to entire university(3 medical schools) Implementation at RWJMG incomplete (5 practices)2007 – RWJMG contracted independently with GE for hostedCentricity EMR Rollout of EMR extended to entire RWJMG group (42practices) Goal set to implement all practices by 12/31/20102009 – ARRA and meaningful use
RWJMS LeadershipDean, RWJMSDirector listsPresident,RWJUMGCOOMedicalDirectorClinical ITDirector sInterfaceSpecialistDesktopSupport
ChallengesPrevious paper medical record system fragmented withinconsistent managementBad habits Poor documentation practices Lack of communicationResistance to change among providersReluctance to trust electronic systemsPerceived slowness of using electronic systemsConcern about reducing patient loads duringimplementationConcerns about patient confidentialityConcerns about down time.
Success Factors Commitment and support of medical school and practiceleadership to make EMR implementation official policy Endorsement by board of governors that includes all clinicalchairs Dedicated staff to lead EMR implementation EMR implementation driven by and led by clinicians
Success Factors, cont’dRegular, frequent team meetings Shared goals and expectations Maintain communication among team members Problem solving/troubleshootingProviding as much electronic data as possible (interfaces)Lots of hardware (computers and printers)Providing remote access to the EMR
Meeting the Challenges Scheduled rollout with timelines Development of a medical records policy that supporteduse of the EMR Consolidation and centralization of medical recordsmanagement across the group practice Implementing enthusiastic practices first Taking advantage of critical mass effect Flexibility in approach to documentation Training ancillary staff to do as many functions aspossible.
Communication Regular reports to the board of governors Email notices to all faculty and all EMR users IT Advisory Committee with departmental representatives Face-to-face meetings with clinical practices Tips and Tricks EMR Wiki
Tips and Tricks
ProjectManagementLinda Travers RN, MS, NE-BCProject Manager of Clinical OutcomeGE Healthcare
The Core Project TeamFrank Sonnenberg, MDMedical Director of Clinical Information SystemsLinda Travers, RN, MSProject ManagerStacy Gansfuss, RHIAMedical Records DirectorDaniel CacaceEMR Specialist/InterfaceSpecialistGE AnalystsTheresa Savage, Dorothea Spencer,Marian Conroy, RN, MSConstantine PapasavvasRWJMG EMR SpecialistsSonia Rosado-MoraAmanda Kukwa
Implementing EMR is About TeamworkCore TeamsSuper-usersSpecialtiesand customizationClear objectives& GoalsCooperationIntegration & InputLeadership andcommitmentAn implementation is only as good asyour team!
EMR Project OrganizationRWJ Medical GroupLeadershipEMRCore TeamWeekly MeetingClinicTeam #1IT AdvisoryCommitteeMonthly MeetingClinicTeam #2ClinicTeam #3Host TeamWeekly MeetingClinicTeam #4
IT Advisory Committee composition Representatives of Clinical Departments––PhysiciansNurses and administrators Medical Group staff GE Core Team Medical School IT Department Compliance
Core Team Committee Composition RWJ Participants Medical Director Interface Manager Medical Records Manager Two EMR Specialists Compliance and Nursing GE Core Team Project Manager Four EMR Analysts Hosted Team Project Manager System Engineering Interfaces
Project Plan16 Week Base Plan Pre-Kick off/ Kick off Plan & Decisions Workflows Train & Go-Live Maintain/ Circle Back/ Meaningful Use
Value of Project Management& Staying on TaskProject PlanningProject IntegrationScope ManagementOutline the scope andprocess of the projectAssist in the integration ofnew technology in yourfacilityEnsure requirements aredefined and incorporated intothe projectTime ManagementCost ManagementQuality ManagementManage the execution ofmilestones on timeDeliver the project oncontract budgetReduce and manage projectrisks to increase satisfactionResource andProcurement MgmtCommunicationManagementRisk ManagementCoordinate the GE projectteam in addition to thirdparties and the customerteam at the right timeManage communicationbetween resources andprovide feedback to projectstakeholdersIncrease project success bymanaging conflictingpriorities, scope, cost, andtime
Identify Your Project Goals & ObjectivesStay FocusedIdentify the Factors leading to installation of an EMRWhat Benefits are expected from implementation?Expectations of the system and project?Project stakeholders’ needs and expectations?Your project goals Client project goals and objectives defineproject “success.”
Project Success is linked to People who are engagedProcesses that workThe Right Tools
ImplementationMethodologyDorothea SpencerGESS Clinical EMR SpecialistGE Healthcare
Implementation cyclePlanMake decisionsAssess WorkflowsSet up Centricity EMRTrain/Prepare StaffGo-LiveMaintain/Improve
Implementation MethodologyShared Responsibility GE supplies some SW products and value added services Client supplies implementation manpower & HW 3rd Party Partners supply SW products for interfacesClient Contributions3rdParty Partners Contributions3rd Party Products3rd Party Product TrainingInterfacesConsulting/SupportGoals & ObjectivesTechnical InfrastructureOperations KnowledgeProject Team & Implementation ManpowerUser CommunityClientGE Contributions3rd PartyPartnersGEHealthcareSoftware ProductProduct TrainingTechnical ConsultingClinical ConsultingImplementation GuidanceGE Resource CoordinationOverall Project Oversight
Phase 3-4Key Decision Planning Key Decisions influence how the EMR system is set-upfor use by each clinic The core customer project team makes decisions withthe assistance of a clinical analyst Key decisions are documented by the clinic and becomethe EMR operating policy representing all functionalareas of the clinic Key decisions will sometimes need to be re-visited forupdated processes in the clinicPhase 3-4
Clinical Content SelectionGE EMR comes with clinical content informationorganized in kits by specialty Encounter Forms Used to document parts of or all of patient visits You can create and customize these powerful data entry tools Handouts and Letters The system allows the creation of personalized content to improvecommunication between you, your patients and your patient’sreferring provider Custom Lists Medications, problems, and orders
Automated Workflow Planning - Sample
Customization and Content Keep Customization to a minimum ( this usuallychanges after go live) Utilizing Encounter Form Editor additional formscreated to meet the documentation needs Birth History forms were specialized for PediatricPractices Peds Endocrinology- Needed system that calculatedstandard deviation score (SDS) for weight,length/height
Preload PlanningProcess of getting information into EMRHow much information entered depends on many factors includingstaff, budget, time, and the state of current paper charts .Commonly Preloaded Items Current Problems (Diagnosis Codes)Current MedicationsCurrent AllergiesAdvanced DirectivesFamily History Immunizations (Pediatrics)Recent Tests & ServicesRecent Vital SignsHeight and Weight forPediatrics
Post Implementation Identify super users in each practice Train the trainer classes - Promote thedevelopment of super users Dedicated EMR Specialists/Onsite Team On –Going training needs of New staff Circle Back Process- Assess minimal/Meaningful use
Interfaces &Pulling it all togetherDaniel CacaceEMR Specialist/Interface ManagerRobert Wood Johnson Medical Group
Medical RecordsThe importance of consolidationand standard operating procedures
Document Management Lessons Consolidate scanning & indexing staff when possible! Standardize document type classification scheme,provide examples and training to staff tailored to thestandards. Plan on pre go-live scanning to reduce providerdependence on the paper chart. Use Crystal Reports to audit the indexing process,determine standard metrics and publish results to pushusers to increase performance.
Integration of Add-OnsExpand your Centricity EMRenvironment with add-onsoftware
Our Centricity EMR Add-OnsKryptiq ConnectIQ Document ManagementCentricity Advanced ePrescribingCentricity Clinical Content (CCC)Crystal Reports XIDragon Medical 10.1 & Clinically SpeakingComing soon Kryptiq/Indxlogic Advanced Auto Indexing Centricity Patient Online Kryptiq Secure Messaging BISCOM CV Plus for e-fax Ignis Systems EMR-Link
InterfacesImproving patient carethrough data exchange
Identify and Prioritize Potential Interfaces Identify the lab/radiology/hospitals with thelargest volume for your practice. Prioritize interfaces that benefit the entiregroup above those that only benefit oneclinic. Identify and engage key personnel involvedwith each interface. Create a project plan for each interfaceproject and distribute to all parties involved.
Learn to Love HL7 The “Managing Interfaces with CentricityEMR” documentation should become yournew best friend. Third party software like 7scan or 7edit willmake your life much easier. Don’t be afraid to experiment!
An Interface Engine is Crucial An interface engine will allow you to acceptHL7 messages that do not conform to EMRstandards and translate them to somethingthe EMR can import. We use GE ConnectR but newer EMR versionscome packaged with Centricity ClinicalGateway with Cloverleaf, there are alsovarious third party options available. Plan toimplement one ASAP.
Zen and the Art of LinkLogic Maintenance As the number of interfaces and messagesgrew, so did the number of messages that hitthe LinkLogic error queue. Plan to have a detail-oriented person clearthe queue several times a day. Often the error queue is the first place youwill see evidence of problems with aninterface.
Initial Interface Configuration
Current Interface Configuration
THANK YOU!
Rolling Out Centricity EMR To A Large Multi-Specialty Practice Presented By The Robert Wood Johnson Medical Group & GE Healthcare . F rank A. Sonnenberg, MD, FACP, FACMI . 3rd Party Partners supply SW products for interfaces Client 3rd Party Partners GE Healthcare .
