Transcript Online Clinical Data: A Servant, Not a Master

The Future of Health
Information Technology
Necessary Evil or
Blessing in Disguise
Mark R. Anderson, FHIMSS, CPHIMS
AC Group, Inc.
Mark Anderson, FHIMSS, CPHIMSS
Healthcare IT Futurist
34+ Years In Healthcare IT
IDN Expertise
– CIO Position at Three Multi Facility Regional IDN’s
– Executive Team Member at 5 Different IDN’s
– Worked In 158 Hospitals and 21 Payer Organizations
Physician Expertise
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Managed 50 Physician Practices in the Late 1980’s
Former CIO of a 2,300+ physician (500+ Practices) IPA
Currently Conducting EHR Searches for > 100 Practices
National Speaker on EHR - > 380 sessions since 2001
Negotiated more than 100 EHR contracts
Installed over $1B in technologies since 1972
Disclosure
Speaking at numerous professional associations
and at vendor meetings (over 100/Year)
White Papers on the use of technology
Serve on numerous conference boards
EHR Search and Selections (> 100 Practices)
DOQ-IT and CMS EHR Selection Tool
NO Revenue from any vendor based on any
Sales or increase in Revenues
Why is this session important
In 2006, the healthcare industry saw an
explosion in interest in the ambulatory EHR
marketplace
Partially driven by quality indicators, P4P, and a
relaxing in the Stark law that prohibited hospitals
from funding community EHR initiatives.
What does this mean for the average Physician
Practice?
Topics
How will EHR initiatives are changing the way practices
look technology decisions?
What is the government’s involvement in EHRs?
How are hospitals leveraging EHR projects to increase
physician bonding?
How with EHR affect your revenue stream?
Why do systems fail?
How the EHR vendors are rated and why many will not
survive?
Vision
“Technology is simply a catalyst that will
empower providers to drive meaningful
changes in care.”
“ People love progress … but hate
change”
What issues are physicians
interested in?
Maintain or improve Quality
More timely and accurate
payments from carriers.
Save time and money.
Allow them to see more patients
per day.
More productive organization's.
Provide information about their
organization's.
Page No: 7
The Thing About the Future…
…You Hate Getting It Wrong!
And Big Surprises Aren’t Much Better!
With Only the Past for a Compass…
Who will guide you?
Patterns Must Lead to Action
Success = Teamwork
The Digital Medical Office
of the Future
•
•
•
•
Refer in
Update patient demographics
Scan Insurance cards/ • Take patient picture
Scan Driver’s license • Collect Co-pay
Sign consent forms
• Create Encounter
Check-in
• Receive Appointment Request
• Schedule/Reschedule Appointments
• Perform eligibility check
• Document PFSH
• Document ROS
• Take Vitals
Pre-exam
Appointment
Scheduling
The EHR Process
Refer out
Billing
Check-out
Exam
• Schedule follow-up
appointment
• Perform referral
authorization
• Obtain Referral
appointment
• Collect payments
• Review PFSH/ROS/Vitals/
Diagnostic Reports
• Perform Physical Exam
• Document Assessment
• Order Rx/Diagnostic
Page No:Procedures
14
Procedures/Treatment
• Provide Patient Education
Post Exam
• Perform Treatment Procedures
• Draw specimen for Diagnostic Procedures
• Fax/Transmit Rx and Diagnostic Orders
Information Overload
% who already have implemented
EHR Applications
What is the government’s
involvement in EHRs?
Free EHR - Vista
Congress – What till 2009
Personal Health Record Initiatives
Setting Standards – CCHIT
CMS and P4P
Setting Guidelines - HIE
Relaxation in Stark Law
Enabling Responsive Local Patient Care
Patient Demographics
Patient Insurance
Medications
Allergies
Health Maint Alerts
Lab Results
Dictated Reports
Vital Signs
DX and CPT codes
Patient’s
Home
CCD Data
Physician at
Home
Wireless
Access Point
Wireless
Access
Point
EMR/PM
Application
Wireless
Tablet
Practice 1
Wireless
Access
Point
EMR/PM
Application
Wireless
Tablet
Practice 2
EMR/PM
Application
Wireless
Tablet
Practice 3
Connecting Physicians
Delivers the Connected Community
Ancillary
Departments
Hospitals
Employers
Homecare
Providers
Physicians
In-patient
Clinical &
HIE Technology
is
best
positioned
to
Physician Portal
lead the way to a connected care
community
Physician Office
Solutions
Patients
Broad Community
Connectivity
Retail
Pharmacy
Payers & PBMs
It shouldn't take a brain
surgeon to design one
patient centric community
EHR
Offering Physicians Choices
A Flexible and Modular
Path to EMR
Clinical
Access
Results
Printing
•Auto-route to
the office
• Auto-print to
the office
$30-$50
•Physician Portal
•Results Viewing
•Messaging and
Alerts
$50-$70
Level 1
Practice
Support
•eRX
•Orders
•Results
$55-$100
Level 2
Practice
Support
•EMR Light
•Charge capture
•Hlth Maint Plan
•Referral
Management
$500-$700
Level 3
Practice
Support
•Fully functional
EMR
•CDS
•KBS
$700-$1,000
EHR/Interoperability
Page No: 21
Hospital Benefits
Physician Bonding
ER has access to extensive information about patients (prior Meds,
allergies, lab results, chronic issues, health maintenance alerts)
Single source Enterprise Wide documentation
– Nursing, PT, OT, Dietary, Social Workers
Reduce errors by up to 78%
Nursing has access to prior patient clinical information in a summary
format and detailed data by date
35% of nursing documentation is auto generated
Physician Order Entry adoption based on best practices
No change in registration, scheduling, and billing
Auto generation of HPI and Discharge Summary
98% reduction in HPI and Discharge Transcription Costs
Http://www.acgroup.org
Page No: 22
Physician Benefits
Hospital Sponsorship
Help with cost (Relaxation in the Stark Law)
One system for all charting
One system for orders
Reduce charting while in the hospital by 73%
Auto Charge Capture for physician office visits
Hospital Lab results delivered 87% faster
Access to hospital data from home (with security)
Http://www.acgroup.org
Page No: 23
Benefits to the Physician
 Clinical Integration

Pay-for-performance $5K-10K

Interfaces to all sources

Data exchange between
Primary Care, Specialists,
and Hospitals
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Contract terms and
conditions

P4P
 Reduce operating cost > 8%
 Improve Revenue Capture >
3%
 Lower costs = 40% reduction
 Monthly fixed costs with local
support
Http://www.acgroup.org
Page No: 24
Potential Business Benefits
Clinician time savings of between 19% and 26% of non direct
pt. care time
MA/Nurse time savings of between 20% and 28% of daily
activities
Medical Record cost reduction of between 64% to 74%
Transportation cost reduction of between 80% and 92%
Paper cost reduction of between 61% and 68%
Transcription costs reduction of between 73% and 87%
Billing costs reduction of between 6% and 12%
Http://www.acgroup.org
Page No: 25
Potential Business Benefits
Charge capture and coding costs reduction of between 84% and 90%
Reception costs reduction of between 10% and 14%
Lab handling costs reduction of between 61% and 70%
Rx handling costs reduction of between 57% and 64%
Scheduling costs reduction of between 6% and 12%
EOB Posting costs reduction of between 61% and 68%
Collection costs reduction of between 4% and 8%
QA Reporting costs reduction of between 46% and 60%
ER costs decrease by 31% since the ED physicians has access to
prior clinical records and results.
Http://www.acgroup.org
Page No: 26
Benefit to the patient
Answer questions one time
Centralized Patient Record
Reduced potential errors
Improved clinical quality and outcomes
Reduced unnecessary tests by 73%
Reduce costs by reducing waste in the clinical process
ER has access to data at the point of care
Http://www.acgroup.org
Page No: 27
Why systems FAIL!
Http://www.acgroup.org
Page No: 28
EHR Failure rate
Through 2007, the EHR failure rate continues
to increase.
When asked, “1 year of EHR installation, are
you seeing 80% of your patients using the EHR
for charting, ROS, HPI, Evaluation, coding,
orders and results reporting”.
– 73% of the physicians (3,245) indicated that no, they
were NOT using the EHR for 80% of their patients.
– 18% replaced or were not using EHR
– Why, are 73% of the physicians NOT fully utilizing
the EHR after 1 year?
So why are there so many failures?
Http://www.acgroup.org
Page No: 29
Why do Implementations Fail?
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Poor planning
Unrealistic expectations
Lack of physician and provider support
Flawed selection process
Mismanagement of workflow and staffing
changes
Poor Contract Terms
Workflow redesign - COT
Page No: 30
Http://www.acgroup.org
Organizational and Clinical
Transformation
Delivery Model – Levels of
Value Delivery
Transform: Maximum Value
Realization
Implement: EMR Process
Change
Install: EMR Usage
Http://www.acgroup.org
Page No: 32
Roles & Responsibilities
EMR Vendor
Deliver Technology Product
Transformation
Ensure Value Delivery &
Facilitate Exchange
Practice
Adopt & Perform with New
Solution

Provide EMR Best Practices

Strategy – Goal Alignment

Provide Sponsorship

Tech System Assessment

Assess Readiness

Commit Resources

Build Technology Interface

Create Program Structure

Make Decisions

Present Standard Templates

Program Communications

Steering Committee

Train Super Users
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Program Planning & Management

Practice Management Liaison

Train Users

Process Development
Clinical

Configure Software

Benefit Tracking

Administrative Workflow Team

Load Software

Change Management Activity

Clinical Staff Workflow Team

Test Support

Vendor Management

Provider Workflow Team

Respond to Change Requests

Roll Out Management

Billing Workflow Team

Integrate Lessons

Page No: 33
Technical Workflow
Team
Http://www.acgroup.org
Liaison
What are Practices Purchasing
Source: AC Group annual survey of buying patterns
When will Physicians Purchase
Source: AC Group annual survey of buying patterns
When will Physicians Purchase
Implementation
Gap
Source: AC Group annual survey of buying patterns
Who will be purchasing
% of sales by Service
AC Group annual survey of buying patterns
How the EHR vendors are rated and
why many will not survive?
Too many vendors to count
Too many vendor promising the world
Too many failures
How do you tell them apart?
What are you looking for?
How do you evaluate them?
Market Change over time
Over 380 vendors claiming to sell EHRs
Selecting the
wrong vendor
could cost
you over
$50K per
provider
EMR/EHR Selection Tool
AC Group conducted extensive
evaluation of the EHR
marketplace
– 9th report
– Completed in October 2007
– Included over 3,000 functional
questions
– 48 categories of functionality
– 26 subcategories of charting
functionality
114 Vendors have participated
EMR/EHR Selection Tool
Charting Vendors
EMR Light Vendors
EMR Vendors
EHR Vendors
CHR Vendors
Combined PMS/EHR
FQHC
Mental Health
AC Group Product Evaluations
EHR Functionality Only
PMS – EHR Functionality Only
Total Company Rating
– Company Stability
– End-User
Satisfaction
Revenues
CCHIT
Total Ambulatory Revenues
Client Base
Technology
KLAS
AAFP
AC Group
Certification Commission for Healthcare
Information Technology
CCHIT is the recognized certification authority for
electronic health records and their networks, and an
independent, voluntary, private-sector initiative.
The mission is to accelerate the adoption of health
information technology by creating an efficient, credible
and sustainable product certification program.
Http://www.acgroup.org
Page No: 43
CCHIT Certified EHR Vendors
Certification is good for 3 years – but!!!!!
2006 Certified vendors will need to renew again in 2007
As of Feb 1, 2008 only 13 vendors have passed the 2007 CCHIT
Page No: 44
Http://www.acgroup.org
Top EMR/EHR Vendor Applications
Practices with > 100 Physicians
GE does not want their ranking published
Based on 2,750 Functional Questions Divided Between 46 Categories
Top EMR/EHR Vendor Applications
Practices with 20 to 99 Physicians
Based on 2,750 Functional Questions Divided Between 46 Categories
Top EMR/EHR Vendor Applications
Practices with 6 to 19 Physicians
GE does not want their ranking published
Based on 2,750 Functional Questions Divided Between 46 Categories
Top EMR/EHR Vendor Applications
Practices with 1 to 5 Physicians
GE does not want their ranking published
Based on 2,750 Functional Questions Divided Between 46 Categories
Bottom Line
What does it take to thrive?
BOTTOM LINE
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Physicians need help when it comes to
technology
Physicians need local support
Physicians need help with contracts and
pricing
The community needs to share data
80% of the data is in the office
Lets empower the physician
For More Information
Mark R. Anderson, FHIMSS, CPHIMS
CEO and Healthcare Futurist
AC Group, Inc.
118 Lyndsey Drive
Montgomery, TX 77316
(281) 413-5572
eMail: mark.anderson @ acgroup.org
www.acgroup.org
Questions