We Have Announced Our EHR Selection

We have been on a two year journey to select our EHR product, Marshfield Clinic’s CattailsMD^TM .  My intent over the next few months is tell the story of our journey and provide details of the work ahead of us. I hope this work will be of value to others. Governor Doyle’s press announcement is below.

 

 

 

Friday, June 20, 2008

Contact: Carla Vigue, Office of the Governor, 608-261-2162

Governor Doyle Announces Creation of Largest Patient Database in Wisconsin

 New System Will Improve Safety and Health Care Quality for 2.5 Million Patients

Governor Jim Doyle announced today that Ministry Health Care will begin using an electronic health record (EHR) software suite developed by Marshfield Clinic - CattailsMD^TM - for the majority of its hospitals and Ministry Medical Group, creating the largest patient database in Wisconsin.

“This is an important step forward in our efforts to reduce medical errors, increase patient safety and decrease health care costs,” Governor Doyle said. “With better use of information technology, we can transform our health care system to improve the safety and quality of health care.”

“We are confident this significant IT investment will meet the health care needs of the patients we serve in northern and central Wisconsin,” said Nick Desien, president and CEO of Ministry Health Care.

“I am gratified that the longstanding relationship between Marshfield Clinic and Ministry Health Care has been further strengthened by this agreement to extend our CattailsMD^TM system to Ministry facilities, which will also greatly benefit our shared patients in the region,” said Karl Ulrich M.D., M.M.M., president and CEO, Marshfield Clinic.

More than 1,000 providers in the Marshfield Clinic system, at Ministry Medical Group and Ministry hospital locations will share access to 2.5 million patient records. Implementation of the EHR for Ministry will occur over three to five years.

The EHR makes all patient medical information immediately accessible via computer to medical personnel involved in a patient’s care regardless of where they are located. Currently, paper charts cannot be viewed by more than one person at a time and often need to be physically transported from one location to another, wasting time and adding cost.

Not only will the EHR improve access to patient records, it will provide clinicians critical information in an easy-to-read format.  The EHR will also be more secure. It will allow access only to those providers involved in a patient’s care, as well as track what information was accessed when and by whom.

As part of this agreement, Marshfield Clinic will provide planning, project management, implementation, training, customer service and technical support services to facilitate the installation of these clinical software applications.

Marshfield Clinic’s Cattails MD^TM is the first provider-developed ambulatory EHR in the nation to achieve Certification Commission for Healthcare Information Technology (CCHIT) certification.  It is used daily by more than 13,000 providers and support staff.  For more information about Cattails MD^TM, go to http://www.cattailsmd.com.

Widespread implementation of EHRs has been a top priority of Governor Doyle since he took office. In 2005, he created the Wisconsin eHealth Care Quality and Patient Safety Board, which is charged with developing an action plan for the statewide adoption and exchange of electronic health records. Governor Doyle has provided millions of dollars in tax credits for automating medical records and he ordered Act 108 to reduce barriers for providers to access electronic health information, while still maintaining appropriate privacy measures.

PowerPoint, Keep it Simple

PowerPoint is an essential ingredient for many presentations. Remembering it is an ingredient and not the whole meal can be the key to successful communication. We communicate to transfer ideas, an overly complicated PowerPoint diverts attention from the presenter to the medium and reduces knowledge transfer. When it comes to PowerPoint, less is more.

Keeping It Simple:

• Pick a simple format and stick with it
• Use no more than four to seven lines per slide
• Simplify the wording of each line
• Reduce lines of text when including images
• Rarely use animation, it usually distracts the audience
• Rarely use sound, sound as well can distract the audience

Your audience can read text on the slide, you do not need to read it to them. Your verbal presentation should amplify each slide’s context adding depth and understanding.

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Mistakes Are Good

Communicating can be frightening, especially if you worry too much about making a mistake.  Of course you strive to be accurate, but you will eventually make a mistake.  It is good when a mistake is pointed out to you because:

At least one person heard your message

The issue was important to them

You engaged them

They cared enough to point out an error

Thank people who point out mistakes and empower them to become involved in the improvement process.  Restat your mistake and what the correction will be and ask if you got it right.  Make sure to follow through and correct your mistake.  In future presentations you can even thank the individual for how they influenced the process. 

 

Clinical Reference Resources On-Line

Increasingly, doctors are turning to on-line resourses for clinical information. I first noticed the trend when we installed computers in each of our exam rooms with  connectivity to the Internet.  We found Google was a great tool to find information and direct us to sites we trusted.  I was amazed at how quickly each of our clinicians complained to me when our connectivity was interrupted. I even heard clinicians stating they could not provide quality care without connectivity to the Internet.

The trend continued when our local hospital (St. Michal’s Hospital in Stevens Point, Wisconsin) started a digital library and provided MedConsult and UpToDate access.  Our collection of books began to get dated as we turned to online resources containing the latest information.  About the only books we updated were radiology and dermatology references.

In late 2006, our system developed an enterprise level Library Without Walls. Our local hospital library was moved offsite since most services were provided on-line.  Use of these resources has been increasing at a steady pace.  Below you will find the number of topic views per quarter for just one resource, UpToDate.

I expect the trend to continue since online resources are more current than printed textbooks and are far easier to search.

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Backward Planning

When planning a project you can either start at the beginning and plan forward, or you can start at the end and plan backwards. If you have been a forward planner, try starting the process with backward planning and finish with a forward planning reality check.

When you begin the planning process at the end, you are forced to specifically define the end state and you are encouraged to consider what are the measures of success.  Failed projects tend to have an ill defined end point and no measures of success.  Once you know the end state, you can determine what is the very last step before you achieve it.  You can then continue to work backwards until you arrive at the beginning.  Now you can start at the beginning and plan forward filling in the details of the backward plan. 

The forward planning process is where you make sure to include all the elements of change management and determine how you will achieve the all important stakeholder engagement and buy in.

md-leader.com

Working as a Team

My employer, Ministry Health Care, partners physician leaders with a non-physician leader.  The teams are intended to provide patient centered vision from the clinician and strong administrative management skills from the partner.  The concept works well when the two truly work as a team.

My partner is Ministry’s CIO.  Behind closed doors we sometimes agree and sometimes disagree but the collaboration always produces a stronger deliverable than either of us could have accomplished in isolation. Once the door is opened, we present a united front. Communication of vision is so important, we just cannot afford to disagree in public.

Ministry is a large organization spread over north and central Wisconsin. Though we often present together, more often we go our separate ways to appear in front of diverse audiences.  We work hard to present the same message using the same PowerPoint presentation. The current PowerPoint is constantly updated but the document is located on QuickBase which can be accessed from any internet connection.  We access the latest version just prior to each presentation.  We also use a custom design template with an embedded graphic for each type of presentation. The various templates help to tie the message together.

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Forwarding E-mail

When forwarding e-mails, take the time to write an introduction or summary at the top including where the information originated and why it should be of interest.

Be careful that long e-mail strings do not include information that should not be forwarded. Read it thoroughly and delete sections if needed.

Check to make sure the Subject Line is short and descriptive.

Always use a signature and include your name, title and contact information.

Questions are Good

I just love questions after sending out a communication. A question means:

• They read what you sent
• The issue was important to them
• You engaged them
• You know additional types of information to include next time

Make sure to answer every question personally.  An e-mail response to a question sent via e-mail works, a phone call or a personal visit works even better. Assume if one person asked the question others are thinking of the same issue. I often send a follow-up communication with answers to all the questions asked.  If the topic is ongoing, consider starting a Frequently Asked Questions intranet page and do not forget to send out the URL.

Any Questions?

Triage E-mail

If you want to get a handle on your e-mail, triage it.  I use a number of Outlook e-mail folders that seem to work fairly well for me. I based my approach on one advocated by David Allen in Getting Things Done. One of the key’s to success is to make sure the subject line describes the content of any e-mail that is saved. Here is my triage process:

 

 

A description of my Outlook e-mail folders

• Somedaymaybe: contains anything I want to keep available for future use as a project and should be reviewed on a periodic basis.  The file contains potential projects and personal projects (such as vacations) that I might want to do.
• Reference: contains material I want for future reference.  From time to time, I move all the contents to a network location that is backed up on a daily basis.  Moving the files reduces the size of my mailbox. Having a good subject line facilitates searches for files.
• Project: any item requiring two or more steps is considered a project.  The folder is reviewed weekly.
• Waiting for: contains items that have been delegated or sent elsewhere asking for information. The folder is reviewed weekly allowing me to address overdue items.
• To Do: contains items requiring one step to complete that I choose not to complete when originally triaging.

Other ACTIONS in Outlook

• Do IT: complete any associated actions and delete the e-mail at triage.
• Move to Calendar: e-mails and attached documents needed for meetings are saved in the description of the meeting in Outlook, then deleted from e-mail.
• Future E-mail Delivery: the future e-mail delivery function can be used as a ticker file. I forward the e-mail to myself for future delivery then delete the original.

 http://md-leader.com

Communicate Something Rather Than Nothing

Establishing access to a communication specialist has been one of my CIO’s better moves.  Our specialist has taught us so much not the least of which is to communicate often.

There is never a time when all the information is complete, the idea fully developed or the story fully told.  It is tempting to hold off a communication until next week when we know more information, and then next week hold off another week. Before you know it, you have delayed a month and never communicated.

Establish how often you should be communicating with an audience (just ask them, they will tell you) and stick to the schedule.  Say what you can and if more will be forthcoming don’t be afraid to say so.  Your audience will appreciate it.