Transcript The Electronic Medical Record at Carilion Clinic

The
Electronic
Medical
Record
at
Carilion Clinic
Tools for building the Clinic
•
•
•
•
•
•
•
Plan
Leadership
Board Governance
Physicians
Standards
Infrastructure
Integrated Electronic Medical Record
An Integrated
Electronic Medical Record (EMR)
• Same look and feel inpatient and outpatient
• Ability to share records across the enterprise
• True continuum of care delivery with a single record
• Universal view of problems/medications/allergies
• Patients are not repeatedly asked the same questions
• Facilitates patient access through our system
• Higher patient satisfaction
• Better clinical outcomes
Electronic Clinical Tools at Carilion
• 1990 Radiology Management – Siemens
• 1990 Pharmacy – Siemens
• 1992 Cardiology – GE Muse
• 1999 Ambulatory EMR – Logician
• 2000 Emergency Department – EDIS
• 2000 OR – ORMIS
• 2001 PACS – AGFA
• 2003 Bed Scheduling – TeleTracking
• 2003 Transcription - MedQuist
• 2004 Medication Authentication – Siemens
• 2005 Acute EMR – CPSI
Carilion’s Commitment to
Clinical Technology
FY00
FY01
FY02
FY03
FY04
FY05
FY06
FY07
IT Operating (M)
$20.2
$20.6
$22.9
$26.2
$26.9
$28.8
$30.9
$33.8
Operating %
3.2%
3.0%
3.1%
3.3%
3.2%
3.1%
3.0%
3.0%
IT Capital (M)
$24.1
$34.9
$36.7
$32.9
$25.2
$30.0
$26.5
$34.7
Capital %
28.8%
42.4%
43.7%
33.7%
36.8%
34.5%
22.8%
32.6%
- Operating:75th percentile among peers
- Capital:
95th percentile among peers
Clinical Technology at Carilion
Technology
US 50th Percentile
Time
The Challenge
Technology
Integration
US 50th Percentile
Time
Carilion Clinic Today is Best of Breed
EMERGENCY
DEPARTMENT
Roanoke Memorial
Franklin Memorial
New River Valley
Giles Memorial
Bedford Memorial
Stonewall Jackson
Wellsoft
EDIS
CPSI
Alignment within
applications
Carilion Clinic Today is Best of Breed
EMERGENCY
DEPARTMENT
Roanoke Memorial
Orders
Management
Siemens Invision
Siemens Soarian
Radiology
Siemens RMS
AGFA PACS
Pharmacy
Siemens MAK
Pyxis
Siemens Pharmacy
Cardiology
GE Muse
OR
GE ORMIS
ED
Wellsoft EDIS
Document
Imaging
AMS Sovera
Portal
Medicity
Franklin Memorial
New River Valley
Giles Memorial
Bedford Memorial
Wellsoft
EDIS
Stonewall Jackson
CPSI
Alignment within
applications
Alignment across
applications
Imaging
ED
Primary Care
Pharmacy
Lab
Inpatient Care
OR
TSG Application Interface Chart
68
592
685
586
Quantum Med
75
Pharmacy
Pillbox
Wellsoft
EDIS
2 or 2
2 of 2
Siemens
Financial
SSI
1040
Antrim
1030
1 of 3
Credit
Card
Payment
162
875
161
1038
230
HEDIS
DB
580
262
1094
920
Sovera
PFS
975
704
2 of 2
25
702
164
CTVision
Datis
3M
Coding
810
960
20
157
2 of 2
BPI.net
Softmed
2 of 2
1 of 3
Planning
& Budget
Various Clients
& Web
206
Various
Datasets
PerSe
965
971
880
Softwise
Internal
Audit
882
873
878
CASB-FS
CCL&PA
1028
CPSI
779
101
2 of 2
156
950
995
Trendstar
790
865
Vision
2 or 2
997
Total
Interfaces: 509
SSI
50
OneStaff
Harford
377
PR Dept
397
399
Various
Websites
Health Stream 380
Wachovia
401
400
379
375
SHPS
1036
374
650
MS4
Decision
Support
387
396
Centricity
402
638
643
HQM
500
1 of 2
OASIS
Medicare
642
Sovera HIM
3 of 3
Trendstar
2 of 2
Interfaces not on diagram:
103, 105, 110, 195, 196, 525, 550, 584,
636, 687, 692, 700, 1041, 1112
405
SSI
3 of 3
NC AVAYA
NC CRMH
720
722
Rauland Borg Nurse Call
695
Atlas
Labworks
LabPort
Lab
Outreach
152
856
MDAssociates
183
GE Cardiology
MUSE
876
Pharmacy
OneSource
674
137, 935
597, 762
808
1078
200
201
134
568
124,849
150
Coro-metics
Fetal Mon.
eMPI Helper
softmed
1 of 2
187
1029
Xtend
160
1005
LBS
142
583
eDischarge
146
816
992
Digisonic
170
668
123
GroupWise
415
505
Delta Dential
Anthem
708
Medicaid
PerSe
3 of 3
266
572
138, 90
260
Power
Scribe
(Pathways)
2 of 2
b2b Vision
630
130, 260
556,
128, 139
265, 582
102
McKesson
Horizon
GE
Centricity
Dynamedix
Genesys
Misys
Vision
616, 618
610
Power
Campus
90
95
CarePort
PaWS
CASB
Common
Master Tool Kit
120, 121, 123
124, 125, 126
127, 128
149
842
410
689
2 of 2
220
221
222
PACS
(IMPAX)
180
660
121, 132,
515, 562
145,146,147
1091
148,149 150
152,153,154,
155,158,159
160
1 of 2
120, 131,145
181, 200, 510,
558, 612 662,
780, 1090,1075
175
Anthem
626
628
KRONOS
693
Transcription
Paitent Keeper
155
864
2 of 3
2 of 3
MedQuest
1035
622
394
188
Eclipsys
EMPI
1 of 2
632
640
625
250
612, 620
624, 639
641
976
55
Lawson
915
Sovera
HIM
530
127, 170
185, 221
695, 866
1026
CPSI
35, 133
148, 520,
564, 624
670
1039
SCA
Hyperion
716
1070
Sovera
PFS
735
205
217
390
760
762
765
830
158,
641, 970
962
100
207, 210
1 of 2
240
151
846
785
212
215
FACS
712
Pyxis
2 of 2
930
NCHS
Updated: December 1, 2006
TOTAL Number of Interfaces: 509
850, 1015
1020
620, 814
2of3
678
510, 515,
520
GE Centricity
Cardiology
Automated
Mailing
Service
660, 662
674, 676
682, 666
668, 670
677
222
1075
147, 201 1078
218
219
777
PerSe
672
Sybase
Integration
Engine
860
MEMS
Rosebud
VA
Medical
Novius
Radiology
VA Dept
Health
180, 181
183, 184
185, 186
187, 189
1025
1026
1027
755
153
858
223
540
Soarian
136
186
596
677
927
1105
780, 805, 808, 814, 816, 830, 837, 842, 844, 849, 856, 858, 860, 862, 864
866, 900, 907, 915, 927, 935, 955, 962, 970, 976, 992, 1000, 1005
870, 795,
820, 770,
848, 776
778
843
925
Professional
Billing
184
837
125, 135, 219, 223, 245, 760,
594, 676, 765, 1029, 1039, 1093, 1095
Siemens
Invision
826
792, 800,
886, 890
Professional
Research
GE
ORIS
IDS
Carousel
1 of 2
680
1090 159,263,
1091 189,604,
1093 682,1000,
1027
1095
1105
35
639
955
838
225
Restricted
WebSite
Wellsoft
EDIS
1110
Pyxis
Siemens
Pharmacy
750
1077
263, 556, 558,
562, 564, 568,
570, 572,
582, 594, 596,
583, 597,604
1 of 3
825
Internet
Web
Sites
Sovera
HIM
1050
812
Financial
Support
Financial
Services
PaWS
SunTrust
840
95, 126,
154, 220
266, 862
1025
600
761
1 of 2
130. 131
132, 133
134, 135
136, 137
138, 139
141, 142
265
LabCorp
B2b Optma
2 of 2
1 of 2
OmniCell
1 or 2
CoPath
235
FACS
839 730
Eclipsys
EMPI
560
1045
HBO
REV3
Siemens
Soarian
MisysLab
65
RMHIS
HBO-CDM
140
714
710
MAK
HEDIS
Intergual
844
245
IMPAC
Teletracking
Quantum
Billing
141
666
Dublin Family
Practice
Lawson
2 0f 2
223
805
Computrition
Dietary
907
RescueNet
900
Sanitas
725
The Challenge
Technology
Integration of
Patient
Information
US 50th Percentile
Time
Benefits of an Integrated EMR
• Patient Safety
– Checks for conflicts
– “Hard Stops” for safety
– Common Allergies List
– Common Medication List
Imaging
ED
Primary Care
Pharmacy
Lab
Inpatient Care
OR
Benefits of an Integrated EMR
• Patient Safety
– Conflict checking
– “Hard Stops” for safety
– Common Allergies List
– Common Medication List
• Reduce Variation and Improve Quality
– Paper orders – order sets
– Protocols management
– Standardized Formulary
– “Soft Stops” for Best Medical Practices
Benefits of an Integrated EMR
• Patient Safety
–
–
–
–
Conflict checking
“Hard Stops” for safety
Common Allergies List
Common Medication List
• Reduce Variation and Improve Quality
–
–
–
–
Paper orders – order sets
Protocols management
Standardized Formulary
“Soft Stops” for Best Medical Practices
• Reduce Overutilization
– CT Head
– Creatinine
Benefits of an Integrated EMR
• Patient Safety
–
–
–
–
Conflict checking
“Hard Stops” for safety
Common Allergies List
Common Medication List
• Reduce Variation and Improve Quality
–
–
–
–
Paper orders – order sets
Protocols management
Standardized Formulary
“Soft Stops” for Best Practices
• Reduce Overutilization
– CT Chest
– Creatinine
• Facilitate Research
– Standardize data fields
– Create searchable data
– Support the Research Institute
Benefits of an Integrated EMR
• Patient Safety
–
–
–
–
Conflict checking
“Hard Stops” for safety
Common Allergies List
Common Medication List
–
–
–
–
Paper orders – order sets
Protocols management
Standardized Formulary
“Soft Stops” for Best Practices
• Reduce Variation and Improve Quality
• Reduce Overutilization
– CT Chest
– Creatinine
• Facilitate Research
– Standardize data fields
– Create searchable data
– Support the Research Institute
• Improved Practice
– Coordinated Referrals
– Coordinated Scheduling
Experiences of other Hospitals post
Integrated EMR Implementation
•
•
•
•
Radiology turnaround time reduced
Pharmacist interventions reduced by 50%
Duplicate ancillary tests reduced by 48%
Number of delays in administering medication
has fallen by 70%
• Omitted administration of drugs reduced by 20%
• Test results for mammograms take one day,
down from as long as three weeks
• New medication procedures can be introduced
in hours
Carilion’s EMR Selection Process
• Fast – Four Months
• Broad – Due diligence on four systems
• Deep – Participation of more than 300
Carilion employees
• All hospitals
• All therapies
• All administrative and support services
• Thorough – More than eight site visits
The Slippery Slope
•
•
•
•
•
•
•
•
•
•
Scope
Acute EMR – CCMC (but not Pharmacy)
Acute EMR – CCMC and CNRVMC (but not pharmacy)
Pharmacy and Acute EMR – CCMC and CNRVMC (but not ED)
ED, Pharmacy, Acute EMR – CCMC and CNRVMC (but
definitely not Ambulatory EMR)
Ambulatory EMR, ED, Pharmacy, Acute EMR – CMC,
CNRVMC, CGMH, CFMH (but not CPSI sites)
Ambulatory EMR, ED, Pharmacy, Acute EMR – All Hospitals and
practices
Ambulatory EMR, ED, Pharmacy, Acute EMR, EMPI – All
Hospitals and practices
Ambulatory EMR, ED, Pharmacy, Acute EMR, EMPI,
Registration – All Hospitals and practices (but not scheduling or
billing)
Ambulatory EMR, ED, Pharmacy, Acute EMR, EMPI, Scheduling
– All Hospitals and practices (but not billing)
Ambulatory EMR, ED, Pharmacy, Acute EMR, EMPI,
Scheduling, Billing, Registration – All Hospitals and practices
Scope
(but not lab)
Clinical Information System
Evaluation Process
2
August
8 – 15
26 4
September
5
11
13
16
17
October
18
26
1
November
23
December
Magic
Quadrant for
North
American
Enterprise
CPR 2006
Source: Gartner December 2005
Selection Preference Summary
Vendor 2
Vendor 1
PHYSICIANS
NURSING
PHARMACY
ED
THERAPIES
HIM
IT
INFORMATICS
MAK
INTEGRATED
EMR
Carilion Clinical Application
Integration
Technology
Time
2007
2008
2009
2010
Immediate Benefits – Carilion Clinic
• All physicians have immediate access to a
patient’s entire record
– From any location
• Standardization of order sets
– Best practice adoption
• Tracking referral patterns
Accomplishments to-date
• Created and trained 125-person EMR
team
• Built physician practice content and
training
• Converted 9 years of Centricity records to
new system
– 780,000 patient records
– 43 million data fields
2008
2009
2010
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M
Roanoke
Primary Care
2008
2009
2010
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M
Roanoke
Primary Care
2/20
Daleville
3/26
Blue Ridge
4/2
Vinton
4/9
North Roanoke
4/16
Colonial Avenue
4/16
Urgent Care Roanoke
4/30
Crystal Spring
5/7
Northwest
5/14
Southeast
5/21
Roanoke Salem
5/28
Brambleton
2008
2009
2010
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M
Roanoke
Primary Care
RMH
Peds
Clinics
Surgery
Specialty
OB / Gyn
2008
2009
2010
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M
Roanoke
Primary Care
RMH
Peds
Clinics
Surgery
Specialty
OB / Gyn
NRV Area Practices
Franklin Area Practices
Giles, Lexington,
Bedford Practices
2008
2009
2010
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M
Roanoke
Primary Care
RMH
Peds
Clinics
RMH
Surgery
Specialty
OB / Gyn
Peds All
CPOE CPOE
NRV Area Practices
CNRVMC
All
CPOE
Franklin Area Practices
CFMH
Giles, Lexington,
Bedford Practices
CGMH
CSJH
BMH
Practice 1 Go-live
February 20, 2008
2008
2009
2010
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M
Roanoke
Primary Care
RMH
Peds
Clinics
RMH
Surgery
Specialty
OB / Gyn
Peds All
CPOE CPOE
NRV Area Practices
July 26
CNRVMC
All
CPOE
Franklin Area Practices
CFMH
Giles, Lexington,
Bedford Practices
CGMH
CSJH
BMH
Roanoke Memorial Go-Live
• July 26, 2008
• 159 Inpatient Order Sets being built
• Trained Staff
– 5,000 clinical, financial, and administrative staff
– More than 1,000 classes
• Installed more than 500 new computers
• Created command center
Physician Training
• eLearning – Self paced
• Classroom – Two 4 Hour Sessions
• Simulation Sandbox – Practice on own
Findings
– Leadership first is significant to
ensuring compliance
– Physicians who spend more time in
preparation are most effective Day 1
March
Go-Live at Roanoke Memorial
5/5 – 5/16
Train
Physician
Leaders
April
May
5/26 – 7/19
Train All
Physicians
June
July
7/26/08
CRMH Go-Live
August
7/14 – 7/18
Dress
Rehearsal
September
10/18/08
CPOE
Pediatrics
October
11/18/08
CPOE
All
November
Carilion Clinic Technology Capital
35000000
30000000
$30 M
25000000
20000000
$20 M
NO
EPI
15000000
10000000
$10 M
5000000
0
0
FY2003
FY2005
FY2005
FY2006
FY2007
FY2008
FY2009
FY2010
*
*
- Total budgeted capital spend for new EMR is $65.8 M
Integrated EMR
• Data and control for
– Best medical practices
– Reduced variance
– Improved quality
Integrated EMR
• Data and control for
– Best medical practices
– Reduced variance
– Improved quality
• Integrated system
– Every patient
– Every physician
– All locations
Integrated EMR
• Data and control for
– Best medical practices
– Reduced variance
– Improved quality
• Integrated system
– Every patient
– Every physician
– All locations
• Improved practice
– Referral management
– Coordinated scheduling
Thank you
Personal Health
Record
Enterprise Patient
Scheduling
Next-Generation
Patient Financial
System
Emergency
Department
Information System
Computer Physician
Order Entry
Generation 3 EMR
Ambulatory EMR
Technology
Trigger
Peak of
Inflated
Expectations
Trough of
Disillusionment
Slope of Enlightenment
- Is now the time for an integrated EMR?
Plateau of
Productivity