Transcript Presentation - Open Online Courses

Georgetown University
Selection of Electronic Health Record
Presented by: Suniti Ponkshe
September 22, 2010
Healthcare Market Drivers
Three broad drivers for healthcare transformation:
cost containment, greater collaboration and improved quality
of care
$ Rising healthcare costs and economic pressures are
increasingly constraining access and quality
◦
◦
◦
◦
Tax shortfall
Rise in unemployment
Lack of transparency
Dramatic increase in uninsured population and uncompensated care
 Value-driven healthcare will drive optimization and require
proactive collaboration among all stakeholders
◦ Governments, Payers and Providers shifting focus beyond acute care to Wellness,
Prevention and Chronic Disease management
 Increasing demand for improved quality and outcomes
measurement
“The stars are aligned for historic transformation in Healthcare”
……. And it did ………..
2
Healthcare Journey
“The stars were aligned for historic transformation in Healthcare”
……. And we began our journey ………..
American Recovery and Reinvestment Act
The Health Information Technology for
Economic and Clinical Health (HITECH) Act
The Patient Protection and Affordable Care Act
3
Provisions

American Recovery and Reinvestment Act (ARRA)
 ARRA 8

The Health Information Technology for Economic and
Clinical Health (HITECH) Act
 Adoption of Interoperable Health IT
 ONC Authority
 Medicare and Medicaid Incentives

The Patient Protection and Affordable Care Act (PPACA)




Many Implications for Health IT
Center for Innovation
Service Delivery Models – Accountable Care Organization; Medical Home
Payment Models – Shared Savings; Risk Adjusted Payments
4
The HITECH Vision
• Improved Individual and Population
Health Outcomes
• Increased Transparency and Efficiency
• Improved Ability to Study and Improve
Care Delivery
Data
Meaningful Use of Certified
EHRs
Adoption of EHRs
• Regional extension centers
• Workforce training
Exchange of Health
Information
• State grants for health information exchange
Medicare and Medicaid
• Standards and certification framework
Incentives and Penalties
• Privacy and security framework
Research to Enhance Health Information Technology
5
EHR Adoption in Physician Office Practices
Size of Practice
25
100
20
80
15
10
5
0
Basic System
13%
Fully
Functional
4%
Percentage
Percentage
Level of EHR Function
> 50 physicians
60
50%
40
20
1-3
physicians
9%
0
DesRoches., N Engl J Med 2008
6
Conceptual Approach to Meaningful Use
Stage 3
Stage 2
Stage 1
Advanced
clinical
processes
Improved
outcomes
Data capture
and sharing
7
2010 Technology Trends
Nine Significant Technology Trends for 2010:
1.
2.
3.
4.
5.
6.
7.
8.
*
Clinical Informatics
Computerized Provider Order Entry (CPOE)
Data Infrastructure
HITECH
Privacy
Reimbursement Reform
Smart Phones
Telemedicine
Healthcare Informatics February 2010 Issue
8
Healthcare CIO Trends
Healthcare Information and Management Systems Society
(HIMSS) 2010 Leadership Survey
Key Priorities:
1.
Meeting Meaningful Use Criteria
2.
Focus on Clinical Systems
3.
Leveraging Information
4.
Optimizing Current Systems
5.
Focus on Ambulatory Systems
6.
Patient-Centric Solutions
7.
Interoperability Between In-house Systems
8.
Integration with Medical Devices
www.himss.org/2010survey
9
Most Commonly Used Definition of EHR
Electronic Health Record (EHR)
“a secure, real-time, point-of-care, patient-centric information
resource for clinicians.
 The EHR aids the clinicians’ decision-making by providing access
to patient health record information when they need it and
incorporates evidence-based decision support.
 The EHR automates and streamlines the clinicians’ workflow,
ensuring all clinical information is communicated and
ameliorates delays in response that result in delays or gaps in
care.
 The EHR also supports the collection of data for uses other than
clinical care, such as billing, quality management, outcomes
reporting, and public health disease surveillance and reporting.”
10
Electronic Health Record (EHR) is a building
block process
and the Clinical System is a major foundation block ….
11
Clinical Systems Vendor Landscape has
Changed …….
 Vendors are becoming full service providers -- through acquisitions and some
system building
 Payers are getting into product offering
 Vendors are migrating to an “open system” platform, i.e., ability to interface with
other systems easily
• Health systems are leveraging technology to support and meet their quality strategic
plan such as Patient Safety, saving lives and reliable information
 Some health systems are adopting “Best of Breed” approaches with appropriate
boundaries – supporting quality strategic goal and meeting user needs while adding
value
 Lines between inpatient and ambulatory vendors are diminishing
12
Product Life Cycles
Competitive
New
Pilot sites completed
New sales accelerating
High investment in
development
PreRelease
Major
development
underway
Pilot sites
being installed
Strong new client
sales. Relatively
heavy investment in
enhancements
Declining
Declining
investment in
enhancements
Few new client
sales
Sunset
Little investment
in support
No new client sales
13
Electronic Health Record


Vendor Market
•
Hundreds of vendors
•
Too competitive
•
Diminishing market sector lines
Selecting EHR
•
Structured process
•
Criteria
•
Impact on the workflow
•
Right purchasing option
14
System Selection Approach
Understand
Current State
Define Future State
Vision
Identify Vendor Short
List
Conduct Vendor
Evaluation
Conduct Decision
Conduct Decision
Develop RFQ
Contract Negotiations
Prepare Clinical
Benefits
Preliminary
Implementation
Planning
Identify System
Capability Gaps
Conduct Decision
15
Three areas pivotal to the Process are ……
Vision
Decision-making
Process
Decision
16
Vision Requires Review of Key Strategies
Vision
•
•
•
•
Best of Breed, Best of suites, others
Ownership
Analytics
Others
17
Selection process needs broad support,
collaboration and consensus
Decision-making
Process
18
Project Governance Needs to Involve all
Constituents ….
Clinical System
Selection (CSS)
Executive Steering Team
CSS
Physician Advisory
Team
CCS
Care Delivery
Advisory Team
CCS
Technology
Task Force
CCS
Communication
Task Force
19
An Effective Process is Needed With Milestones
Establish Goals and Key
Requirements
Decision Day
Facilitate Future State
Sessions
Develop Comparative
Vendor Analysis
Decision Day
Create Short List
Conduct Vendor
Demonstrations
Select Finalists
Decision Day
Conduct Additional
Evaluation of Vendors
Select Vendor of Choice &
Begin Contracting
Decision Day
20
Vendor Comparison Criteria
Functionality
Technology
Company
Evaluation based on the key
requirements from future state
sessions
Evaluation based on the
technical requirements
identified in the process
Evaluation based on market
intelligence and experiences
 Meaningful Use Criteria
 Five Priority areas
 ACOs
 Medication Home
 Pharmacy
 Clinical Decision Support
 Results Review
 Usability
 Health Analytics
 Integration with Current
 Vendor Vision
environment
(interoperability)
 Scalability
 Privacy & Security
 Speed and Reliability




Company Viability
Ability to Execute
Customer Service Focus
Vendor Culture and Goals
alignment with the client
21
Comparative Approach
Comparative Scale:
Overwhelmingly recognized as the leader – second to none.
Generally recognized as a leader - could be tied with one
other.
List
of
Vendors
Considered equivalent to others – tied with two or more.
Needs improvement – More than three other vendors
considered materially better.
Not generally available – may be building it but doesn’t
have it today.
Each vendor was scored according to the scale
22
Vendor Usability
CATEGORY
Vendor 1
Vendor 2
Vendor 3
Framework
Poor
Fair
Good
Workflows
Fair
Fair
Good
Layout/Screen organization
Fair
Fair
Good
Templates: Documentation
Fair
Poor
Good
Templates: Orders
Poor
Poor
Good
Customization & personalization
Poor
Fair
Good
Visualizations
Fair
Fair
Fair
Future Development
Fair
Poor
Good
23
Thank You
Suniti Ponkshe
Partner
Accenture
[email protected]
Phone: 703.903.9685
Mobile: 703.966.6689
24
Overview of Major Systems & Implementation Status
DRAFT
Pharmacy/ Medication Safety
Medication
Order Entry
& Formulary
Mgmt
SMS
Dosing
Mgmt
SMS
Medication
Dispensing
Pyxis
Med/IV
Charting
Credentialing
MSO
SoftMed
Chart
Management
User Interface/
Portal
CareNet
Transcription/
Dictation
Medquist
(Outside
Vendor
InterQual
Support for
LOC
Wincoder
Abstracting
WincoderC
oding
Support
SoftMed
Electronic
Signature
GL/AP
Peoplesoft
Pathology
CoPath
Patient
Locator/
Patient Lists
SMS
Blood Bank
Sunquest
Respiratory
Mediserve &
I-Stat
Home Health
Allegheny
Home Health
McKesson/H
BOC
Radiology
Quadris
Emergency
Department
EmSTAT
Surgery
Surgi-Server
Omni-Server
Maximum Utilization
Data Warehouse
Home Grown
PDA
Support
Decision
Support
TQ/T2
Report Writer
Data
Warehouse
Outcomes Measurement /
Comparative Data
Med AI
Standard CDM/
Master File
SMS
Enterprise Patient Access
Order Entry
SMS
Clinical Data
Repository
CareNet
Patient Accounting
SMS/Affinity/Keane
Result
SMS
Common
Medical
Vocabularies
ICD-9/ CPT4
Security
Tools
Novell
Rules
Engine
SMS
HR/Payroll
Peoplesoft
Kronos
Supply Chain
Cardiology
MUSE
Sr. Living
Clinicals
Accu-Med
Cath Lab
Catalyst
OB
GE QS
Sr. Living
Financials
Keane
Admission/
Registration
SMS
Patient
Supply
Charges
SMS &
Par
Excellence
Materials
Mgmt
Peoplesoft
Contract
Management
VCM
Enterprise
Schedluling
HBOC
Eligibility
Verification
HDX
Enterprise Master
Person Index
(MPI)
SMS EAD
Request for
Authorization
Longitudinal
Clinical Data
SMS LCR
Integration
Tools
E-Link
Departmental/ Support Services
Lab
Sunquest
Results
Review
SMS
Core Information Management Components
CMAR
Health Information Management
SoftMed
MRN
Management
and Merge
Physician
Order Entry
Drug Database
Micromedix
Drug
Interactions
SMS
SMS
Document
Imaging
Clinical Decision Support
Physician Clinical Practice
Clinical Documentation
SMS
Patient
Assessment/
Tracking
SMS
Kardex
SMS
I &O
Vital Signs
Task
Lists
SMS
Patient
Assessment
SMS
Flowsheets
SMS
Care
Plans
SMS
Non-MD
orders
SMS
25
Moderate Utilization
Purchased – Not Implemented
In Progress