EMRgecy Medicine: The Impact of EMR/EHR on Healthcare - Keynotes and Expert Panel Discussion 12/10/09 in NJ


Published on

The event was held in Bedminster, NJ, and was sponsored by ACHE-NJ and Cegedim Dendrite. It brought together experts from around the globe to help attendees better understand practical issues, benefits and challenges of EHR adoption, including interoperability, reimbursement, and more. Dr. Kennedy Ganti, the New Jersey Health IT Commissioner, was a keynote presenter as well as one of the guest panelists.

I have received many emails from people unable to attend this event due to time, date or location who wanted access to this presentation - so here it is!

The keynote presentations and introduction by the panel moderator, Michael Fossel, are presented in this slide deck.

(NOTE: A link to the recorded event - including the infamous panel of experts who received major applause and kudos at the conclusion of the event - will be available soon!)

  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

EMRgecy Medicine: The Impact of EMR/EHR on Healthcare - Keynotes and Expert Panel Discussion 12/10/09 in NJ

  1. 1. EMRgency Medicine – Are You Ready? December 10th, 2009
  2. 2. Agenda Opening Remarks Dr. Michael Fossel Understanding the HITECH Act Dr. Kennedy Ganti and the EMR Mandate Lessons Learned: A European Jean-Michel Van Perspective on EMR’s effect on savings costs, lives & time Increasing Your Chances for Paul Roemer Success: What are the Critical Success Factors for EHR/EMR Break Thought Leadership Panelists Discussion Open Q&A Networking & Dessert | 2
  3. 3. Dr. Michael Fossel | Cerner Corporation OPENING REMARKS | 3
  4. 4. Sometimes, your EMR can be a ―PICNIC‖ | 4
  5. 5. Reality: not always a PICNIC | 5
  6. 6. People will never laugh at anything that is not based on truth. - Will Rogers I feel like I’m working for the computer, rather than it working for me.  MD, Iowa, 2007 | 6
  7. 7. | 7
  8. 8. Sound like your EMR? | 8
  9. 9. Extormity and ARRA’s meaningful use "Our legal team is expending incalculable billable hours to develop a carefully worded statement that will depict in illustrative terms our commitment to helping customers and prospects move toward the eventual demonstration of meaningful use," explained Extormity chief financial officer Samantha James in a carefully worded statement. "It is common knowledge that meaningful use criteria are not fully defined, so Extormity is taking great care not to issue an ironclad, no exceptions guarantee," added James. "However, we plan to provide the market with a vague impression of intent designed to inspire a tinge of confidence and an indication of some degree of willingness to comply at some future point, all without creating a legal obligation or definitive pledge to deliver an actionable event." | 9
  10. 10. Who said… | 10
  11. 11. Nothing new under the sun... Who and when? Florence Nightingale 1863 ―Notes on Hospitals‖ Source: London: Longman, et al. | 11
  12. 12. Potential Benefits Reduce errors More ―intelligent‖ care Real-time data Better communication & documentation Secure (and HIPAA compliant) data Reduced labor costs Reduced litigation Automated workflows | 12
  13. 13. Costs of doing nothing… • 33 cents/dollar spent is non-clinical Consider: >90% of ~30 billion transactions/year by phone, fax, or mail Physicians spend an estimated: 20-30% searching for information 38% documenting (nurses 50%) Records misplaced in 30% of visits Patients average 13 pieces of paper/visit Offices average $10/visit on paper records Patient records average 3.3 kg | 13
  14. 14. Deadlines are nearing, penalties are looming Why hesitate? Ill-defined requirements Unanswered questions The opportunity to learn from others Successes in the EU and US How do we achieve success? | 14
  15. 15. THANK THANK YOU YOU | 15
  16. 16. Dr. Kennedy Ganti | NJ Health IT Commission Chair UNDERSTANDING THE HITECH ACT AND THE EMR MANDATE | 16
  17. 17. Stimulus, Software and Sense Understanding the Fundamentals of Electronic Health Data Use and Exchange: | 17
  18. 18. The Case for Health IT Adoption Computerized health data: nothing new Since the 1970s At centers like Boston, Indianapolis and Salt Lake City Electronic medical records such as VA Vista were created Central data repositories Enter the Electronic Medical Record Collection of related pieces of health data on a person's health and disease Electronic version of the standard medical charge Data can be structured Data can be shared | 18 1
  19. 19. The Case for Health IT Adoption Making better decisions- clinical decision support Drug-drug interactions clinical reminders for preventative services 'red flags' on structured lab data ePrescribing- tracking meds better Know if patient actually filled a script Track prescribers tendencies Connecting the dots | 19 1
  20. 20. HITECH: Adding fuel to the fire Health Information Technology for Economic and Clinical Health Act Makes federal funding and planning resources to build an interconnected, interoperable national health data exchange network Provisions: $18 billion for CMS to promote "meaningful use" of EMR systems $2 billion for ONC for infrastructural upgrades in HHS, education of health IT professionals, promotion of interoperable clinical data repositories $1 billion to Federally Qualified Health Centers (FQHC) for renovation and acquisition of health IT systems $550 million for Health IT and other uses for Indian Health Services $300 million to support regional and sub-national efforts for HIEs $40 million to be used by Social Security Admin to use EMRs to submit disability claims | 20 2
  21. 21. Meaningful Use Policies, standards and metrics that guide clinical usefulness of EMRs Specifies goals by policy, patient setting and time (every two years starting in 2011) Guide for CMS for promoting incentive payments and eventually non-use penalties Has harmonized goals between ambulatory and inpatient care Pro- grounded in sound clinical and health policy principle Con- Not very helpful in other care settings (Long term care, physical therapy, etc) | 21 2
  23. 23. Group’s Expertise Cegedim Group 2008 : €849 million with 8,200 employees (80 countries) Cegedim Healthcare Software (CHS) 29% of group’s activity Main market in western Europe a) Healthcare provider b) #1 in France, #2 in the UK, #1 in Italy, #1 in Spain, #2 in Belgium Definition of EHR: Data exchange, e-prescribing, CPOE, e-claim | 23
  24. 24. Adoption Rate Across Top Countries 1. Early starters Fig 1- Use of EHR Systems in Hospitals Fig 2 - Use of EHR Systems by Primary Care Physicians Percentage of Hospitals Using Percent of Primary Care Physicians Country EHR Systems Country Using EHR systems DENMARK 65 DENMARK 95 FINLAND 100 FINLAND 95 SWEDEN 88 GERMANY 42 France 40 France 70 SPAIN 70 NETHERLANDS 98 US 8 SWEDEN 100 UK 89 US 28 Sources: Castro, D. ITIF, Sept 2009 a) European initiatives earlier than US (Northern Europe): early 1980’ 90’ with e-claims submission, e-referral, e-clinical record | 24
  25. 25. US and EU: Similar Barriers 1. Privacy issues a) Danish Web portal Sundhed.dk= privacy functions! Thru Digital Signature, access tracking (40% healthcare related Internet traffic) b) Sweden: Good Policy - government-run database (4 to 5 % opt out) c) Netherlands: stored in healthcare providers. Privacy control (2% opt-out) 2. Data ownership a) Patients do not manage their data but own them and decide who can view/modify them 3. Cost of IT adoption Fig 3 – Cost of IT Adoption and % of total cost Denmark Small subsidies (30%) Netherlands Tax deductible and incentive payments for every patient (50%) UK Financial incentives (75%) France Subsidies (75%) Spain Financial incentives (90%) Source: Gartner, Ministry of Health Sweden and Sécurité Sociale Report France | 25
  26. 26. Benefits of e-Health (France, Spain, Holland, UK, Denmark, Czech Republic ) 1. ROI ?  Yes 2. Benefits for Patient Safety (2005-2008) 15% reduction in prescription errors/year = Electronic Transfer of Prescription France: 200,000 reduction of prescription errors Czech Republic: 75,000 reduction of prescription errors Netherlands: 26,000 medication errors through CPOE and CDS Six States: potential reductions of 5 million outpatient prescription errors across the studied states Source: Gartner, Ministry of Health Sweden and Sécurité Sociale Report France | 26
  27. 27. Benefits of e-Health (France, Spain, Holland, UK, Denmark, Czech Republic ) 3. Benefits for Quality of Care UK: over 250,000 surplus laboratory tests were avoided since 2005 France : 11,000 readmissions to hospital for CHF were avoided through EMR (an additional 26,000  savings of over €110 million, if full elec.) 4. Increasing Physician Availability UK: Over 90,000 appointments covered through “Did Not Attends” option enabled by Electronic Appointment Booking (600,000) Czech Republic: Almost 560,000 bed-days were become available every year through Telemedicine, direct saving of €32 million Sweden: Over 92,500 GP appointments/year were made available alone through the use of web-portal Source: Gartner, Ministry of Health Sweden and Sécurité Sociale Report France | 27
  28. 28. Mid + Long-term Costs & Benefits (France, Spain, Holland, UK, Denmark, Czech Republic) 1. Benefits on Annual basis Average HPOs : annual benefits = annual costs  year 3 Fig 4 - Annual Costs And Benefits Of E-Health 60 Sites From 1994 To 2008, In € Mill Present value of annual costs Present value of annual benefits | 28 Source: European Commission « Economic Impact of eHealth Report » 2008
  29. 29. Mid + Long-term Costs & Benefits (France, Spain, Holland, UK, Denmark, Czech Republic) 2. Benefits on Cumulative basis Average HPOs: annual benefits > annual costs  year 5 Cumulative benefit by 2008: € 330 million Cumulative investment costs (incl. operating expenditure): €155 million Fig 5 - Cumulative Costs And Benefits Of E-Health 60 Sites From 1994 To 2008, In € Mill 2500 1500 500 Present value of cumulative costs Present value of cumulative benefits | 29 Source: European Commission « Economic Impact of eHealth Report » 2008
  30. 30. Future of the US e-Health Each country is different There is no one best practice! Same strong signals as in Europe a) National leadership groups, CCHIT b) Set of Standards, HL7, SNOMED c) Incentives d) Top-down communication | 30
  31. 31. Thank You for Your Attention « Yes, you can!!! » | 31
  33. 33. EMR—What Should I Know? What is the elephant in the room? What does this mean—EMRs must be interoperable & interconnected? Know before you buy—what connects to what? If EMRs aren’t connected, doctors will still need electronic and paper files | 33
  34. 34. EMR—Where Does that leave you? Focus on yourself, on what you control Don’t let Washington drive your decision ARRA Certification Meaningful Use Decide why EMR is right for you Figure out what your team should include Define your requirements Set a budget | 34
  35. 35. EMR—Fail Safe Points What are the EMR Fail Safe Points (FSPs)? EMR is healthcare’s Y2K time bomb. There a is concurrent national rollout of EMR; standards not available until 2010. The costs are very high, so are the penalties 1/3rd to 2/3rd of EMRs implemented have failed There may not be time to earn the incentives | 35
  36. 36. EMR—Ambulatory Practices A good argument can be made for waiting. Within 12-18 months they will likely have the opportunity to acquire a plug-and-play EMR in-house or SaaS, including: Project management Selection Implementation Adapting workflows Training Support | 36
  37. 37. EMR is Wide Open New England Journal of Medicine (NEJM) received responses from 63.1% of hospitals surveyed: Only 1.5% of U.S. hospitals have a comprehensive electronic- records system present in all clinical units. 7.6% have a basic system present in at least one clinical unit. Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Respondents cited capital and maintenance costs as the primary barriers to implementation | 37
  38. 38. EMR if it doesn’t connect… Just because EMR’s have been implemented, doesn’t mean they’re of much value. “I've witnessed more serious errors with the EMR than in my previous 25 years as a physician.” Christine A. Sinsky, MD "...our system for delivering medical care is clearly in crisis...At the heart of the problem is the fragmented nature of the way health information is created and collected," Bill Gates Most EMRs don’t operate beyond the walls of the building in which they were implemented | 38
  39. 39. EMR Are you ready? Enterprise Readiness Assessment Federal funding EMR Incentives, Implementation grants Playbook Readiness And penalties Methodology has a 6 phase scorecard. Implementation Risk Management Assessment Cost Benefit/Funding Analysis | 39
  40. 40. Enterprise Readiness Assessment The Enterprise Readiness Assessment identifies gaps in: Change Management Readiness Technology Readiness Risk Management Standards Readiness | 40
  41. 41. EMR Implementation Playbook The Implementation Playbook defines a program or set of projects the enterprise needs to execute in order to implement EMR. Potential projects may include: Requirements SW selection Change Management Integration Policy, Procedure or Process Training | 41
  42. 42. Enterprise Risk Assessment The Enterprise Risk Assessment should help you identify potentially fatal EMR implementation risks: Staffing Program management Readiness | 42
  43. 43. EMR Cost Benefit/Funding Analysis The Cost Benefit Analysis identifies: The cost of implementation and the level of funding necessary to successfully implement EMR Funding sources such as grants or federal government loans The short term costs and the long term benefits ROI development and monitoring | 43
  44. 44. EMR Implementation Management Implementation Management oversees projects to successfully implement each EMR project managing: Project task management Budget, Schedule, & ROI Issues tracking and resolution Staffing and skill requirements Project accountability and visibility | 44
  45. 45. In Summary | 45
  47. 47. Overview Panel: What is an EMR? Dr. Naomi Grobstein Meaningful use Dr. Kennedy Ganti Implementation Dr. Ganti/Dr. Fossel Interoperability Paul Roemer Which vendor? Dr. Spencer Kroll Are EMR’s good? Jean-Michel Van Getting reimbursed Dr. Kennedy Ganti Who owns the data? Dr. David Memel Q&A | 47
  48. 48. QUESTIONS & ANSWERS | 48
  49. 49. NETWORKING & DESSERT | 49