Good afternoon! My name is Michele Fronckiewicz. I am the Executive Director of Child Health Administrative Services – also known as CHAS. Don’t let our name fool you…. While our name denotes a focus on child health, we quickly learned that our services are valuable to all practices. My colleagues at HealthBridge invited me to share our Electronic Medical Record journey with you and how our organization leveraged HealthBridge to make our implementations a success.
We are a subsidiary of Cincinnati Children’s Hospital that provides revenue cycle management services and electronic medical record systems and support to community based physician groups. We were formed in 1997 to provide locally supported practice management systems and revenue cycle services to community-based pediatric practices enrolled in the Tri-State Child Health Physician Hospital Organization. In addition to its strong results, CHAS is known for its successful system implementations, both practice management and EMR. Throughout the life of our organization, our team has completed over 50 implementations. Our specialty is workflow design with our system. Within the first three years of our formation, we quickly evolved on a number of fronts: 1) we grew outside the pediatric world and our client base now includes pediatric and adult primary care and specialty care practices; 2) we grew outside the I-275 loop in Cincinnati. Our service area extends from Greensburg, Indiana on the west side to Athens, Ohio on the East. We provide services to practices as far south as Lexington, Kentucky. Within our service area, we have 4 markets: SE Indiana; Greater Cincinnati/Northern Kentucky; Lexington and Athens, Ohio. We expect to continue to expand geographically in the future And 3) we expanded our service line to include electronic medical record application and support services.
Our founding physicians had their eye on EMR when our organization was born. Our EMR journey officially began in 2004 as our client base grew more and more interested in generating efficiencies and improving clinical outcomes for patients. Recognizing that we had two product lines to support, one of our earliest decisions was whether to pursue a best-of-breed solution versus a single-vendor/application solution. After significant research and internal discussion, we chose a single-vendor solution in order to avoid expensive interfaces and increased maintenance. Due to the nature of our client base, a mix of primary care and specialty care physicians, we sought a solution that could support our entire client base. Finally, we sought feedback from our physician client base and other similarly situated physician practices. Ultimately, over 50 physicians contributed to the selection of our solution through contributions of required functionality, review and evaluation of system demonstrations and participation in site visits to existing clients on the finalist platforms. Our ultimate choice in a solution was consensus driven between Cincinnati Children’s and community physicians.
One of earliest exercises during the system search process was to identify the required functionality for our providers. We conducted a survey in 2004 and asked physicians and practice managers what was most important to them. As I reviewed this list in preparation for my talk today, I was astounded! While most of it applies still today, there are a few items that have evolved well beyond the physician’s dreams…..“Print out prescription to give to patient!” In 6 short years, e-prescribing is now required functionality - - - forget the faxes! While these features focus on the physician user interface, the community physician contributors to our project also had tremendous foresight related to data exchange and interoperability.
When we completed our survey, the majority of physicians participating were pediatricians. Back in 2004, community physicians wanted electronic resulting from Cincinnati Children’s; they wanted the ability to connect with immunization registries and they wanted to connect with other existing patient registries so that the EMR was always the master record and that there would be no dual entry into the EMR and registries. As we considered these needs, we worked with the Cincinnati Children’s Information Services department to determine the best solution. From the Cincinnati Children’s perspective, they needed to be able to interface to as many community providers as they could - - recognizing that practices sit on different EMR platforms. From the CHAS perspective, I wanted to connect our clients to as many facilities as I could - - - as fiscally responsible as I could. Our options were: 1) get into the interface business or 2) leverage HealthBridge to reach both the Cincinnati Children’s and CHAS. The solution needed to work for all parties…. We selected to go with HealthBridge to get a bigger bang for each “interface” dollar we spent.
So my commercial for HealthBridge starts now….We are so blessed to have HealthBridge in our community. CHAS has achieved great client satisfaction because of this interface and we’ve achieved more than similarly situated practices around the country. I have colleagues in other markets whose exchange of information is limited because they don’t have a HealthBridge equivalent. They are recognized as a national leader in health information exchange. They are able to deliver results from 36 facilities/hospitals, 3 national labs and other diagnostic centers. They partner with other key regions to deliver greater access to providers. Because of HealthBridge, CHAS clients in Indiana can receive electronic results from all their key facilities – in Indianapolis, Batesville and Cincinnati. Additionally, there are occasions when I’d like for HealthBridge to connect with another facility. With direction and encouragement, HealthBridge will reach out to the target group and work to include them in the exchange. Without doubt, CHAS’ interface dollar goes a long way with HealthBridge as a partner.
I attended a Health Information & Management Systems Society (HIMSS) event earlier this week. In his opening comments, Dr. Barry Chaiken reported that only 17% of EMR benefits accrue to physicians…..the rest accrue to patients; payers, and so on…..The HealthBridge interface directly and positively impacts the physician. I’d like to share how the HealthBridge interface benefits the physicians utilizing our system. Our interface went live nearly two years ago. Since then, HealthBridge sent over 62,000 records to our electronic health record system. 65% of the records are laboratory results and 35% are “transcription reports” - - it could be an ED report, discharge summary, history and physical or radiology reading. When asked what do you like best about the CHAS solution, providers will cite the HealthBridge interface in the top three. We’ve done a great job to date partnering with HealthBridge. We have some ideas about expanding services to include more information from Cincinnati Children’s and we’re beginning to develop a “push interface” to HealthBridge so that our physicians can submit electronic orders to HealthBridge.
In the paper world, the process for managing paper results had at least six steps. They are outlined above.
With the HealthBridge interface, we eliminated three steps - - Staff sorting and distributing paper results Clinical staff returns the paper result for filing Administrative staff files the result in the chart If each of those steps took one minute a piece (and in many instances it takes much longer than 1 minute), I estimate that over the past two years, the HealthBridge interface has eliminated over 3,000 of non-value added time from the health care encounter. The interface drives efficiency - - - and while the interface is an investment, it paid for itself and more.
Some of you may wonder how the information presents to the clinician for review. In our system, HealthBridge results land in a physician’s provider approval queue for review. The clinician may customize the presentation of data and provide instruction to the staff on next steps. Laboratory results are saved as discrete data points and lab values may be reviewed longitudinally to show trends. An electronic name/time/date stamp exists on the result for historical purposes.
The next phase of our journey includes HealthBridge as well. Like many other hospital systems in our region, Cincinnati Children’s made a decision to help its medical staff members invest in Health Information Technology. Our Community EMR Project launches in July, 2010 and will provide a subsidized EMR to qualified physician offices. Our project builds upon the existing HealthBridge – NextGen exchange. As I mentioned earlier, we are pursuing a bi-directional interface so that physicians on our system can electronically order tests and referrals via their EMR.
We’re pursuing this strategy to address the meaningful use criteria. Please keep in mind that these components are based on the language in the proposed rule. As of earlier this week, CMS reported that the final meaningful use rule is due by the end of June – beginning of July. I anticipate that the original criteria will change based on the public comments. In the proposed rule - stage one, it is expected that a physician who is meaningfully using a system can receive structured results and display them in a readable format; Exchange clinical information electronically with other providers Submit data to immunization registries Submit reportable lab results to public health agencies and Submit syndromic surveillance data to public health agencies.
When I think about meaningful use and EMR implementations, I think the key elements of success are similar. I’ve listed a few of the shared success factors…..I believe you need a strong solution and a strong team to achieve meaningful use.
Be warned - - There are many vendors in the exhibit hall today. Each of them touts a meaningful use system….. Just remember, even with all those key components in a successful EHR implementation and a strong Regional Extension Center, it is up to the physician to meaningfully utilize the application. Meaningful use is up to you, the physician….
An EHR isn't Enough: Information Exchange for Meaningful Use
An EHR isn’t Enough:
Information Exchange for Meaningful Use
June 18, 2010
Child Health Administrative Services, LLC
What is CHAS?
• Subsidiary of Cincinnati Children’s
• Provides customized practice management,
clinical and workflow solutions to community
• Supports both pediatric and adult, primary
and specialty care physicians in Indiana,
Kentucky and Ohio
Our EMR Journey
• Best of breed vs. integrated model
• Primary and specialty care
• Physician engagement
Required Functionality - 2004
• Patient record flow is intuitive
• Entry of data for documentation allows for different methods –
keyboard; checkboxes; light pen; mouse; touch screen; handwriting
• Allergy checking and adverse reaction tracking
• Design and store patient education materials
• Automatic printing of immunization history on a state-accepted form
• Print out prescription to give to patient
• Disease/condition specific assessment templates automatically pop
up based on “Chief Complaint”
• Physical assessment can be grouped by body systems with drop
down boxes which default to normal findings.
• Automatic assignment of CPT codes based on documentation
• Telephone calls can be documented as part of the patient record
Additional Service Needs - 2004
• Interface with CCHMC for labs/radiology
• Interface with State immunization registries
in Ohio and Indiana
• Interface with patient registries
HealthBridge: The Ideal Solution
• National leader in health information exchange
• With one interface, connect to 26 facilities, 3 national
labs and local diagnostic centers
• HealthBridge’s relationship with HealthLINC in
Bloomington provides access to additional Indiana
• Willing partner for expansion to new facilities
• Since September, 2008
– 62,207 results processed through the interface
• Including lab (65%), radiology and transcription (35%)
– Feedback highly positive from physicians and
– Great opportunity to provide greater impact:
nurse practitioners; additional transcription and
ordering physician processes
Paper result arrives in provider office.
Staff sorts results and distributes to MD.
Nurse contacts family with result status.
Nurse presents paper result for filing/scanning.
Staff pulls chart and files or scans and indexes result to e-chart.
MD reviews and provides direction for phone call to family.
Electronic result arrives in patient chart and provider approval queue.
MD reviews, approves and forwards request to nurse to initiate phone call to family.
Nurse contacts family with result status.
CCHMC Community EMR Project
• Launches July, 2010
• Provides access to a subsidized EMR via the
Stark-AKS HIT exceptions
• Builds upon existing HealthBridge-NextGen
Meaningful Use (PFR) – Stage 1
• Receive structured results and display in
• Exchange clinical information electronically
with other providers
• Submit data to immunization registries
• Submit reportable lab results to public health
• Submit syndromic surveillance data to public
Meaningful Use – Key Components
• Physician champion and engaged physicians
• EHR vision and specific, measurable goals
• EHR application with interoperability
• Strong, local support of the application