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Selecting an EHR System Mohtaram Nematollahi,PhD Health Information Management Expected Benefits of EHRs Reduce adverse drug events, medical errors, and redundant tests and procedures Help identify illnesses, prescribe drug/treatment and track preventive care Provide organized patient treatment history Improve communication between patients and providers Improve office efficiency General thoughts about paper versus electronic Paper not always available To Paper not always understandable To a degree, neither is electronic a degree, neither is electronic Paper is difficult to replace if lost To a degree, so is electronic General thoughts about paper versus electronic Paper does not support “real time” information about quality and cost control” To a degree, neither does electronic Paper is costly to compile and maintain To a degree, so is electronic What is an EHR? Secure, real time, point of care, patientcentric information resource for clinicians Aides decision-making through access to information and decision support Automates/streamlines work-flow, closes gaps in communication Supports collection of data for non-direct care Billing Outcomes/quality reporting Public health reporting Scope of EHRs “Best of Breed” Systems Niche systems (e.g. lab, radiology, pharmacy, accounting) Don’t always integrate with one-another Different processes from end-user’s standpoint (e.g. log-on, menus, etc…) Scope of EHRs Prime Vendor Systems Different systems from one vendor Lower integration costs More standardization from end user’s perspective Key Considerations Is the time right? Does an EHR realistically fit with our current priorities, needs, and abilities? Can we get buy-in and leadership? What are our system needs? How do we select a vendor? Can we afford it? Is the time right? Are there clinical or administrative issues that may be improved through an EHR? Results reporting delays? Supporting documentation for claims? Is the time right? What is our current workflow? Scheduling, triaging, registration Documentation of encounter, orders Result mgmt, protocols, clinical decision support, referrals Copayment capture, claims processing, billing How are we structured? Floor plan (power sources, network connections, hardware) Service sites Is the time right? What are our “outside” relationships? Safety-net networks? Can we make the initial investment ? More to come Is the time right? What are our future plans/expectations? Expansion of care-sites? Expansion of service types? Can we get buy-in? Common Barriers to Buy-In Initial capital cost/time cost Confidentiality/Security Maintenance costs Interference with doctor-patient communication Difficulty of learning new technology Lack of technical support in case of system failure Concern about ability to change the system Lack of perceived benefits from computerization Can we get leadership? Clinician “Champion” Credible Good communicator Passionate about the EHR CEO (in small practice, may be the physician) Provide resources Clear obstacles Project Manager Ideally, trained and skilled regarding EHRs Prior implementation experience Can maintain buy-in? Developing and maintaining buy-in Identify users’ motivation for EHR Keep people informed and engaged Involve end-users in tailoring the EHR Involve end-users in workflow re-design What are our system needs? On-site or Off-site Application License service providers (ASPs) own software and maintain on off-site servers EHR accessed through high-speed Internet connection What are our system needs? Clinical specifications Documentation Multiple of encounters note creation options (templates, dictation, voice recognition, handwriting) Automated chart documentation (problem lists, medication lists) Decision support tools What are our system needs? Clinical specifications Order entry (lab, radiology, other) Does it track orders? “Pick lists” of frequently used orders? Tailored forms Prescription-writer database (drug interaction checking) What are our system needs? Clinical specifications Results Flow reporting (lab, radiology, other) charting (labs, vital signs) Patient follow up/health maintenance deficiency alerts Patient handouts (available in multiple languages?) What are our system needs? Continuity of care Software interfaces with internal and outside labs Inpatient reports (downloadable) Remote access E-mail integration Telephone message documentation and tasking Patient web portal What are our system needs? Registration and billing specifications Patient registration index Generates appointment lists? Generate a patient summary? e.g. chronic problems, allergies What are our system needs? Registration and billing specifications Charge Built entry in chargemaster? Updates to chargemaster items/services and codes? Searchable list of codes? Alerts to coding modifiers? What are our system needs? Other administrative specifications Scanning in reports Interface capability Data format Security (audit trails, user access hierarchy, passwords) Generation of reports allowing for practice analysis Quality reporting How do we select a vendor? Initial considerations Does the vendor’s system interface with your existing systems? Is the particular product usually marketed to your practice size? Are others in the area using the product? How do we select a vendor? Initial considerations Is the vendor’s product certified? The Certification Commission for Healthcare Information Technology (CCHIT) Evaluate functionality, interoperability, and security Criteria and listing of certified products http://www.cchit.org/index.asp How do we select a vendor? Request for Proposals Background about your practice Ranked functional requirements Vendor information History of company Product maturity Number of employees Financial status Other clients (references) How do we select a vendor? Requests for Proposals Hardware and network requirements Interface capabilities Implementation plan Training Customer maintenance and support Proposed costs and payment schedule Can we afford it? The average implementation for a sole practitioner 12 to 18 months, including planning, design, implementation, and training Longer period for small practices Lower productivity during initial learning curve One study estimated $11,200 in first year Can we afford it? Average implementation cost per full time provider $14,500 - $63,000 Network fees, database licenses Training fees Maintenance $7,200 per year Return on investment 2.5 years on average Can we afford it? Costs balanced by savings Adverse drug events Drug utilization Laboratory/radiology utilization Charge capture Can we afford it? Costs balanced by savings Billing errors Medical records space, paper charting Bargaining power Pay for performance