Transcript Gateway Medical Associates

Ambulatory information
systems
Wendell Murray
Wendell Murray Associates Inc.
www.wpmassociates.com
Phone: 484-678-9681
E-mail: [email protected]
Copyright © 2006 Wendell Murray All rights reserved
What I do
• Help physicians practices select and implement practice
management (PM) and electronic medical records (EMR) systems
• Help healthcare entities of any type: ambulatory, hospital, nursing
homes, etc. with operational, strategic and information system
issues
• Specific example of PM/EMR system selection and implementation
at Gateway Medical
What a client gets
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40%-150% return on investment in information technology
Quick evaluation and selection of a software vendor
Best possible deal with the selected vendor
Best possible implementation of a system
Operational and strategic review of the practice
Help in negotiating with insurance payers, particularly Independence
Blue Cross and related companies
• Advice regarding relevant trends in the healthcare marketplace
• Unbiased, knowledgeable advice in all areas
– I have no financial or other relationships with any vendor
Areas of expertise and experience
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Financial management/analysis
General management
Operations management
Strategy development
Business analysis/planning
Business process improvement
Software/website development
Supply chain management
ERP system implementation
Project management
Industrial sales and marketing
Wendell Murray
Background
• 1990s
– Owned, ran manufacturing businesses in northern NY State
• 1980s
– systems consulting
– financial work
– media/entertainment industry
• Companies
– Accenture
– Home Box Office
– Time Inc.
– The Walt Disney Co. (VP-Finance of Consumer Products)
• University of Vermont, Amos Tuck School (Dartmouth Collegeaffiliated business school)
Current work
• Operational improvement, business and
financial analysis, systems consulting
• Business development
• Focus on healthcare
– Ambulatory information systems
• Work in Italy
– Near-perfect knowledge of Italian language
– Many business, university and healthcare contacts
– Existing healthcare-related projects
Example of Gateway Medical
Gateway Medical Associates
Project
• Gateway: large primary care practice in Chester County
PA
• Decided to invest in an electronic medical records (EMR)
system
• Ended up replacing practice management (PM) system
in addition to EMR system
• Illustrative case of benefits of utilizing information system
Gateway Medical
overview
• Primary care practice in Chester County PA
– 28 providers
– 7 medical offices, 1 administrative office
– 100,000 active patients
– 120,000 visits per year
– 120 employees
– $10 million in revenue
Gateway Medical
Impetus to invest
• Decision to invest
– Push from CMS-funded project to encourage physicians to
automate
• Pennsylvania one of several states selected for the
project
– Good experience installing existing PM system in 1999
– Awareness of mandate from Medicare
Gateway Medical
Physicians’ perspective
• Physicians perspective
– Most physicians also shareholders in practice
– View system as incremental cost
– Resistance to change
– Fear of technology
– Range of comfort with technology
• None to fairly adept
• Somewhat a function of age
– Spend if CMS mandates
Gateway Medical
Project stages
• Project development
– Almost 2 years elapsed time to start seeing
benefits
– Project started early spring 2005
– Request for proposals late spring 2005
– Proposal review summer 2005
– Software vendor selected fall 2006
– PM installed spring 2006
– EMR installation August-November 2006
Gateway Medical
Ambulatory software vendors
• About 10 major suppliers
• Some large, e.g. GE, Mysis, Epic
• Others fairly small, some private, some public
– eClinicalWorks
– Allscripts (Healthmatics)
– Nextgen
– iMedica
Gateway Medical
Consensus from survey
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Systems from all vendors work adequately
Over 20 practices contacted
No practice would use paper charts again
No matter what the hassle or cost an EMR is worth it
Implementation goes smoothly
Interface to separate (PM) system works adequately
Some replaced existing PM while installing EMR
– Incremental cost = cost of interfaces
– Many advantages to integrated system
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Less complicated
Easier for vendor to update code
Fewer “moving parts”
Single database
Gateway Medical
Benefits
• Quality of care is better
– Drug interactions
• 33,000 patients die yearly due to adverse drug reactions
– All patient information available immediately
– Clinical procedures
• Common treatment regimens implemented
• Better prevention tools
– Comprehensive documentation
• Operations are more efficient
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Electronic prescribing/refill management
Lab ordering
Electronic messaging internally/externally
Dramatically improve reporting to payers
Office workflow improvement
Patient management
Reduced clerical input
Gateway Medical
Provider productivity gains
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Reality is that there are few, but….
Patient encounters don’t take more time
Providers generally don't see more patients, but.…
Providers leave work earlier and….
Providers can finish paperwork remotely, e.g. from
home
Gateway Medical
System cost categories
• Six segments of costs
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Initial license fees, i.e. “investment”
Annual license and other fees
Custom programming: interfaces
Third-party licenses: underlying system, e.g. Microsoft licenses,
Oracle licenses
– Third-party licenses: drug databases
– New hardware
Gateway Medical
Equipment configuration
• Client/server architecture
• Servers
– 1 Application/database server
– 4 Terminal services servers
• Clients
– Existing PCs for office and some nursing staffs
– New wireless Tablet PCs for providers and each
provider’s nursing assistant
• Wireless access points in each office
• Offices connected by T-1 lines
Gateway Medical
System cost
Third party software licenses
Healthmatics license fee
Hardware costs
Implementation
Discount
Total initial investment
Yearly fees
$ 54,000
232,000
205,000
131,000
( 62,000)
$ 560,000
$ 68,000
Gateway Medical
Staff/other expenses
• Reductions in headcount:
 Filing needs
 Nursing staff
 Other clinical support staff
 Other administrative staff
• Reductions consistent with experience of other practices
• Pro-active changes to procedures needed to realize these
savings
• Eliminate transcription cost
Gateway Medical
Reduction in headcount
Nursing
Office staff
Employed providers
Other clinical
Total headcount
2006
2007
39
56
11
3
109
35
35
11
1
82
Reduction
4
21
2
27
Gateway Medical
Reduction in wage expense
Nursing
Office staff
Employed providers
Other clinical
Total wages
2006
2007
Reduction
$1,267,000
1,740,000
814,000
93,000
$3,914,000
$1,129,000
1,253,000
814,000
40,000
$3,236,000
$138,000
487,000
53,000
$678,000
Gateway Medical
Other line items
• Revenue
– Possible increase due to higher coding
– Possible increase due to higher physician productivity
– $0 to $500,000 increase
• Other expenses
– Reduction in telecommunications costs
– Open source PBX and use of cable/ DSL rather than T-1 lines
– $80,000 savings
– Elimination in transcription costs
– $46,000 savings
Gateway Medical
Possible increases in revenue
• Increase of 5% in volume of patients seen applicable to
all areas (productivity increase)
• Increase of 5% in higher fee-for-service coding (socalled “up coding”
Gateway Medical
Information systems changes
• Replace T-1 lines with DSL or cable Internet access
• Implementation of software PBX (private branch
exchange) system with Asterisk
• Asterisk
 Open source software
 Widely implemented
 Uses Voice over IP (e.g. Internet and LAN) in place of telephone
circuits
 Managed via software rather than hardware
Wendell Murray information
Wendell Murray
Wendell Murray Associates Inc.
602 Rosetree Lane
Kennett Square PA 19348
Tel:
610-624-1893
Mobile:
484-678-9681
E-mail:
[email protected]
Website:
www.wpmassociates.com