IHS-EHR Site Questionnaire

The purpose of this questionnaire is to allow the IHS Electronic Health Record (EHR) Program to gather information about a facility — the type of work done there, and the clinical, business, and technical environment. Completing the survey helps the EHR Program support implementation efforts and stimulates early thinking about what transitioning to a computer-based health record will involve.

Choosing to transition from paper charts to the EHR requires a commitment by virtually all organizational departments to significant changes in business processes. A facility interested in EHR should begin the process of team building and planning as early as possible before the anticipated date of implementation.

Last Updated: 2010-09-07 — Source: IHS EHR Program

I. Facility Information

Name

Facility legal name

Affiliation

IHS Tribal Urban

Address

Street, city, state, zip

Category

Hospital Clinic Emergency Room Urgent Care

II. Principal EHR Contact Person

Name

Title

Telephone

Fax

E-Mail

III. Local EHR Implementation Team

It is important that sites take a team approach to planning for and implementing the Electronic Health Record. Some suggested members of that team are listed below, but each site will have unique preferences and needs for who should be involved. The most important consideration is that your facility has strong administrative and clinical leadership ("champions") behind the EHR effort.

Please provide contact information for your team members, and specify a role and contact information for additional team members not listed below.

CEO/HSA

Name: Telephone: E-Mail:

Clinical Director

Name: Telephone: E-Mail:

CIO/Information Systems

Name: Telephone: E-Mail:

Director of Nurses

Name: Telephone: E-Mail:

HIM

Name: Telephone: E-Mail:

Business Office Manager

Name: Telephone: E-Mail:

Chief Pharmacist

Name: Telephone: E-Mail:

Laboratory Supervisor

Name: Telephone: E-Mail:

Radiology Supervisor

Name: Telephone: E-Mail:

Additional roles (as needed)

(Role) Telephone: E-Mail:
(Role) Telephone: E-Mail:
(Role) Telephone: E-Mail:

IV. Description of Facility

General description, location, population served, etc.

Open text response

Types of clinical services provided (medical, dental, mental health, pharmacy, etc.)

Open text response

Does the facility have satellite clinics?   Yes / No

If yes, do you expect them to participate in the initial installation of EHR?   Yes / No

Medical staff description

Describe the medical staff, including the number of physicians, the number of midlevel providers, full-time vs. part-time providers, and a general idea of staff stability, vacancy rates, turnover, etc.

First implementation area

In what part of the facility do you plan to implement EHR first (inpatient ward, outpatient clinic, emergency room, etc.)?

  • How many providers work regularly in this area?
  • Describe the daily census/patient volume in this area.
  • What are the hours of service in this area?

V. EHR Components To Be Installed

Describe the EHR components and functions that the facility plans to implement. This list is not comprehensive, but it provides an idea of the different components available.

Provider order entry for medications (pharmacy)

Yes / No

Provider order entry for laboratory tests

Yes / No

Provider order entry for radiology exams

Yes / No

Provider entry for inpatient nursing orders

Yes / No

Documentation of immunizations

Yes / No

Template-based note authoring

Yes / No

Dictation system for note authoring

Yes / No

Charge capture for billing purposes

Yes / No

VI. Current RPMS Environment

Describe the current RPMS application environment at the facility. List all clinical support and point-of-service applications currently in use, including RPMS versions and patches.

Is the facility running RPMS (general)?

Yes / No

Computing Environment

Hardware:

Server:

Operating system, etc.:

Pharmacy

RPMS version/patch:

Pharmacy package name:

Does your facility currently use a Pharmacy Point of Sale (POS) application?   Yes / No

POS Package Name:

Laboratory

RPMS version/patch:

Does your facility currently use Ward Order Entry for Laboratory?   Yes / No

If Yes, lab orders are entered by:   Provider   Nursing Staff   Other

Do you use a local health facility to process your labs?   Yes / No

Reference Lab and POC Tests

Reference lab interface:   Yes / No

If Yes, is the interface bidirectional or unidirectional?

CLIA waived tests?   Yes / No

Result entered into RPMS?   Yes / No

Radiology

RPMS version/patch:

Does your facility currently use Ward Order Entry for Radiology?   Yes / No

If Yes, radiology orders are entered by:   Provider   Nursing Staff   Other

Does your facility transcribe dictated radiology reports into the Radiology package?   Yes / No

PIMS

RPMS version/patch:

Scheduling GUI

RPMS version/patch:

Billing

RPMS version/patch:

RCIS

RPMS version/patch:

Contract Health

RPMS version/patch:

Diabetes

RPMS version/patch:

Visual DMS:   Yes / No

CRS

RPMS version/patch:

GUI CRS:   Yes / No

Immunization

RPMS version/patch:

iCare

RPMS version/patch:

Case Management

RPMS version/patch:

Emergency Room System

RPMS version/patch:

Women's Health

RPMS version/patch:

Asthma Register System

RPMS version/patch:

Dental

RPMS version/patch:

Dentrix:   Yes / No

Behavioral Health

RPMS version/patch:

IHS Patient Chart:   Yes / No

Behavioral Health GUI:   Yes / No

Other major RPMS applications

Open text response

Is your facility running PCC Plus?

Yes / No

VII. Current Network and Computing Environment

One of the main requirements (and advantages) of an electronic record is that all users have access to the system at the point of service. Nobody should be looking for a computer to enter or retrieve information.

Please describe your facility's current computer network situation and share your thoughts about getting it ready for EHR.

Windows PC clients or wireless in all exam rooms?

Yes / No

Windows PC clients or wireless in all provider offices?

Yes / No

Windows PC clients or wireless in all nursing areas?

Yes / No

Is the facility fully networked including access points at all clinical support areas (pharmacy

Yes / No

laboratory

Yes / No

radiology

Yes / No

registration

Yes / No

business office

Yes / No

medical records)?

Yes / No

Describe the type of network, speed/bandwidth capability, etc.

Open text response

Hardware and Network Requirements

A thorough review of the local technology environment will be required at any facility implementing the RPMS EHR. Facilities will need to evaluate hardware needs in or near exam rooms and provider offices to ensure that providers and other users of the EHR have access to the system at the point of service.

Because the EHR is a client/server application, it does not require a separate server to run. The VueCentric framework resides on each client (user) computer, and all data resides on the RPMS server. Updates to the framework application or GUI components are deposited in a single object library folder, which automatically updates the client computers each time the application is launched.

I/T/U health care facilities vary greatly in size, services provided, and in a number of other factors. For this reason, it is difficult to provide a single set of recommendations for hardware and network infrastructure that will fit all sites. Contact your Area MIS department or CAC for questions regarding these requirements.

If your facility does not meet these requirements, how do you plan to achieve full hardware and networking capability? Include timelines.

Open text response

Has a financial commitment been made by facility administration to bring the network up to the level necessary for EHR implementation?

Yes / No

IT Support Environment

Number of dedicated IT staff for clinic:

Hours of operation for IT department:

If the IT department hours do not match the hours of service in clinical areas using EHR, how would you handle hardware and network problems after hours to support clinical care?

VIII. Clinical Support Environment

Two key players in a local EHR implementation effort are the clinical champion and the clinical application coordinator (CAC). The clinical champion is typically a physician who provides the energy and motivation to bring the medical staff on board with the EHR. The CAC is often a nurse or other health professional whose permanent job is to be a resource and troubleshooter for clinical users, helping the EHR to work for them. The CAC also provides ongoing training for new staff and on new components and features of the EHR.

Who is the local "clinical champion" for EHR implementation?

Open text response

If this person is not the clinical director, does this person have the authority to make recommendations, set policy, and/or motivate staff as necessary to achieve successful EHR implementation?

Yes / No

Does the facility have a full-time CAC?

Yes / No

If Yes, please provide the CAC's name and contact information.

Name: Telephone: E-Mail:

If No, is there a plan to hire a fill-time CAC?

Yes / No

If Yes, what is the timeframe for this hire?

If CAC duty hours do not match the hours of service in clinical areas using EHR, how might the facility support clinical users who may have problems using EHR during off hours?

Open text response

If no CAC is planned, how do you envision that the facility will cover the functions of a CAC in support of clinical use of the EHR?

Open text response

VIII. Business Process Environment

Has the facility undergone a recent (within two years) formal evaluation of clinical and administrative business processes, such as in preparation for accreditation?

Yes / No

If Yes, please describe some of the business process changes you implemented in response to the recommendations.

If No, please describe how you might go about evaluating and redesigning your business processes in preparation for the EHR implementation.

IX. Comments

Please make additional comments regarding your facility, your staff, and your plans for implementation of the EHR. This will help EHR Program staff understand your unique circumstances so that we may provide better support to you in this effort. Feel free to include any specific questions or concerns you may have. Attach additional pages if necessary.

Attestations

The undersigned administrators and staff request the assistance and support of the IHS Office of Information Technology in preparation for, installation of, and implementation of the IHS Electronic Health Record. In so doing they attest to the following:

  • • The organization's administration is committed to supporting implementation of the electronic record, including expenditure of funds as needed to bring the facility's network and computer hardware infrastructure to the level necessary to operate the EHR in a clinical environment.
  • • The medical staff is supportive of plans to implement the EHR system.
  • • The administration and medical staff are both aware that clinical implementation of an electronic medical record system will reduce provider productivity in patient care during a transitional period that may last for several months.
  • • The local Tribal government has been consulted and is supportive of plans to implement the EHR system.
  • • The organization will participate in a program of evaluation of the success and effectiveness of the IHS EHR. This is required as a part of funding for IHS-EHR, and will involve collection or reporting of various types of clinical, productivity, and revenue data.
  • • The organization's Governing Body is aware of the organization's plans to implement the EHR, and has committed its full support.

CEO/HSA

(in lieu of signature)

Clinical Director

(in lieu of signature)

CIO/IRM/Site Manager

(in lieu of signature)

Date Submitted to EHR Program