Electronic Medical Record Adoption Model


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HIMSS Analytics 7 Stage Electronic Medical Record Adoption model

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Electronic Medical Record Adoption Model

  1. 1. Electronic Medical Record Adoption Model Ohio Critical Access Hospital Network Health Information Technology Summit May 19, 2009 Russ Hessler President CSO HIMSS [email_address]
  2. 2. EMR Adoption Model <ul><li>Enabling Healthcare Reform </li></ul><ul><li>Using Information Technology </li></ul><ul><li>Electronic Medical Record Capabilities and Expected Benefits in US Non-federal Hospitals and Physician Clinics </li></ul><ul><li>December 17, 2008 </li></ul>
  3. 3. EMR Adoption Model The Wedding
  4. 4. EMR Adoption Model CSO HIMSS <ul><li>Central and Southern Ohio Healthcare Information System Society (CSO HIMSS) </li></ul><ul><li>Currently over 500 members </li></ul><ul><li>Experiencing record growth </li></ul><ul><li>Members scattered throughout the State of Ohio </li></ul><ul><ul><li>Membership not bound by geography </li></ul></ul>
  5. 5. EMR Adoption Model CSO HIMSS
  6. 6. EMR Adoption Model HIMSS History <ul><li>Healthcare Information Management Systems Society (HIMSS) </li></ul><ul><li>organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. </li></ul>
  7. 7. EMR Adoption Model HIMSS History <ul><li>Healthcare Information Management Systems Society (HIMSS) </li></ul><ul><li>represents more than 20,000 individual members and over 350 corporate members that collectively represent organizations employing millions of people. </li></ul><ul><li>frames and leads healthcare public policy and industry practices through </li></ul><ul><ul><li>advocacy, </li></ul></ul><ul><ul><li>educational and professional development initiatives </li></ul></ul>
  8. 8. EMR Adoption Model HIMSS History <ul><li>Healthcare Information Management Systems Society (HIMSS) </li></ul><ul><li>Vision </li></ul><ul><li>Advancing the best use of information and management systems for the betterment of healthcare </li></ul><ul><li>  </li></ul><ul><li>Mission </li></ul><ul><li>To lead change in the healthcare information and management systems field through knowledge sharing, advocacy, collaboration, innovation and community affiliations </li></ul>
  9. 9. EMR Adoption Model HIMSS History <ul><li>Healthcare Information Management Systems Society (HIMSS) </li></ul><ul><li>1961 – Organized as healthcare management engineering society </li></ul><ul><li>1966 – Affiliated with AHA </li></ul><ul><li>1993 – Established independent association </li></ul><ul><li>2001-2006 – Growth through acquisition and affiliation </li></ul><ul><ul><li>2001: CHIM — corporate members </li></ul></ul><ul><ul><li>2002: CPRI-HOST — focus on EHRs </li></ul></ul><ul><ul><li>2003: MS-HUG — Microsoft developers & IT pros </li></ul></ul><ul><ul><li>2004: Dorenfest & Associates — c reated data services and market research business </li></ul></ul><ul><ul><li>2006: AFEHCT — focus on business systems </li></ul></ul><ul><li>2005 – Growth through expansion outside of US </li></ul><ul><ul><li>2006: opened office in Brussels; launched WoHIT Conference </li></ul></ul><ul><ul><li>2007: launched HIMSS Asia-Pac Conference </li></ul></ul>
  10. 10. EMR Adoption Model HIMSS Analytics <ul><li>In 2004, HIMSS purchased the Dorenfest IHDS+ Database™ and created HIMSS Analytics </li></ul><ul><li>consists of 5000+ hospitals, including Critical Access Hospitals </li></ul><ul><ul><li>tracks 100+ applications and related equipment </li></ul></ul><ul><li>original database was sold primarily to vendors to use for prospecting purposes </li></ul>
  11. 11. EMR Adoption Model HIMSS Analytics <ul><li>HIMSS Analytics has established a process whereby the Market Research Associates (MRA) survey hospitals on an annual basis and update the database. </li></ul><ul><li>information track includes systems utilized, hardware, and buying plans </li></ul><ul><li>up to 30 different peer comparison reports available </li></ul><ul><ul><li>Peers are categorized by type of facility, bed size, overall revenue, and services provided </li></ul></ul><ul><li>reports are provided to all organizations that participate in the survey process </li></ul><ul><ul><li>including graphical presentations </li></ul></ul>
  12. 12. EMR Adoption Model HIMSS Analytics <ul><li>HIMSS Analytics created the EMR Adoption Model™ </li></ul><ul><ul><li>Hospital based </li></ul></ul><ul><ul><li>Stages 0 - 7 </li></ul></ul><ul><li>developed a methodology and algorithms to score hospitals surveyed relative to their IT-status </li></ul><ul><li>provides peer comparisons reports </li></ul>
  13. 13. EMR Adoption Model . . . To be considered. <ul><li>All application capabilities within each stage must be operational before that stage can be achieved </li></ul><ul><li>All lower stages must have been achieved before a higher level is considered as achieved </li></ul><ul><li>A hospital can achieve Stages 3-6 if it has met all of the application requirements for a single patient care service (e.g., single nursing floor, cardiology service) </li></ul><ul><li>Using the rules above, additional points are given for the implementation of applications in stages higher than the one fully achieved by the healthcare organization </li></ul>
  14. 14. EMR Adoption Model STAGE 0 <ul><li>Stage 0 </li></ul><ul><li>Some Clinical automation may exist </li></ul><ul><li>Laboratory and/or pharmacy and /or radiology NOT installed. </li></ul>
  15. 15. EMR Adoption Model STAGE 0 <ul><li>Stage 0 Benefits </li></ul><ul><li>Hospitals </li></ul><ul><li>operational efficiencies for the automated ancillary departments. </li></ul><ul><li>Physician Clinics </li></ul><ul><li>status quo in the majority of physician offices in the US today. </li></ul>
  16. 16. EMR Adoption Model STAGE 1 <ul><li>Stage 1 </li></ul><ul><li>Laboratory, pharmacy and radiology installed </li></ul>
  17. 17. EMR Adoption Model STAGE 1 <ul><li>Stage 1 Benefits </li></ul><ul><li>Hospitals </li></ul><ul><li>lab and radiology test results can be sent electronically to ordering physicians, assuming the lab and radiology systems have that capability built in. </li></ul><ul><li>diagnostic results can be assessed from the various ancillary clinical systems </li></ul><ul><li>single sign-on functions improve the efficiency for accessing results from multiple systems. </li></ul><ul><li>Physician Clinics </li></ul><ul><li>physicians access to clinical protocol and content Websites for researching diagnoses and treatment information. </li></ul><ul><li>clinic offices are more efficient and more profitable. </li></ul>
  18. 18. EMR Adoption Model STAGE 2 <ul><li>Stage 2 </li></ul><ul><li>Major ancillary clinical systems feed data to clinical data repository (CDR) that provides physician access for retrieving and reviewing results. </li></ul><ul><li>CDR contains a controlled medical vocabulary (CMV) and the clinical decision support system and rules engine for rudimentary conflict checking </li></ul><ul><li>Optional for extra points – Information from document imaging systems may be linked to the CDR. </li></ul>
  19. 19. EMR Adoption Model STAGE 2 <ul><li>Stage 2 Benefits </li></ul><ul><li>Hospitals </li></ul><ul><li>ancillary systems can be interfaced using CDR’s results reporting capability – allows physicians remote access to results. </li></ul><ul><li>reliance on paper chart is significantly reduced for care delivery. </li></ul><ul><li>Physician Clinics </li></ul><ul><li>patient safety increased by legible, computer-generated prescriptions. </li></ul><ul><li>improved patient care with the use of order sets that ensure complete and thorough diagnostic testing based on protocols and clinical guidelines. </li></ul>
  20. 20. EMR Adoption Model STAGE 3 <ul><li>Stage 3 </li></ul><ul><li>Clinical documentation installed (e.g. vital signs, flow sheets, nursing notes, care plan charting, and/or the electronic medication administration record (eMAR) system are scored with extra points and are implemented and integrated with the CDR for at least one service in the hospital) </li></ul><ul><li>First level of clinician decision support is implemented to conduct error checking with order entry (i.e. drug/drug, drug/food, drug/lab, conflict checking normally found in the pharmacy) </li></ul><ul><li>Some level of medical image access from picture archive and communication systems (PACS) is available for access by physicians via the organization’s intranet or other secure networks </li></ul>
  21. 21. EMR Adoption Model STAGE 3 <ul><li>Stage 3 Benefits </li></ul><ul><li>Hospitals </li></ul><ul><li>significant efficiencies for nursing – standardization of nursing practice, alerts and reminders, electronic medication administration record integrated with pharmacy system which contributes to reducing medication errors, validating patient histories rather then recreating them, and so on. </li></ul><ul><li>Physician Clinics </li></ul><ul><li>patient safety increased by drug interaction warnings by checking known current medications with medications being ordered to identify and flag any potential interactions </li></ul>
  22. 22. EMR Adoption Model STAGE 4 <ul><li>Stage 4 </li></ul><ul><li>Computerized practitioner/physician order entry (CPOE) for use by any clinician added to nursing and CDR environment </li></ul><ul><li>Second-level of clinical decision support related to evidence-based medicine protocols implemented </li></ul><ul><li>If one patient service area has implemented CPOE and completed previous stages, this stage has been achieved </li></ul>
  23. 23. EMR Adoption Model STAGE 4 <ul><li>Stage 4 Benefits </li></ul><ul><li>Hospitals </li></ul><ul><li>improves patient safety by eliminating medication errors associated with handwriting errors. </li></ul><ul><li>improves patient safety by adding a higher level of clinical decision support at order creation. </li></ul><ul><li>Physician Clinics </li></ul><ul><li>further reductions in medication errors due to advanced clinical decision support tools. </li></ul><ul><li>physicians able to participate in pay-for-performance initiatives </li></ul><ul><ul><li>due to quality and outcome reporting capabilities. </li></ul></ul>
  24. 24. EMR Adoption Model STAGE 5 <ul><li>Stage 5 </li></ul><ul><li>The closed loop medication administration environment is fully implemented in at least one patient care service area. </li></ul><ul><ul><li>The eMAR and bar coding or other auto-identification technology, such as radio frequency identification (RFID), are implemented and integrated with CPOE and pharmacy to maximize point-or-care patient safety processes for medication administration. </li></ul></ul>
  25. 25. EMR Adoption Model STAGE 5 <ul><li>Stage 5 Benefits </li></ul><ul><li>Hospitals </li></ul><ul><li>improves medication management by identifying potential medication errors that clinicians may not be aware of. </li></ul><ul><li>provides a data set to improve the management and administration of medications for use in both outcomes and protocols analyses. </li></ul><ul><li>Physician Clinics </li></ul><ul><li>physicians able to move from predominate focus on sick care to wellness and prevention activities with chronic illness patients. </li></ul><ul><li>clinics connected to health information exchanges to share patient encounter information with other providers and feed personal health records for consumers. </li></ul>
  26. 26. EMR Adoption Model STAGE 6 <ul><li>Stage 6 </li></ul><ul><li>Full physician documentation/charting (structured templates) are implemented for at least one patient care service area. </li></ul><ul><li>A full complement of radiology PACS systems is implemented (i.e. all images, both digital and film based, are available to physicians via an intranet or other secure network) </li></ul>
  27. 27. EMR Adoption Model STAGE 6 <ul><li>Stage 6 Benefits </li></ul><ul><li>Hospitals </li></ul><ul><li>improves the timeliness and accuracy of physician documentation to support care delivery process. </li></ul><ul><li>provides a higher level of clinical decision support with physician protocols and therefore improves clinical outcomes. </li></ul><ul><li>eliminates or significantly reduces the costs/expenses for dictation and transcription. </li></ul><ul><li>may reduce discharge-not-final-billed days for many services. </li></ul>
  28. 28. EMR Adoption Model STAGE 7 <ul><li>Stage 7 </li></ul><ul><li>The hospital has a paperless EMR environment </li></ul><ul><ul><li>clinical information can be readily shared via Continuity of Care (CCD) electronic transactions with all entities within health information exchange networks (i.e. other hospitals, ambulatory clinics, sub-acute environments, employers, payers and patients) </li></ul></ul><ul><ul><li>allows the health care organization to support the true sharing and use of health and wellness information by consumers and providers alike </li></ul></ul><ul><ul><li>HCOs use data warehousing and mining technologies to capture and analyze care data, and improve care protocols via decision support </li></ul></ul>
  29. 29. EMR Adoption Model STAGE 7 <ul><li>Stage 7 Benefits </li></ul><ul><li>Hospitals </li></ul><ul><li>all medical record data is on-line and available to all clinicians via secured access. </li></ul><ul><li>all patient care data can be shared with other organizations that are treating the patient using a standard transaction that contains clinical data. </li></ul><ul><li>majority of the patient care data is discrete and provides a rich environment for analyzing clinical outcomes and protocols in a more timely and complete manner. </li></ul><ul><li>quality and outcomes reporting is a by product of the complete EMR environment. </li></ul>
  30. 30. EMR Adoption Model 2008 – 2009 Q1
  31. 31. EMRAM HIMSS Analytics Reports <ul><li>HIMSS Analytics Reports </li></ul><ul><li>IS Department Expense Comparisons </li></ul><ul><li>IS Department Operational Comparisons </li></ul><ul><li>IS Department FTE Comparisons </li></ul><ul><li>EMR Adoption Model Comparisons </li></ul>
  32. 32. EMR Adoption Model <ul><li>HIMSS Analytics </li></ul><ul><li>866-546-2900 </li></ul><ul><li>[email_address] </li></ul><ul><li>www.himssanalytics.org </li></ul>