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| Implementing Electronic Medical Record Systems: Organizational Benefits, Challenges, and Solutions |
| Sunday, May 24, 2009 |
| 9:00 AM–10:20 AM |
| North 221 AB |
| Area: OBM; Domain: Service Delivery |
| Chair: Jean Pavlov (NorthCare Network) |
| Abstract: Electronic medical record (EMR) systems are an important emerging development in behavioral and physical health care, and are being rapidly implemented in Michigan’s public mental health system. Selecting, implementing, and supporting EMR systems presents a multitude of opportunities to apply OBM principles and practices, although time and agency resource limitations often impose constraints and compromises. These processes are discussed from several perspectives. General EMR benefits related to controlling-reducing costs, improving productivity, and enhancing service quality are outlined. Recent collaborative efforts in Michigan are described, including efforts to more effectively harness technology and support change management within large agencies. A four-county agency implementation effort is presented with reference to Six Sigma principles, highlighting the outcomes resulting from employing a subset of these principles. The impacts of EMR implementations are discussed from a clinician perspective, referencing productivity, quality, and adherence to standards, as well as exploring shifts in clinician and administrator behavior required to successfully implement an EMR. Finally, OBM principles applied to a regional EMR implementation spanning all of Michigan’s upper peninsula are outlined. |
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| Realizing the Benefits of Electronic Health Records: Michigan’s Collaborative Efforts |
| JEREMY NELSON (Afia Health) |
| Abstract: Informed by national health care trends and In pursuit of increased quality, efficiency, and productivity, a number of Michigan mental and physical health agencies were early adopters of electronic health records. Pioneering efforts in the state were heavily based on public-private partnerships and interagency collaboration. Collaboration was, in part, driven by a need to overcome information technology limitations resulting from funding and resource challenges. These early endeavors prompted new organizational perspectives on the role of information technology and the need to intelligently manage large organizational changes. Successful electronic medical record implementations have produced significant benefits at all organizational levels. As these systems become more prevalent, fundamental changes in health care are likely to emerge, prompting additional organizational adjustments and challenges. As information becomes more accessible, consumers will become more informed and will demand further increases in quality and efficiency. Clinical and administrative staff will be challenged to reassess how they interact with consumers. Organizational behavior management principles and techniques, often applied informally in many implementation efforts to date, hold significant promise for assisting agencies attempting to effect and manage change on the way to responding to new consumer demands. |
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| Integrating and Adapting OBM Practices in a Public Agency EMR Implementation Effort |
| JEAN PAVLOV (NorthCare Network) |
| Abstract: Bridging the gap between theory and practice, private and public sector management, this presentation covers the needs analysis, procurement and implementation of an electronic medical record (EMR) at a rural community mental health agency in Michigan. Many performance management systems, such as Six Sigma, require the kind of financial investment and employee commitment not typically found in public agencies; however variations on systems of this type can be implemented successfully, bringing order to the integration of large-scale, enterprise systems such as an EMR. The changing nature of managing a public health system due to increasing contractual demands dependent upon information management is reviewed within the context of the decision to purchase an EMR. Demonstrated success using performance management tools earlier at the agency on smaller projects is outlined. Finally, a comparison of the ideal application of a Six Sigma methodology in this scenario versus what was actually accomplished, how it was done and the resulting impact is discussed in detail. |
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| Clinician and Clinical Administrator Perspectives on Successful EMR Implementations |
| RALPH L. OLSON (Pathways Community Mental Health), Kathy Dettling (Livingston County Community Mental Health) |
| Abstract: Electronic medical record (EMR) systems present unique challenges and benefits viewed from clinician and clinical administrator perspectives. Clinical staff commonly possess long-established patterns of behavior related to clinical work as well as its associated administrative functions that require significant adjustment in shifting from moving from paper to electronic records. In addition to playing central roles in assisting clinical staff make nesssary adjustments, clinical administrators must also participate in selecting, implementing, and managing organizational changes prompted by an EMR. EMR selection and implementation processes, in particular, bring into sharp focus differences in clinical and administrative perspectives. Successfully reconciling these markedly divergent repertoires has been a critical organizational task on the way to realizing benefits inherent in an EMR. Behaviors and processes central to agency successes are discussed from a behavior analytic perspective, and examples are enumerated at executive, project management, clinical administrative, and clinician levels. Practice improvements facilitated by EMR implementations at a clinical service level are also presented. |
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| Capitalizing on Combined Resources and Experience: Regionalizing an Electronic Medical Record |
| Jean Pavlov (NorthCare Network), JEREMY NELSON (Afia Health) |
| Abstract: Capitalizing on combined resources and experience, this segment examines the opportunities for increasingly integrating OBM methods to standardize processes and measures throughout a decentralized rollout of an EMR system, both regionally within Michigan and within other state systems. The use of process maps, relationship maps and job models to communicate EMR organizational impact is illustrated. Identification of critical-to-process measures and the need to manage upstream supporting measures is described. Iterative EMR product
development aligned with target population need, as evaluated through user and developer feedback loops, is investigated. Anticipated challenges and strategies in adapting the system to accommodate dynamic state regulatory requirements as well as ongoing fundamental changes in the healthcare field, changes in the way providers relate to consumers, changes creating a growing scrutiny of healthcare information in general, is discussed. Overall, this presentation addresses how, in our opinion, a controlled EMR implementation across numerous, typically unrelated public institutions can achieve a higher quality solution, at lower cost, when actively managed using a common toolset. |
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