However, the use of EHR is still in question. The 2010 CDC/NCHS national Ambulatory Care Survey projects that almost 50% of physicians have already purchased some type of EHR product, but only around 10% are using the product as a fully functional EHR product.Around 25% are using EHR as a basic systems. This means that 15% of all providers have purchased an EHR and are NOT using the product at all. Part of the reason is usability, identified slowdown in patient care, and many of these systems have crashed over time and data was lost. When this occurs, physicians lose trust in the EHR solution.
We need to allow choice but move everyone in one direction
First lets start by looking at the time it takes to collect the information.
Healthcare and BI
Mark R. Anderson, FHIMSS, CPHIMS CEO of AC Group, Inc.
Mark Anderson, FHIMSS, CPHIMSS Healthcare IT Futurist CEO of AC Group National Speaker on EHR > 800 sessions since 2001 Semi annual report on Vendor product functionality and company viability 36+ Years In Healthcare IT CIO Position at Three Multi Facility Regional IDN’s Installed over $1B in technologies since 1972 Provided EHR information to over 25,000 Physicians Over 400 EHR Search and Selection Projects and 12 community HIE projects. Former CIO of a 2,300+ physician (500+ Practices) IPA
BI Tools in Healthcare Healthcare organizations are overwhelmed with data. But without a program in place to target, gather, deliver and analyze the most relevant data, these organizations will continue to be data rich but information poor. Forward-thinking healthcare organizations realize that data— and, thus, business intelligence (BI)—is at the center of informed and precise decision-making that will improve patient and service outcomes in addition to ensuring their organizations’ future. To achieve the full benefits of BI, organizations must take an enterprise-wide, strategic approach vs. tackling small tactical projects, and realize that the greatest efficiencies come from integrating data historically stored in silos of databases in financial, operational and clinical systems.
BI Tools in Healthcare A strategic focus is the difference between simply recognizing the value of managing key information for analytical purposes and transforming the culture to evidence-based decision-making at all levels at the point of care. Cost savings are the main driver for implementing BI in healthcare organizations, followed by the need to improve medical outcomes. But who actually receives the cost benefits? A strategic approach to BI, which cuts across the organization, requires buy-in from not only top executives but also physicians and clinical staff. Without buy-in and acceptance of the data, clinicians will not act of the BI intelligence.
So where are we today?8 Http://www.acgroup.org Page No: 8
Why are Practices not using what they Purchased?
Stage Functionality 2008 2011 Meets MU Complete EHR; CCD transactions to shareStage 7 data; Data warehousing; Data continuity with 0.3% 1.00% 100.0% ED, ambulatory, OP, BI Tools Physician documentation (structuredStage 6 templates), full CDSS (variance & compliance), 0.5% 2.80% 75.0% full R-PACSStage 5 Closed loop medication administration 2.5% 3.70% 50.0% CPOE, Clinical Decision Support (clinicalStage 4 2.5% 10.30% 10.0% protocols) Nursing/clinical documentation (flow sheets),Stage 3 CDSS (error checking), PACS available outside 35.7% 49.70% 5.0% Radiology CDR, Controlled Medical Vocabulary, CDS, mayStage 2 31.4% 15.40% 0.0% have Document Imaging; HIE capableStage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 11.5% 6.70% 0.0%Stage 0 Lab, Radiology and Pharmacy not Installed 15.6% 10.50% 0.0%
Hospital functionality Pharmacy/Medication Safety Physician Clinical Practice Clinical Decision Support Physician Results Rules and Data SeverityMedication Outpatient Order Sets Report Writer MAR Order Entry Review Alerts Warehouse AdjustmentOrder Entry Prescriptions Comparative Substitution/ Task Lists/ Outcomes Resource Dosing Formulary Provider Database Cost Workflow Pathways Protocols Measurement UtilizationManagement Management Documentation Access Management Tools Access to Ambulatory Provider Positive Rounding Patient History/ Patient Locator/ Credentialing Drug Drug Practice Profiling Patient Tools Problem Lists Patient Lists Interactions Databases ManagementIdentification Enterprise Patient Access Robot Interface Core Information Management Components Admission/ Enterprise Eligibility User Interface/Portal Registration Scheduling Verification Data Aggregation and Reporting Tools Technical Request for Consumer Departmental/Support Services Denial Authorization Portal Management Common Radiology/ Master Person Clinical Research Lab Cardiology Data Medical PACS Index (MPI) Repository Clinical Documentation Repository Vocabularies Patient I&O Emergency Surgery Decision Flowsheets Pathology Order Rules Standard Assessment Vital Signs Department Support Entry Engine CDM Repository Other Kardex Task Lists Care Plans Blood Bank Departmental Security Integration Consumer PDA Systems Tools Tools Content Support Transition Non-MD Specialty Planning Orders Documentation Health Information Management Care Management Initial & Clinical Critical Care Patient Interfaces Chart Precertification Discharge Documentation Education to Monitors Transcription/ Coding Concurrent Denial Management Authorization Planning Dictation Support Review Management(Deficiencies) Payor InterQual Supply Chain Document Workflow Electronic Communication Support for Work Lists Pathways Patient Support for Imaging Tools Signature and Notes LOC Tracking & Supply Product Reconciliation Charges Standards Social MRN Post Acute Readmit Disease Release of ServicesManagement CDMP (?) Placement Alerts Management Interface to Information Support and Merge ERP System Solution Sets Solution Components
Connecting Physicians Delivers the Connected Community Hospitals Ancillary Departments Employers Physicians Hospitals are best positioned and In-patient Clinicals & best served to lead the way to a Physician Portal connected care communityHomecare Physician Office RetailProviders Solutions Pharmacy Broad Community Patients Connectivity Payors & PBMs Page No: Http://www.acgroup.org 17
It shouldnt take a brain surgeon to design one patient centric community EHR with BI tools Page No:Http://www.acgroup.org 18
The Problem Today Referral tracking is paper based Patient’s must register each time they see a new Physician Patients must provide each provider duplicate information: Social History, Medical History, Family History What Medications are you on? Physicians do not have adequate and timely information about the patient Business Intelligent Tools (BI) only works when you have data. What the community needs is a new way of connecting and sharing timely patient information.
DRT is Discrete Reportable Transcription Allows the provider to use the EHR for viewing of patient clinical information. After the physical exam, the provider dictates their note like they have the past 20+ years. The dictated report is sent to a transcription service for transcription or via Dragon The Software takes the dictation, creates a clearly defined patient note and then automatically populates the EHR with practice specific discrete recordable and reportable data directly into the practice’s EHR.
Data Entry Time New Patients Established Patients 350 300Seconds 250 200 150 100 50 0 Dicate Handwrite EHR DRT EHR Number of seconds for data entry of discrete clinical data Source: 573 Patient charts
ARRA/HITECH ACT Feb 17, 2009 –ARRA/HITECH Acts signed into law $19.5 billion for health IT adoption, EHR and HIE Goal (forecast) is adoption and meaningful use of EHR by 90% of physicians and 70% of hospitals by 2015 Bulk of funds appropriated go towards incentive payments to eligible providers (EPs) and eligible hospitals (EHS)
HITECT Requirements In order to qualify for the incentive payments, both physicians and hospitals have to prove three things: 1. Use of a certified EHR product with ePrescribing capability that meets current HHS standards. 2. Connectivity to other providers to improve access to the full view of a patient’s health history. 3. Ability to report on their use of the technology to HHS. The second area is “meaningful use”
Cost? What Cost? Acquisition Implementation and Training Maintenance and Upgrade Lost Productivity Personal Cost (The Pain & Suffering) Inappropriate Physician Tasks Page No: 33
EHRs cost to much? 5 – Year Total Cost per Provider$90,000$80,000$70,000$60,000$50,000$40,000$30,000$20,000$10,000 $- Level 1 Level 2 MU 2008 2011 2013 2015 Costs
Three way interaction Trusted EHR Advisor Vendor Practice
Who do physician’s Trust? Sample of 3,215 Physicians
Technology DecisionsCurrent Main Vendor Similar Vendor with ExpertiseBest of Breed Vendor New Comers 5% 15% 55% 25%
National Survey’s and Certification ONC 2011 Certified Products – 499 Vendors CCHIT 2011 Products – 89 Vendors Regional Extension Centers (REC) – 35 Vendors KLAS top 10 EHR vendors – 10 Vendors Black Book – 15 Vendors AC Group – 35 Vendors Top selling vendors – 10 Vendors 38
EHR Failure rate Through 2012, the EHR failure rate continues to increase. When asked, ―1 year of EHR installation, are you seeing 80% of your patients using the EHR for charting, ROS, HPI, Evaluation, coding, orders and results reporting‖. 73% of the physicians (3,245) indicated that no, they were NOT using the EHR for 80% of their patients. 18% replaced or were not using EHR Why, are 73% of the physicians NOT fully utilizing the EHR after 1 year? So why are there so many failures? Page No: 39
Take Home Message Create a culture of accountability as part of the deployment of dashboards and balanced scorecards. Prepare stakeholders that a long period of data preparation and cleansing may be necessary before applications can roll out. Improve capabilities to track patients, costs, and assets. Incorporate information from business systems and clinical systems. Involve physicians and other key stakeholders in the planning process. Obtain a highly motivated stakeholder to create an immediate win that will generate enthusiasm throughout the organization for evidence-based decision- making
For More InformationMark R. Anderson, FHIMSS, CPHIMS CEO and Healthcare Futurist AC Group, Inc. 118 Lyndsey Drive Montgomery, TX 77316 (281) 413-5572 eMail: email@example.comWeb Site: www.acgroup.org