Transcript Document

Electronic Medical Records for the
Physician Practice
Strategies for Navigating the Quagmire
Kevin Kennedy, MHS, CPHQ, CPHIT
Director of Quality Improvement
October 24, 2008
Institute of Medicine Reports
• “To Err is Human, Building a Safer
Health System” (1999)
• “Crossing the Quality Chasm: A New
Health System for the 21st Century”
(2001)
Institute of Medicine Report
“To Err is Human…”
Top 10 Causes of Death in 1998
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Heart Disease
Cancer
Stroke
Lung Disease
Medical Errors
Pneumonia
Diabetes
Motor Vehicle
Suicide
Kidney Disease
724,269
538,947
158,060
114,381
98,000*
94,828
64,574
41,826
29,264
26,295
* Estimated
“The Right Care for
Every Person Every
Time.”
Stephen Jenks MD, Former Director
Quality Improvement Group
Office of Clinical Standards and Quality
Centers for Medicare and Medicaid Services
Electronic Medical Records (EMR)
Avoid Medical Errors
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Availability of records
Enhance communication
Provide decision support
Reduce medication errors
Improve quality measures
Provide economic benefit?
Bates, David MD, Family Practice News, October 15,2004
Medicine is a Very “Communication
Intensive” Industry
Enhanced communication between
physicians, settings, and patients can:
• Coordinate chronic disease management
and medications
• Improve quality of referrals and consults
• Avoid medical errors that lead to liability
Electronic Medical Records
• “At the turn of this century, . . .the average
industry was investing $8,000 per employee on
computer technology, health care was spending
$1,000.
• By now, if you belong to a frequent shopper club,
your grocery store almost certainly has far more
computerized data than your healthcare
provider..."
Electronic Medical Records
"With almost three-quarters of physicians in
solo or small-group practice settings, it is
critical to recognize not only the financial
barriers, but the greater need for technical
assistance in implementing electronic
health records, compared with physicians in
larger healthcare settings with existing
support systems. . .”
Anne-Marie Audet, Vice President
The Commonwealth Fund
Primary Objectives
• Describe EMR basics
• Discuss the six stages involved in adopting
an EMR system
– Assessment, planning, selection, implementation,
evaluation, and improvement
• Share our experiences with clinics in
Nevada and Utah
“I just don’t see how doctors can
stay in the game unless they are
somehow plugged into an
electronic medical record”
Tufts-New England Medical Center, CEO, The Boston Globe, Feb. 10, 2006
HIT vs. EMR/EHR
• Health information technology (HIT) is a
general concept
• Electronic medical record (EMR)/electronic
health record (EHR) is a specific concept
relating to systems having the ability to
capture data from various sources for
clinical decision support at the point of care
The Burning Platform for EMR
Systems
• During the 1990’s, EMR system adoption was
usually limited to larger organizations
• Currently, 20 to 30% of outpatient clinics use
EMR systems (20% in NV and 30% UT)
• Estimated that 50 to 60% over the next several
years
• Small outpatient practices expected to be fastest
growing sector for EMR system adoption
What Are Benefits of EMR
Systems?
• Improved care
– Views of entire medical histories
– More efficient workflow – reduce the paper
chase
– Generate patient specific reminders
– Reference medical research and protocol data at
the point of care to enhance diagnostic and
treatment plans
What are the Benefits of EMR
Systems?
• Reduction of errors
– IOM report
– Coding confusion, illegible documentation,
poor information management contribute to
errors
– EMR systems improve documentation and
communication and assist in managing critical
information
What is the Business Case?
Return on Investment (ROI)
• The amount of time it will take your
practice to re-coup the dollars spent on the
EMR project.
• Process of confirming that the system is
delivering anticipated benefits.
• Is it required? No, But it will help in
demonstrating, evaluating, and assessing the
success of the project.
Financial Benefits
• Reduction in Costs
– Storage space
– Transcription services
– Staff time pulling and filing paper records
Reduction in Costs
• Some vendors state an ROI is possible
within 12 months while others state over
three years
• Low hanging fruit is reduction in
transcription costs
• Potential staff reduction or reallocation
– If average physician needs four FTEs for
support, this number can be reduced by at least
one FTE with an EMR
Increased Revenues
• Many providers down-code to prevent claims from
being denied
• EMRs assist providers in coding to assure that the
correct codes are used with support documentation
• More accurate coding can decrease claims denials,
increase reimbursement rates, and improve cash
flow via shorter billing-to-payment cycles
• EMR is vital tool for improved reimbursements
through pay-for-performance initiatives
Net cost of doing business
The Big Picture
cost
Time
“The impact and expectation of costjustifying patient safety IT initiatives
using a traditional ROI must evolve to
focus beyond the financial benefit. It
must encompass overall patient safety,
patient satisfaction, and employee and
physician satisfaction benefit categories”
L.M. Newell “Who’s Counting Now? ROI for Patient Safety Initiatives”,
Journal of Healthcare Information Management
Satisfaction
• Provider
– Leave the office earlier
– Access patient information remotely
– Better understanding of the practice operations
– More time spent caring for patients
– Less time spent chasing charts, paper, and
resources
Satisfaction
• Staff
– Cleaner workflows – less waste
– Better understanding of roles and responsibilities
– Leave the office earlier
– More advanced skill sets
•
Patient
– More information about the office visit
– Better access to health information
– Better organized office
EMR System Technical Options
• Interfaced practice management (PM) and EMR
systems vs. integrated
– Terms often used interchangeably although difference
can be significant
• Interfaced – independent applications that talk to
each other
• Integrated – share common master files
– All modules usually come from a single vendor or
two closely linked vendors
Hosting Options
• Application Service Provider (ASP)
– Lease EMR application and network, hardware
and IT maintenance services
– Beneficial for smaller practices lacking IT
expertise
– Significantly reduces initial investment
Hosting Options
• On Site
– Clinic purchases software license, network
servers, operating systems and employ or
contract for maintenance
– System backups completed on site
– Security issues are clinic’s responsibility
So, how does a clinic even begin
the process?
Challenges of EMR Transition
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Failure to plan properly
The horror stories - systems going down
Problems with vendors
Change is difficult
Investing in EMR but not fully utilizing the
product
The Six Stages of EMR
Migration
Stage 1 - Assessing Your
Readiness
• Challenges and financial impacts involved
in successful EMR implementation can’t be
ignored
• Critical that physicians and management
evaluate whether your practice is ready to
take on the challenges
Assessing Readiness
• Decision-Maker Buy-In
– Does everyone agree on the goals and
expectations for the EMR system?
– Do you have a physician champion?
Assessing Readiness
• Staff Buy-In
– Is your staff capable and enthusiastic about
installing an EMR system?
– Will the key staff members have the patience
and willingness to be involved in the transition?
Assessing Readiness
• The Learning Curve
– Can your practice afford the financial impact of
reduced patient volume for a 2-3 month period?
– Will the physicians have the time and patience
for an EMR system transition period?
Assessing Readiness
• Practice Management Integration
– Have your physicians and management
carefully considered the differences between an
interfaced and integrated system?
– What is your level of satisfaction with your
current PM system? Are you willing to trade it
for a new integrated system?
Practice Tasks During
Assessment
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Assess current workflow
Begin/continue regular staff meetings
Assign physician champion
Organize EMR selection team
Stage 2 - Practice Tasks During
Planning
• Write down the clinic goals and priorities
(these should be agreed upon previously)
• Translate goals into available EMR system
functions and features
• Address concerns of staff with lower levels
of readiness
• Develop a timeline and project plan
How to Select an Electronic
Medical Record System
“A natural tendency might be to call a few
vendors.. and ask them for a demo. Stop.
Unless you want the vendors to control the
selection process, you need a plan.”
K. Adler, Family Practice Management, February 2005
Stage 3 -Vendor Selection
• Use translated goals list of functions and
features – your rating system
• Create a clinic-specific case scenario
• References and sites visits – don’t skip!
• Additional hardware and support plans
• Negotiating a contract
Partners for Patients Electronic
Health Record Market Survey
American Academy of Family Physicians Center for
Health Information Technology
Stage 4 - Implementation
• Workflow analysis – have a plan for
changes (roles, scanning, handoffs, etc.)
• Data conversion, interfaces, testing
• Recovery and security planning
• Training – iterative and “super users”
• Go-live – modify workload
Major Workflows Associated with
the Patient Visit
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Scheduling
Check-in/registration
Authorizations
History and physical
Provider’s SOAP process
(Subjective/Objective/Assessment/Plan)
Labs/imaging/medication orders
Referrals
Checkout
Billing
Stage 5 - Evaluation
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Workflow analysis – identify problem areas
Additional training/learning
Check progress towards initial goals
Using data in your EMR to improve care
Ongoing checks – all staff (workarounds?)
Stage 6 - Improvement
• Workflow analysis
– Identify bottlenecks, possible role redesign
• Using data to check progress
– First step is checking data integrity – never perfect
– Next – set goal(s) and track progress
– Find “best practices” internally and externally
• Use the EMR to its capacity
Experiences Thus Far
“The transition is a process NOT an event”
• Difficult to generate specific ROI but it is
possible to have a general idea of ROI
• Sometimes too many choices with EMR
vendors – one size does not fit all
• Clinics find it challenging to use 100% of
system capacities
Summary
• EMR is a valuable tool to improve
outcomes
• EMR helps to deal w/complexity of
decisions being made under time constraints
• EMR can help reduce medical errors and
liability risk
Discussion
Contact Information
Kevin Kennedy
702-933-7311
[email protected]
This material was prepared by HealthInsight under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of
the U.S. Department of Health and Human Services (DHHS). The contents presented do not necessarily reflect CMS policy.
Publication #: 9SOW- NV-2008-00-020