Recommendation for a good EMR system


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This presentation gives an overview of Electronic Medical Records consultancy provided to MACH

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  • MACH is a group of 24 internal medicine physicians and associated professionals including nurse practitioners, physician assistants, and supporting nurses.MACH physicians see patients at Newton Wellesley Hospital, Mass Eye and Ear, and the Faulkner Hospital.MACH is required to implement patient electronic medical records (EMR) by one of their hospital partners or lose its privileges at the hospital.MACH as no IT units and they ran a lean organization making it difficult to change.Mach needs a system that integrates and supports the following to make them more competitive:·  Internal and external Labs information                            integration·   Physician order entry·   Health care provider documentation·   Lab, x-ray and procedure results·   Medication management·   Billing and finance informationEMR will increase the number of Patients physician see per hour
  • The EMR system must comply with minimum regulatory requirement - Mach needs to make sure the EMR system comply with the requirement of one if not all of the following health agencies:·         Health insurance portability and accountability act of 1996 (HIPAA)·         American Recovery and Reinvestment Act of 2009 (ARRA)·         Certification Commission for Healthcare IT (CCHIT)·         EHR-Lab Interoperability and Connectivity Standards (ELINCS)
  • Recommendation for a good EMR system

    1. 1. Presented by Casey Ryan | Manav Gupta | Michael Budiman | Muhammad Ali Usmani Sajith Kaimal | Temidayo Adebayo
    2. 2. Overview MACHMedical Associates of Chestnut Hill MACH needs a system that 3 practices | 24 staff members integrates and supports the following – Standard med practice software 1. Internal / External lab info integration No IT units | lean organization 2. Physical Order entry 3. Health care provider Requires EMR implementation documentation 4. X-ray and procedure results 5. Billing and finance info
    3. 3. Compliance MACH HIPPAMach needs to make sure theEMR system comply with therequirement of one if not all ofthe following health agencies ARRA EMR CCHIT ELINCS
    4. 4. EMR Framework MACH MACH Mission | Strategy | Business Value 1 EMR Recommendation
    5. 5. EMR Framework MACH MACH Mission | Strategy | Business Value 1 Mission: Being the premier provider of physicians and healthcare services EMR area by emphasizing in the Efficient , Effective and Innovative Quality care for our Recommendation patients Strategy: Focus on process improvement with enabling technology to achieve increased efficiency. Business Value: Access to hospitals, Improve healthcare , Access to AARP Incentives, Improve Brand
    6. 6. EMR Framework MACH MACH Needs Assessment MACH Mission | Strategy | ( Business Context | Users, Business Value Business Process | Compliance) 1 2 EMR Recommendation 3 4 Vendor Research Selection Criteria | (Build vs Buy | SWOT | POCs | Scale | Weightings questionnaires | demos | client references)
    7. 7. Build Vs. Buy MACH In-house Vendor-based  Better ability to customize the  Typically low setup cost, product as per business needs economies of scale  Ability to retain direct control  Proven reliability & & privacy of internal functions performance benchmarks  Less time to implement o Not core competency of  Statutory / Legal MACH requirements taken care of o High cost in establishing in- house facility and longer ramp- o Challenges in communication up time of precise requirements o MACH needs to hire qualified o Dependency on vendor for staff support and maintenance
    8. 8. Which EMR should MACH use ?Recommendation MACH can go for buying Vendor-based package as it would provide quicker Time-to-Market & a cost-effective solution Building software is not MACH’s core competence & its on the hook to be on EMR in 6 months! Traditional EMR Cloud-based EMR  Virtualization, Remote You can scale only to the computing over network limits of your hardware  Easy Scalability  Better disaster recovery  Security concerns  Pricing based on usage  Easy inter-operability
    9. 9. McKesson Specialty Health 1. Healthcare services company -> pharmaceutical solutions | medical supplies | technologies 2. Operates in two business segments 1. Distribution Solutions (97% of total Sales) 2. Technology Solutions 3. Total Revenues 112B (March 2011) 4. Number of Employees: 36,000 5. Strengths-> Market Leadership | Broad Solution Portfolio | Industry Recognition
    10. 10. McKesson Lytec MD & RelayHealth 1. Lytec MD combines the practice management features of Lytec 2011 with electronic health record (EHR) 1. Bright Note One Touch Technology 2. RelayHealth connectivity services connects healthcare providers to payors, pharmacies, patients and other providers
    11. 11. eClinicalWorks“eClinicalWorks is the only EHR in the marketplace thatmeets our requirements for full interoperability, 1. Privately-held, leader inadvanced security and private cloud hosting,” ambulatory clinical solutionsDr. John HalamkaCIO of Beth Israel Deaconess Medical Center andHarvard Medical School 2. Its solutions extend the use of electronic health records beyond practice walls with the latest technologies and create community-wide records 3. Established customer base of more than 55,000 providers & 250,000 plus medical professionals across all 50 states
    12. 12. eClinicalWorks On-demand SaaS | Premises Industry Standards client / server 3-tier technology using HTTPs & XML HL7 Continuity of Care Record (CCR) Continuity of Care Document (CCD)Enterprise Business Healthcare InformationOptimizer (eBO) to Technology Standardsprovide more Panel (HITSP)dynamic reporting
    13. 13. EMR ratings for MACH Weighs Scores Lytec eClinical MD Works 2.41 2.63Current Offering 65% 2.42 2.59 EMR /PPM Features 50% 2.42 2.44Usability 10% 2.60 2.60Patient access 10% 2.00 3.00Federal / State Compliance 5% 3.00 3.00Privacy & Security Protections 10% 2.80 2.60Integration 5% 2.00 2.00BI & Reporting 5% 2.00 3.00Legal Implications 5% 2.40 3.00Strategy & Cost 30% 2.30 3.00Market Presence 5% 3.00 1.00
    14. 14. EMR impact –Organizational structure Impact ManagementCurrent workflow disruption during transition • Schedule training sessions during less busy season • Hire temporary staffs for parallel • Clarify project milestones and phasesPotential resistance from physicians and admin • Rally supports from the more vocal and/or staffs during training and learning curve tech-savvy physicians period • Provide big picture of short-term and long- term EMR benefits • Provide financial incentives for overtime related to training and learning curveAdministrative staffs reduction • Provide job referrals for impacted staffs • Shift role of impacted staff to another areaIn-house IT support staff addition • Assess in-house versus 3rd party consultant cost-benefit
    15. 15. EMR impact – Process and Output Impact Measurement ManagementHistorical data conversion from • Number of patient charts • Hire temporary admin staffs paper-based to digital for data input and data format integrity checkPhysicians spend more time on • Physicians’ daily schedule patients than on administrative tasksPatients data are more readily • Number of days needed to available to physicians get information into patient chart • Record and compareQuicker information flow to • Time needed to complete measurement units (in pharmacies and other prescription hours/days) before and after medical institutions • Time needed to process EMR implementation referralsQuicker information flow to • Time needed to complete patients prescription • Time needed to notify patients of drug recalls
    16. 16. Impact Example (Org Structure)Source: MedicaLogic. Ambulatory EMR: Establishing a business Case [White paper]
    17. 17. EMR impact –Cost and Revenue Impact Measurement ManagementQuicker cloud-base • “Meaningful Use” standards • Synchronize implementation implementation = higher set by Centers for Medicare timeline with CMS chance of MACH to qualify and Medicaid Services (CMS) “Meaningful Use” checklist for HITECH Act fundingReduction of overhead costs • Time spent on chart-pulls, • Calculate salary cost based transcription and other on hours spent on admin administrative task tasksIncrease of per-visit patient • Number of patients visit per • Track number of patients charges doctor visit per doctor before and after EMRFaster and more accurate billing • Number of days between • Track number of days and patient visit and invoicing cases before and after EMR • Number of cases of billing disputesCost of implementing EMR • Profit and Loss statement • Formulate and monitor might put MACH in net loss short-term and long term position in the short term financial forecast and budget
    18. 18. Impact Example (Cost and Revenue)Source: MedicaLogic. Ambulatory EMR: Establishing a business Case [White paper]
    19. 19. Ultimate impact of EMR
    20. 20. Implementing EMR Phase One (2 months) Designate Project Organize Internal Manager & ERM Committee Physician Champion Training Set Clear Goal for “Going Live” Date Implementation Budget
    21. 21. Implementing EMR Phase Two (3 months) Possible Tasks for after Complete Software “Going Live” configuration & Integration Conduct post go reviews GO LIVE !
    22. 22. Recommendation • Finalize requirement / workflow automation /Month 1 initial launch goals • Vendor Engagement / Contract Approval • Hardware / Software Review & AcquisitionMonth 2 • Steering committee creation • Project plan creation and assignment of internal and vendor resources and projectMonth 3 manager • Finalizing implementation Budget • Finalize Integration plan for initialMonth 4 launch with other systems ( practice and hospitals) • Finalize migration /archiving ofMonth 5 existing paper records • Hire supporting staff ( temp or permanent)
    23. 23. Recommendation • Initiate Configuration of software template /Month 1 data import • Initiate h/w acquisition and set up • Initiate Data migration / archivingMonth 2 • Initiate Training • Initiate Systems IntegrationMonth 3Month 4Month 5
    24. 24. Recommendation • Complete the ConfigurationMonth 1 • Complete the Integration • Complete TrainingMonth 2Month 3Month 4Month 5
    25. 25. Recommendation • Go Live !Month 1 • Monitor systems use • Conduct post go live reviews • Identify process improvement opportunitiesMonth 2 • Ensure EMR adheres to "meaningful use "Month 3Month 4Month 5
    26. 26. Recommendation • Utilize reports / metricsMonth 1 • Provide follow up action plan for ongoing • Support service needsMonth 2Month 3Month 4Month 5
    27. 27. QUESTIONS
    28. 28. Bibliography Centers for Medicare and Medicaid MedicaLogic. Ambulatory EMR: Services; Medicare and Medicaid Establishing a business Case [White Programs, Electronic Health Record paper]. Retrieved from Incentive Program Final Rule. Released July 13, 2010. Accessed Establishing-a-Business-Case-for- October 10, 2010, at Ambulatory-EMR.pdf /pdf/2010-17210.pdf Issues-in-EMR-Implementations.pdf Meaningful use Deconstructed - _Use_Deconstructed
    29. 29. Implementation: Phase One - Develop Project Plan Objective 1: Designate an Internal Project Manager & Physician Champion 1. Set clear goal for “going live” date 2. Provide vision of long /short term goals 3. Help to reduce potential disruption of workflow 4. Possible resistance from staff to new systems Objective 2: Implementation Budget 1. Assess the amount of work and available time 2. Evaluate cost of in-house IT support staff 3. Review current personnel , redundant staff 4. Costs will be high early in implementation 5. Increase of per-visit patient charges after implementation 6. Formulate 5-7 year forecast and budget 7. Budget for Training Objective 3: Training 1. Vendors will train all staff 2. No use of “train the trainer” program 3. Provide financial incentives for overtime related to training and learning curve 4. Schedule training during slow season 5. Acclimated and familiar to new devices before in exam room
    30. 30. Implementation: PhaseTwo-Organize internal EMRcommittee Objective 1: Strategy for transition from paper documents 1. Compliance with federal/state requirements on destruction of medical records 2. Scanning and shredding paper documents to save on storage costs Objective 2: Additional IT support staff 1. Assist in maintenance and daily IT operations Objective 3: Hardware Decisions 1. Check for slow, outdated equipment 2. Upgrade from “low memory” devices 3. Eventual template customization 4. Transcriptions will be replaced with template-based documentation Objective 4: Tasks after “Going Live” 1. Connect multiple lab interfaces 2. Designating patient portals 3. Gradually customize system 4. Monitor progress to see if adjustments may help
    31. 31. eClinicalWorks - Pricing
    32. 32. Meaningful Use Below are the Meaningful Use requirementsThis rule implements the provisions of the 1. Use CPOEAmerican Recovery and Reinvestment Act 2. Implement Drug-Drug and Drug-Allergy Checkingof 2009 (ARRA) (Pub. L. 111–5) ARRA set 3. Use e-Prescribingaside more than $19 billion in funding for 4. Record Demographicsmedical services providers that make 5. Maintain a Problem List"meaningful use" of "certified" EMR 6. Maintain a Medication Listsystems 7. Maintain a Medication Allergy List 8. Record Vital Signs 9. Record Smoking Status 10. Implement Clinical Decision Support 11. Report Quality Measures 12. Provide Patients with Electronic Copies of Health Information 13. Provide Patients with Clinical Summaries 14. Capability to Exchange Clinical Information Electronically 15. Protect Electronic Health Information
    33. 33. Cloud is Secure Enough for the Pentagon.Security in the cloud Why Not for You?Drawing on the findings from multiplebenchmark studies on best practices in • Resource relocation: Relocate resources andcontent security and security software data for filtering, traffic controlling,as a service, analysis shows that users of verification, encryption and other securitycloud-based web security had measures. This ability provides more resiliencesubstantially better results than users of against security threats.on-premise web securityimplementations in the critical areas of • Multifactor authentication: Multi-factorsecurity and compliance. Compared to authentication systems combine somethingcompanies using on premise web you know (password), with something yousecurity solutions, users of cloud-based have (hard token), and/or something you areweb security solutions had 58% fewer (biometric).malware incidents over the last 12months, 93% fewer audit deficiencies, Physical security: Reputable cloud computing45% less security-related downtime, vendors often host their systems in facilitiesand 45% fewer incidents of data loss that have much stronger physical securityor data exposure. controls with meaningful certifications that many small-to-midsize companies cannot provide on their own.
    34. 34. Electronic Medical Records Need MoreTo Support “Meaningful Use”