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Electronic Health Records Cash Cow or Money Maker Kate Horkings Health Information Services Operations Director Our Locations Southern Health Vital Signs • Acute, Sub-acute, Mental Health, Aged & Community • Service area of 2,800 square kms and 750,000 people • 12,000 staff • Annual turnover of $700 million Southern Health Vital Signs • 134,000 inpatient attendances • 700,000 outpatient attendances • 1.8 million Patient Master Index entries • 2.6 million MR location moves annually Why are we doing this? Our Vision • A paperless Medical Record always at hand Advanced health record management Improve error rates Remove Paper handling Vastly Improve efficiency Enhanced Information access and distribution Improve clinical productivity Improve accessibility First place to find results and reports Better decision support Full history always at hand Multi-site access for clinical discussions Clinical focus on the patient not the process Better patient outcomes Results acknowledgement Improved care HealthSMART clinical integration Better service coordination No clinician need to manage record Increased privacy of Health information Preparing for an EHR System How does a Health Service start? An EHR is a journey, not a destination Think BIG, Start Small Target Objectives • Reduce clinical access times for current medical records by 100% • Reduce clerical costs by 50% (per record movement) • Reduce medical record movement to other sites by 100% • Improve time to provide test results viewing in medical records by 95% • Return floor space • Reduce incidence of lost records to 0% Scanned MR – The Bridge to an EHR Paper Based Record Includes: Requesting the MR Awaiting MR arrival Receiving MR Electronic Health Record Includes: Logging into EHR system Typing in appropriate UR Number Updating tracking screen Sending MR to requestor Systems / Databases Used: Homer – PMI & Tracking PRT – Mental Health Tracking Lab Vision – Pathology Merlin – Pharmacy Systems / Databases Used: Homer – PMI EHR System – including Interfaces with Pathology, Pharmacy etc. The Southern Health Project DELIVERABLES • Expand Casey model across SH to replace paper records - Execute two year project (Infrastructure and business change) - Change Medical records processes and lower costs by 52% - Achieve 3 year return on investment • Implement new functionality to gain additional benefits - Results acknowledgement - Electronic discharge summaries - Electronic alerts The Southern Health Project BENEFITS • Gain patient, staff and financial benefits proven at Casey • Greater efficiency at clinics @ Casey • Enable clinicians to make informed decisions based on timely access to accurate record and results information • Use clinical buy in to support HealthSMART clinical system project and ultimately EHR • Safer working environment – less physical handling of records Outpatients Clinic Retrieval Process 2 hours Get Outpatient List for Clinics Search Local Records Request additional Records from storage 15 minutes Collate in booking order Eliminated Processes Deliver to Clinic Appointments Open Record Search Appointments SMR for Patient Treat Patients Open Record Record Treatment observations Record Treat treatment Patients observations • A significant number of processes are eliminated through the use of a scanned medial record. Lessons Learnt • Know your current processes • Monitoring systems of a paper based department are still paramount • Turn around time is critical • Clinical buy-in is essential • Forms management is critical • Implementation plan – big bang or site based Testimonials “I think the CPF system is desirable in that it allows me quick and easy access to obtaining patient information at times when the patient record is off site or needed by others (eg the ward, coding) etc. It allows for rapid review of the patient’s presentation, management and staff involved which is often necessary in a short space of time.” Medico Legal Officer Southern Health Testimonials “I loved the scanned record as it was; 1. User friendly – very easy to use and teach somebody else to use. 2. Convenient to be able to look up patient information quickly. 3. Really great if a patient arrives for an appointment on the wrong date as history is available electronically and patient can thus be easily seen. All in all, makes for greater efficiency in clinic.” Manager, Outpatient Services South East Sector Financial - Operating Cost Control Operational cost $5m Increased record numbers and record management cost drives up total costs $4m SMR roll out $3m Costs are much less sensitive to increased records numbers and IT automation contains record management cost $2m 2004 2005 Note: $ values approximated 2006 2007 Year 2008 2009 2010 Financial Return on Investment FINANCIALS – 3 year payback Net Cumulative Cashflow - CPF Deployment 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 1,000,000 -1,000,000 Y1 Y2 Y3 Y4 Y5 -2,000,000 -3,000,000 Elapsed Time Net Cumulative Cashflow (000) SMR deploy As Is Op Ex Net Cumulative Cashflow Including Intangibles Cap Exp Total Op Ex As Is v SMR Cap Ex Cumulative Cash Flow Total Year 1 $4,168 $0 $4,168 $3,738 $1,978 $5,716 -$1,547 -$1,547 Year 2 $4,424 $37 $4,461 $3,354 $1,377 $4,731 -$270 -$1,817 Year 3 $4,763 $487 $5,250 $2,880 $0 $2,880 $2,371 $553 Year 4 $4,948 $4,948 $2,932 $0 $2,932 $2,016 $2,570 Year 5 $5,109 $5,333 $2,681 $0 $2,681 $2,652 $5,223 $18,940 $5,223 $225 $24,163 Reduces the unit cost from $11.97 to $5.92 Contributes to a financially sustainable organisation with marginal growth costs Has a 3 year payback period Financial Accountability Added Value Adding Value to Southern Health Project Savings • Major operating cost savings will come from: • Labour • Storage • Consumables • Transportation Paper Vs Scanning - some costs Paper Department $23.04 per separation Scanned Department $11.40 per separation 51% reduction Tracking in a paper dept $1.17 per move Tracking in a scanned dept $0.58 per move 51% reduction Paper Record Construction $1.62 per record Scanned Record Construction $0.00 per record 100% reduction Remember…. Be brave, be determined, be resolute! What may seem impossible today, may be the norm tomorrow! It’s not going away! Moving to an EHR is not an alternative. It is not an IF, it is a WHEN! Don’t get left behind, the planning starts NOW!