Critical Success Factors For Physician Adoption Of Emr & Ehr August 2010


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Critical Success Factors For Physician Adoption Of Emr & Ehr August 2010

  1. 1. Health Care Business Advisors Page of 4 Critical Success Factors for Physician Adoption of EMR & EHR Data for Compliance or to Improve Physician Operations? An EMR/EHR produces lots of data, but how is it converted to meaningful information; and towhom is it meaningful? Payors use data to ensure claims are paid according to contract and to trackcost trends of insureds, physicians and hospitals. Hospitals use data to better manage supply chain(including pharmaceutical and device orders), to evaluate cost trends of services and physicians, and toimprove revenue capture and collection. Each of these could be used by physicians but have not beenwidely adopted. Why? The principal reason is that external forces -- hospitals, payors, pay-for-performance, government -- impose varying and complex requirements for more information. Physi-cians are focused on compliance rather than on creatively deploying capital to produce information thatenables them to substantiate and improve their quality outcomes. Because most electronic initiativesfocus on adherence to external rules and regulations, too often neglected is a value proposition that de-fines how electronic data can be used internally by physicians to improve their operations and return oninvestment. Information Physicians Need to Embrace EMR/EHR Data gathered from EMR/EHRs should empower physician performance improvement. In or-der to understand and embrace the return-on-investment for expenditure of capital and time physiciansmust be educated on how information will produce demonstrable and quantifiably better outcomes.Data must empower physicians with a better understanding of their patients’ diseases and how theirtreatments positively or negatively effect results; how it can mitigate their malpractice risks; and, howit will increase cash flow through all elements of the revenue cycle. Information should be used princi-pally to improve internal operations, and secondarily for demonstrating to patients, payors and othersthe value of their services. Critical Success Factors Common Causes of Failure Mission of EMR/EHR adoption is production  EMR/EHR solutions purchased for compliance of meaningful information for physicians own with external demands organization Physician Vision that information ensures that  Adopting “Me-too,” or copycat strategies or the best medicine is the most cost-effective  Canned solutions Clear, precise definitions of internal informa-  Information required and defined by external tional goals parties Physician and administrative champion for  No internal champion. information use Information used for continuous process im-  No succession plan provement and communication of outcomes Implementation of “canned” or generic solutions are really “me-too strategies” that don’t takeinto account the differences between data and information and how it can best be used to further a spe-cific organization’s culture, objectives and strategies. EMR solutions are frequently misaligned withthe organization’s needs and objectives for the use of information gathered. Physicians must under-stand how the use information obtained from the EMR/EHR will help them be the best, most cost-effective physicians. EMR/EHR initiatives focused on compliance with external demands do notsolely create a value proposition that most physicians embrace. Joseph Mack, MPA President (949) 481-0602
  2. 2. Health Care Business Advisors Page 2 of 4 Value Drivers for Physician Adoption of EMR & EHR Clinical Informatics An EMR/EHR enables development of clinical informatics for continuous quality improvementand reduction in risk. Data gathered include defining, creating and measuring certain performance in-dicators suggested in the following:  Hospital admissions/readmissions  Complications  Post-surgical wound infections  Adverse drug reactions  IatragenisisThis information can be used for:  Longitudinal studies  Disease/chronic care management improvement  Monitoring and enhancing procedural, medication, laboratory results and/or disease problem lists and resolution management  To automatically generate alerts, triggers, required actions  For creation and improvement of triage nurse or call center protocols, processes and informa- tionElectronic information provides the basis for real-time continuous process improvement of:  Clinical protocols and evaluation of clinical outcomes data  Medical record uniformity and accessibility  Development of clinical programming and planning efforts Obtaining and Quantifying Risk/Reward of Treatment Alternatives Effective information can also be used to improve physician bedside manner by:  Quantifying and stratifying actual and anticipated outcome measurements to determine risk level of treatment options.  Medical risk information contributes to the understanding, prevention and treatment of dis- ease.  Clinicians must not only understand risk, but also be able to communicate potential risks and benefits to their patients effectively.  Providing information patients understand about risk that might inspire them to comply with treatment and to modify high-risk lifestyle choices.  Supplying information for physicians to use in interpreting and placing into context for individ- ual patients information obtained through the internet and other sources. Transforming data into information enables physicians to evaluate standardized performancecriteria, and to take remedial steps to improve performance and outcomes of individual physicians andgroup members. Mitigate Malpractice Risk and Exposure Information generated from the EMH/EHR can also help physicians mitigate their risks ofnegative outcomes, including malpractice exposure and potentially result in discounts and reductions inmal-practice premium costs. Recent researched examined more than 1,000 physician groups with 20 ormore doctors and found that the groups on average employed 32% of 16 recommended care-management processes, including use of nurse care managers, development of disease registries andfeedback to physicians on quality of care. Documentation and quantification of physician use of clini-cal care guidelines and pathways provides compelling evidence that creates real qualitative and eco-nomic benefits such as: Joseph Mack, MPA President (949) 481-0602
  3. 3. Health Care Business Advisors Page 3 of 4 Value Drivers for Physician Adoption of EMR & EHR The ability to “tell their story,” by defining the usual, customary and reasonable treatment within their service area rather than to accepting insurers’ or attorneys’ use of generalized UCR data ap- plied to their practice. Reduction in malpractice cases and loss damages since an EMR/EHR should:  Make it easier for physicians to access and review medical history  Catch medication errors and adverse drug interactions  Track test results and ensure prompt, effective patient follow-up. Revenue Cycle ImprovementIntegration of clinical and financial information will greatly assist physicians with improvement of cashflow, reduction in accounts receivable and reduction in collection costs. Among the benefits are: Enhanced leverage with payors to secure better contractual rates.  Denials and underpayments from insurers account for approximately 5% - 7% reduction in pay- ment, respectively.  The cost to audit medical group processes (i.e. coding, billing) and payor reimbursement to con- tractual terms ranges between 1% - 3%.  Inattention or inability to review contractual revenue results in an average loss of 14%. Improvement in charge capture and cash acceleration  Increased charge completeness and accuracy resulting in increased revenue  Aggressively manage large account balances that are 1-30 days from patient encounter  Focus on 20% of claims driving 80% of charges  Increases in collection rates due to timely follow-up Identify, quantify and manage Performance Drivers  Collector Productivity  Management Effectiveness  Billing & Collection Metrics  Organizational Requirements  Causes of denials and rejections Information obtained from an EMR/EHR will be embraced wholeheartedly by physicians. How-ever, most value propositions focus on external causes for adoption, rather than empowering physicianswith information for continuous improvement of their practice. Operational ChallengesHaving an EMR in place is not a panacea. Staff must constantly monitor input and follow-up to ensurecompliance and to ensure that problems are not missed or are corrected promptly. Even after years ofuse, physicians remain resistant to changes in the EMR inputs and processes suggested by informationproduced. Additional operational challenges include: Important information embedded in paragraphs of boilerplates can easily be overlooked. This in- creases the chance of missing critical data. Overlooking important information is a significant cause of malpractice.  positive finding embedded in a string of negative findings can easily be missed. A EMRs contain templates for various types of specialists and types of visits which are helpful for documenting repetitive acts.  However, inadvertently using the wrong template can cause potential malpractice problems. Joseph Mack, MPA President (949) 481-0602
  4. 4. Health Care Business Advisors Page 4 of 4 EMR & EHR ServicesWe work with physicians and staff to identify their vision, objectives, key issues, and critical success inimplementing an EMR or EHR tailored specifically to them. Outcomes include: Development and/or implementation of protocols Creation of medical record uniformity and accessibility Collection and evaluation of clinical outcomes data Development of clinical programming and planning efforts Staffing priorities Timing Capital Server-based Application Service Provider (“ASP”) or internet-based Vendor selection and evaluation Experience Counts Joseph Mack was administrator of large group practice that had EMR in place for over 7 years. He trained new physicians in its use, refined clinical rules and protocols, and redesigned boiler- plate screens to optimize the ease and efficacy of use and how the information was used. He created a clinical informatics department to ensure that information was input appropriately by physicians and staff, to direct the use and improvement of data gathered to improve clinical out- comes, and which facilitated the development of clinical process redesign and information flow. The group’s malpractice carrier discounted its annual premium 5% for having this function and process in place. Developed the strategies and created a marketing and sales plan for an $8 billion insurance com- pany to use decision support systems to improve financial and clinical processes throughout the United States. Created business intelligence and decision support solutions to automate, identify, capture, and compile data into information to drive financial and clinical performance improvement for hospitals and physician organizations nation-wide. Used predictive modeling and ASP information technology data to compile information from across hospital departments into disease specific benchmarks for cost reduction and quality im- provement. Evaluated legacy IT systems, needs requirements, priority and capital requirements. Conducted due diligence on outsourcing hospital IT department. Evaluated vendors and made site visits to hospital installations. About Joseph Mack & AssociatesJoseph Mack & Associates (“JMA”) is a full service health care management consulting firm. Our spe-cialties include: Strategic Planning and Business Development; Performance Improvement and Proc-ess Redesign; Hospital/Physician Integration; Revenue Cycle Enhancement; Cost Reduction; Creationand Implementation of Business and Clinical Informatics; and, Implementation and Enhancement ofElectronic Medical Records. Joseph Mack, MPA President (949) 481-0602