Fit for purpose


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Fit for purpose

  1. 1. Perspective Ramez Shehadi Dr. Walid Tohme Jad BitarFit for PurposeDeveloping Enterprise-Wide ElectronicMedical Records
  2. 2. Contact InformationBeirutRamez ShehadiPartner+961-1-985-655ramez.shehadi@booz.comDr. Walid TohmePrincipal+961-1-985-655walid.tohme@booz.comJad BitarSenior Booz & Company
  3. 3. EXECUTIVE As healthcare providers transform their business models to focus on delivering a continuum of care for their patients,SUMMARY they are under increasing pressure to ensure that critical information is available in the right place and at the right time. Although traditional hospital information systems worked well in a world in which patients’ needs could be met within a single facility, that technology is evolving to connect the growing network of facilities and caregivers that are engaged in serving a multitude of interconnected patient needs. These constellations of facilities and Knowing which technology fits best providers are increasingly supported for each organization requires a care- by a large set of healthcare technol- ful analysis of which core functions ogy systems—all of which rely on a facility needs, what requirements it electronic medical records (EMRs). has for clinical information systems, By creating a holistic view of patient- how the capabilities of existing facili- related information, EMRs bring the ties can be leveraged and integrated promise of enhanced quality of care, into the network, and what con- reduced medical errors and costs, and straints may be involved in executing improved business performance for an enterprise EMR solution. In the healthcare organizations. Today, a absence of this tailoring, organiza- range of enterprise EMRs is available tions may end up with an EMR to help bridge existing information solution that doesn’t fit their own par- gaps, make healthcare institutions ticular needs—and the quality, cost operate more efficiently, and improve savings, and performance that EMRs patient satisfaction and outcomes. promise would be wasted.Booz & Company 1
  4. 4. KEY HIGHLIGHTS• A combination of competitive pressures, patients’ demands, technological advances, and expanded rules and regulations is forcing healthcare organizations to migrate from stand-alone facilities to integrated, full-service provider networks.• Traditional technology solutions that helped stand-alone facilities increase productivity and patient satisfaction are evolving in order to deliver an enterprise-wide view of patient care that incorporates multiple facilities and caregivers.• Enterprise EMR solutions are THE FORCES Prompted by these pressures, providers have moved from a credited with enhancing provider OF CHANGE discrete view of care, in which they awareness of the full patient focus on specific episodes, to an history, reducing administrative integrated approach in which they costs, limiting errors and data aim to deliver a continuum of care duplication, and contributing to to their patients from the cradle increased patient satisfaction. to the grave. This new delivery One of the major changes affecting model is transforming the industry• When properly designed and the healthcare industry over the past by replacing single providers with tailored to the specific needs of decade has been the transformation multiple-facility systems operating each facility in the network, these of its delivery model. Care outcomes in integrated healthcare networks enterprise solutions can bring are becoming an important (IHNs)—collections of various types the promise of enhanced care, indicator of quality within the of healthcare delivery facilities that reduced costs, and improved healthcare community, eclipsing include primary, secondary, and business performance. volume of patients, length of stay, tertiary care (see Exhibit 1). and occupancy rates. And because today there are a greater number These networks help facilities achieve of co-morbidities and a higher economies of scale by pooling their prevalence of chronic diseases, buying power, eliminating duplicative patients more frequently need to administrative and clinical roles, be treated by different specialists consolidating technology applications over a longer period of time. Stand- and other equipment across facilities, alone facilities, with their increasing and centralizing core business complexity and the additional functions such as human capital and time they require for reporting, finance. Through IHNs, facilities are also struggling to comply attract a critical mass of cases, further with new regulatory demands. developing their clinical expertise. Regulations and standards, such as From a care perspective, IHNs offer the Health Insurance Portability and a more holistic view of the patient Accountability Act (HIPAA), have than was previously possible, along been expanded over the last decade with better coordination across the in order to cover different aspects of different levels of care. healthcare delivery, such as access to care, outcome of services, and This transformation of the delivery confidentiality of patient information. model from stand-alone facilities2 Booz & Company
  5. 5. to integrated healthcare networks in one place across multiple facilities making it easier for communitydemands technology solutions that allows them to monitor and treat physicians to interact with hospitals:link caregivers across an IHN, as patients across the continuum of care, With advances in medicine translatingwell as outside of it. Such solutions and better leverage evidence-based into shorter hospital stays and moregive caregivers the access to patient medicine to increase the chances of outpatient treatment, hospitals aredata that permits them to effectively successful treatments in similar cases. increasingly looking to physicians tocollaborate and to make the right These technology solutions are also refer patients.decisions about patients’ care. Giving helping hospitals create a competitiveproviders access to all patient data advantage in the marketplace byExhibit 1Different Levels of Technological Needs for Organizations in a Sample IHN General Hospitals Specialty Centers (Imaging Centers, Reference Laboratories, Outpatient Clinics) Primary Care ClinicsNote: The size of the object representing each organization illustrates the degree of functionality required of that organization’s EMR solution.Source: Dr. Mohammad Al-Yemeni presentation at HIMSS IT Leadership Summit, Oman, November 2009; Booz & Company analysisBooz & Company 3
  6. 6. EVOLVING TO This growing constellation of facilities and providers is supported by a large solutions that can support a provider’s different network facilities by linkingAN ENTERPRISE set of healthcare technology systems modules to EMRs for additionalVIEW that rely on EMRs. Essentially, the EMR is a single record that provides a functionality. Basic EMR solutions cover functions such as clinical patient’s information across facilities, documentation and capture, clinical and encounters. By using a unique dashboard, clinical workflow support, patient identifier, an EMR is able to controlled medical vocabulary, and a capture all of a patient’s data, such as clinical data repository. EMR solutions age and sex, personal characteristics, allow hospitals to better manage their laboratory and radiology results, patients and their facilities through and current medication and allergies. one system, improving patient care This record becomes the sole source and increasing productivity and of information for a patient and patient satisfaction. To gain efficiencies can be accessed by physicians, throughout the hospital, basic EMR nurses, referring doctors, and other solutions interface with other clinical authorized users—either within and administrative systems such as medical facilities or remotely hospital information systems (HIS), through a secure connection. It is the pharmacy information systems (PIS), centerpiece and the unifying factor or lab information systems (LIS). within an IHN’s integrated application portfolio. An enterprise EMR goes a step beyond the basic EMR solution The emergence of IHNs in healthcare by comprising a set of clinical delivery is changing the EMR functions and workflows that landscape, as hospitals now interact are fully integrated to provide with a number of facilities and other patient information throughout the outside partners. As a result, the stand- continuum of care (see Exhibit 2). alone EMR needs to be replaced withExhibit 2EMR Solutions Offer Varying Degrees of Functionality Based on Organizations’ Needs BASIC ENTERPRISE EMR FULL ENTERPRISE EMR Interdisciplinary Care Plan t on or isi Ph form pp ec In ar a Su al D m tio ac n ic Scheduling Scheduling y lin C Admission, Admission, Single Single Discharge Discharge & Transfer Patient Record & Transfer Patient Record Nurse Patient Triage Billing Referral Referral Registration Registration Tracking Tracking Enterprise Enterprise En an d er ci ize Master Master Ad R M inis ord rd ysi ter Patient Index Patient Index ed tra m ec try Ph pu ic tio om al n C O Clinical DocumentationNote: There are also interim options between the basic EMR solution and the full EMR solution, which can be customized for individual facilities’ needs.Source: Booz & Company4 Booz & Company
  7. 7. Although solutions vary from vendor make more-informed decisions decreased duplication, and theto vendor, an enterprise EMR typically based on all possible information elimination of manual entry, asintegrates the core functionality of a through a rules-based engine. For well as a reduction in multiplestand-alone EMR (i.e., a single patient example, a CDSS will assist caregivers requests for similar diagnosticsrecord) with various additional by checking for drug interactions, • Increased patient satisfaction duemodules, including: incompatibilities among prescribed to improved service delivery time drugs, and a patient’s allergy profile and increased caregiver focus onEnterprise master patient index and dosage errors. patients(EMPI): This module ensures thatthe patient database is normalized The clinical and administrative To achieve all of these benefits, anby eliminating duplicate records benefits of an enterprise EMR enterprise EMR must be able to fullyand by preventing users from are widely recognized within the integrate with other existing clinicalcreating them inadvertently. healthcare community: and administrative systems withinTypically this module will cross and the IHN. Often, systems exhibit thematch data elements from patient • Improved outcomes, because ability to communicate with onedemographics, registration data, and caregivers have access to a another through the exchange of dataencounter data from all clinical and patient’s full medical history such as patient demographics, butadministrative systems. they are not capable of exchanging • Improved service, as the critical decision support data, automation of many low-value-Computerized physician order including alerts. This failure arises added tasks allows caregivers toentry (CPOE): This system enables from the lack of integration between focus more on patient carecaregivers to order laboratory and multiple solutions and providers,radiology tests, evaluate patient • Fewer errors, thanks to and points to the absence of clear standardization across interoperability standards. Anstatus, and document the actions departments, analytics, and enterprise solution from a vendor,they have taken. smart systems which is typically integrated, canClinical decision support system • Reduced administrative costs solve these interoperability issues.(CDSS): The CDSS helps caregivers due to increased productivity, To achieve the full benefits of an enterprise EMR, it must be able to fully integrate with other existing clinical and administrative systems within the IHN.Booz & Company 5
  8. 8. ONE SIZE DOES tightly integrated in a single enterprise system. doctors) that need a quick, affordable solution which integrates the singleNOT FIT ALL patient record with a few additional The key is to understand each modules. Some vendors claim to be provider’s needs. During able to install such solutions very Booz & Company’s recent rapidly (one practice per week), development and implementation of including “go-live support.” In a an IHN IT strategy, we analyzed the recent Booz & Company study forPrimary, secondary, and tertiary enterprise EMR requirements of nine a large IHN, we found that basicfacilities typically have different facilities within the IHN (see “Case EMR vendors combined elementsneeds in terms of their EMRs. As Study: Tailoring an Enterprise EMR”). of the common hospital database,such, these facilities place a high such as insurance information andvalue on the ability to customize The facilities ranged from large patient data elements, with tailor-enterprise EMR solutions to fit multi-specialty hospitals to midsized made functionality that met thetheir individual needs. For example, specialty centers to small primary physicians’ specific demands (e.g.,one facility may need a slimmed- care centers. Our review of specific area pharmacies, ordering privileges).down EMR system with minimal facility requirements revealed that a Typical modules within a basicscheduling capabilities, while basic EMR was not sufficient for all EMR solution include an EMR/another will require a full-fledged facilities, but a full enterprise EMR single patient record system withEMR system with the ability to was excessive for some facilities and minimal functionality, or a scaled-control bed usage. would be too costly and complex to down version that includes just health deploy and manage. To customize the information and data; registrationVendors today are increasingly EMR solution, we went beyond the and scheduling; limited prescriptionoffering solutions with more two-level basic and enterprise models order entry; and laboratory andpowerful hardware and more and categorized the IHN facilities radiology results.customizable software that are more into three groups according to theirresponsive to healthcare providers’ EMR requirements: basic enterprise Partial Enterprise EMRneeds. Partnerships and acquisitions EMR, partial enterprise EMR, andhave helped a few vendors to offer enterprise EMR. This version is often used by specialtyenterprise EMR solutions that serve center facilities that require moremany users—referral management for Basic Enterprise EMR functionality than a small clinicalcommunity doctors, CPOE and EMR office but have fewer and morefor caregivers, and revenue cycle The basic EMR solution is best suited specialized needs than a large, generalmanagement for administrators— to small physician offices (around 10 multi-facility hospital because of their6 Booz & Company
  9. 9. CASE STUDY: TAILORING AN ENTERPRISE EMR A major healthcare investor was building an integrated healthcare network encompassing several facilities, including an acute care center with around 400 beds and a portfolio of outpatient clinics and specialty services, such as a diabetes clinic. The group wanted to understand how to create a centralized patient view by integrating clinical applications across these facilities, including EMR, radiology information systems (RIS), picture archiving and communications systems (PACS), LIS, CPOE, CDSS, and PIS. To define the most appropriate solution, we first identified key market trends in clinical information systems along with best practices in deploying them. After looking at top vendors’ offerings, caregivers’ needs, and the IHN’s portfolio, we determined that EMR, HIS, PIS, CPOE, and CDSS should be offered as a single enterprise solution, with RIS, PACS, and LIS considered separately. We advised which capabilities should be offered centrally (e.g., order entry, image archive) at the enterprise level, and which should remain local (e.g., specific clinical systems). We then developed a target model for the IHN’s EMR thatspecialization (e.g., diabetes clinic took into consideration each facility’s needs. For example, one of the facilitiesor sports medicine center). Modules involved was a national reference laboratory focused on LIS that had no need forthat appear in this category include enterprise EMR functionality.all those in the basic EMR category,in addition to clinical decision One of the most challenging aspects of launching such a large enterprisesupport, electronic image viewing, system is ensuring interoperability across the different systems. To that effect,and the ability to order laboratory we designed an enterprise integration solution that makes sure all deployedand radiology tests. Typically such a systems can interface seamlessly. We also developed an operating modelsolution for specialty centers requires to ensure that the EMR is managed properly and that the different facilities’significant effort to develop custom needs are taken into consideration as the system evolves. The operating modelfunctionalities as bolt-ons to out-of- included the team to manage the EMR once it was operational, the processesthe box modules. and policies to ensure its efficient operations (especially in capturing users’ needs), a budget that encompasses capital and operational expenditures toFull Enterprise EMR deploy and manage the EMR, and a governance model that aligns the EMR with each facility’s objectives as well as with the IHN’s overall objectives.The full enterprise EMR is typically Based on these recommendations, the team was able to articulate an integratedaimed at large, multi-specialty IT vision to the company’s senior management that helped them achieve theirhospitals, but tailored to the facility vision of a paperless environment. The efficient exchange of clinical informationbased on clinical and administrative across systems offers enhanced quality of care by providing clinicians with aworkflows. This version comprises holistic perspective on all their patients’ information and reducing the number ofthe full suite of modules and medical errors. The new system also lowers overall costs, including a significantfunctionalities available. In addition reduction in administrative the functionality offered by thepartial enterprise EMR solution,additional modules that would beintegrated include extended clinicaldocumentation, PIS, nurse triage,patient billing, CPOE/order entry,medical administration record, CDSS,and EMPI.Booz & Company 7
  10. 10. CONCLUSION By creating a holistic view of patient- related information, EMRs promise with the necessary EMR capabilities is essential. Before investing time enhanced quality of care and fewer and money in an enterprise EMR, medical errors, reduced costs, and healthcare organizations should improved business performance undertake a thorough review of their for healthcare organizations. day-to-day needs to determine which However, delivering a multi-facility, EMR solution fits the bill and what multifunctional IT solution is a degree of customization is required. complex task and the typical one- Without this tailoring, organizations size-fits-all approach typically may end up with an EMR solution offered by vendors is needlessly that doesn’t fit their own particular time-consuming and costly. A needs—and the quality, cost, and tailored approach that matches performance promise that EMRs each healthcare organization’s needs bring will be wasted.8 Booz & Company
  11. 11. Endnotes1 For more information, please see Ramez Shehadi, Dr. WalidTohme, and Jad Bitar, “Healthy Links: Ensuring Interoperability inHealthcare Delivery,” Booz & Company, 2009.About the AuthorsRamez Shehadi is a partner Jad Bitar is a senior associatewith Booz & Company in with Booz & Company inBeirut. He leads the information Beirut and a leader in thetechnology practice in the information technology practiceMiddle East. He specializes in with a focus on healthcare.e-business and technology- He specializes in healthcareenabled transformation, helping and business technology,both private corporations and particularly strategy,government organizations organization, operations, andleverage technology, achieve innovation.operational efficiencies, andimprove governance.Dr. Walid Tohme is a principalwith Booz & Company in Beirutand a leader in the informationtechnology practice witha focus on healthcare. Hespecializes in the managementand strategic use of technologyto enable the transformationof healthcare organizations,services, and infrastructure.Booz & Company 9
  12. 12. The most recent list of Worldwide Australia, Dublin Middle East Mexico Cityour office addresses and Offices New Zealand & Düsseldorf Abu Dhabi New York Citytelephone numbers can Southeast Asia Frankfurt Beirut Parsippanybe found on our website, Adelaide Helsinki Cairo San Auckland London Dubai Bangkok Madrid Riyadh South America Brisbane Milan Buenos Aires Canberra Moscow North America Rio de Janeiro Asia Jakarta Munich Atlanta Santiago Beijing Kuala Lumpur Oslo Chicago São Paulo Delhi Melbourne Paris Cleveland Hong Kong Sydney Rome Dallas Mumbai Stockholm Detroit Seoul Europe Stuttgart Florham Park Shanghai Amsterdam Vienna Houston Taipei Berlin Warsaw Los Angeles Tokyo Copenhagen Zurich McLeanBooz & Company is a leading global managementconsulting firm, helping the world’s top businesses,governments, and organizations.Our founder, Edwin Booz, defined the professionwhen he established the first management consultingfirm in 1914.Today, with more than 3,300 people in 59 officesaround the world, we bring foresight and knowledge,deep functional expertise, and a practical approachto building capabilities and delivering real impact.We work closely with our clients to create and deliveressential advantage.For our management magazine strategy+business,visit to learn more aboutBooz & Company.©2009 Booz & Company Inc.