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If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
If NOT for “meaningful use”, then…….Why?
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If NOT for “meaningful use”, then…….Why?

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Ms. Drury outlines the EHR world for these Davies Winners before ARRA and the EHR Incentive Program existed, sharing the environment and the motivation for these privately owned physician practices …

Ms. Drury outlines the EHR world for these Davies Winners before ARRA and the EHR Incentive Program existed, sharing the environment and the motivation for these privately owned physician practices who have been recognized by HIMSS as Davies Ambulatory Award Winners. The HIMSS Nicholas E. Davies Award of Excellence recognizes excellence in the implementation and use of health information technology, specifically electronic health records (EHRs), for healthcare organizations, independent physician practices and public health systems. The HIMSS process of evaluating applications from these practices and validating the use and value of HIT is rigorous for the applicants and for the HIMSS Ambulatory Award Committee.

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  • 1. If NOT for “meaningful use”, then…….Why? San Luis Valley Health Information Technology Symposium, November 4, 2011 1
  • 2. San Luis Valley AHEC Legal NoticeThe material in this tutorial is copyrighted as indicated in each slide footer and anyreferences made by the author.Companies and individuals may only use this material in accordance with copyrightsexpressly stated. Contact the speaker directly for further informationNeither the Author nor the Presenter is an attorney and nothing in this presentationis intended to be nor should be construed as legal advice or opinion. If you needlegal advice or legal opinion, please contact an attorney.The information presented herein represents the Author’s personal opinion andcurrent understanding of the issues involved. The Author, the Presenter and the SanLuis Valley AHEC do not assume any responsibility or liability for damages arising outof any reliance on or use of this information.NO WARRANTIES, EXPRESS OR IMPLIED. USE AT YOUR OWN RISK. 2
  • 3. If NOT for “meaningful use”,then……WhyBarbara Drury, FHIMSSPresident, Pricare Inc.Professional Development Chair,Colorado Chapter of HIMSS 3
  • 4. • Independent consultant, national practice,Speaker: primarily for physician offices, since 1982Barbara • EHR Risk Manager for COPIC (Colorado) and TDC (Oregon/Washington/Idaho) Drury • HIMSS Fellow, new appointee for 2011-2013 HIMSS Public Policy Committee, Current member of Davies Ambulatory Award Committee, Professional Development Chair for the Colorado Chapter, Spirit of HIMSS 2004, 2009. • Appointed to the ONC’s Technical Expert Panel on Unintended Consequences of HIT/EHR. • Author of many of the Colorado Medical Society ARRA tools, webinars. Editor of the COPIC Benchmarks for EMRs. 4
  • 5. Talking Points• The EHR world ‘before and without ARRA’ – What’s different – What’s the same• Highlights from Davies Ambulatory winners – Practices ‘like yours’ – Common reasons to adopt – Degrees of success• Some insights and reflections 5
  • 6. Before Incentives & Meaningful Use• Adoption of EHRs was at a natural pace and evolutionary (COPIC = 10 yrs, 5% to 30%)• Practices determined important issues to develop ‘reasons’ to consider an EHR solution• Capability of paying for the system and keeping staff were paramount• Vendors could respond naturally to the market• Your practice was your kingdom 6
  • 7. After Incentives (Stark, PQRI, ARRA, MU)• Adoption of EHRs has been artificially accelerated• Incentives (or penalties) have become the over-riding ‘reason’ to consider an EHR solution• Meeting someone else’s criteria for the system is now paramount• Vendors must delay or abandon market needs to respond to other requirements• Your practice is one cog in a complex healthcare ‘wheel’ 7
  • 8. And these Davies Winners?• They excel without external incentives (and may not be MUs)• They improve the health of their patients and the wealth of their practices• They measure everything• They actively engage with their chosen vendors• They always have a plan “B” (or create it)• MU is too narrow for the goals of these Winners and the benefits continue to be advantageous to clinicians and their patients! 8
  • 9. Talking Points• The EHR world ‘before and without ARRA’ – What’s different – What’s the same• Highlights from Davies Ambulatory winners – Practices ‘like yours’ – Common reasons to adopt – Degrees of success• Some insights and reflections 9
  • 10. HIMSS Davies Award for Excellence:• The HIMSS Ambulatory Care Davies Award: designed to recognize the most exemplary implementations and utilizations of electronic health records in independent ambulatory practices.• Applicants must be independent, physician-owned (not hospital- owned) ambulatory practices and must have leveraged technology to impact patient-centric practice of medicine and derived value.• The four categories of the HIMSS Davies Awards program are: hospitals and health systems, independent physician practices, public health, and community health organizations.• Each winner has successfully achieved value from electronic health records to improve healthcare delivery. 10
  • 11. Update from HIMSS for 2012 Davies• Case-study format rather than ‘your story’ – You get to pick area where you excel• Two categories = two committees – Enterprise (5 case studies) – Ambulatory: Enterprise-owned, physician-owned, community health organizations, and public health (4 case studies)• Rolling application, anytime throughout year• Virtual and some on-site visits by HIMSS Committee• www.himss.org/davies/ 11
  • 12. Practice Metrics Year of Implementation Davies Winner Year Number of Physicians/Mid- “Practices levels Number of Others Number of Sites like me?” Method of Paying for Initial Costs Go-live Team old roles OB/Gyn, Rheumatology, Go-live Approach Family Practice, Orthopaedics Go-live Schedule/Patient Flow PlanningFull Davies Applications at: Expanded Services: tests,http://himss.org/davies/pastRecipients_ambulatory.asp subspecialty Technical interaction with PMS Two winners from Colorado (2006- System Alpenglow, 2010 Miramont) PMS from same or different vendor Personal or Practice Standards 12 Form-factor for EHR use
  • 13. Virginia Women’s Center VA Womens Practice Metrics Year of Implementation 2005 Davies Winner Year 2009 Number of Physicians/Mid- levels 37 Number of Others 161 Number of Sites 5 Method of Paying for Initial Costs Loan/7 yrs Go-live Team old roles MD, MA, Operations Go-live Approach Module or two at a time Month 1 at 50%, Mo. 2 at Go-live Schedule/Patient Flow 66%, Mo. 3 at 100% pre- Planning EHR volume. Expanded Services: tests, Research, US, Mammo, subspecialty Nutrition, Psych Technical interaction with PMS System Bidirectional PMS from same or different vendor Same vendor Practice standard, Personal or Practice Standards customized 13 Form-factor for EHR use Notebook, wireless, stylus, cell cards
  • 14. Oklahoma Arthritis Center OK Arthritis Practice Metrics Year of Implementation 2006 Davies Winner Year 2008 Number of Physicians/Mid- levels 5 Number of Others 26 Number of Sites 1 Method of Paying for Initial Costs Self-funded MD, OffMgr, RN, Part-time Go-live Team old roles IT Go-live Approach Module or two at a time Go-live Schedule/Patient Flow Two months of reduced Planning schedule Expanded Services: tests, Infusion, Radiology, subspecialty Clinical Lab Technical interaction with PMS One-way to EHR. Tickets System used. PMS from same or different vendor Same vendor Practice standard, Personal or Practice Standards customized 14 Form-factor for EHR use Convertible notebook, wireless, stylus
  • 15. Village Health Partners Village Health Practice Metrics Partners, TX Year of Implementation 2003 Davies Winner Year 2007 Number of Physicians/Mid- levels 3 Number of Others 7 Number of Sites 1 Method of Paying for Initial Costs Loan/4 yrs Go-live Team old roles MD plus ALL Big Bang (100% of users Go-live Approach and visits) Picked a light month, no Go-live Schedule/Patient Flow FU appts allowed, 6 weeks Planning back to 100% Expanded Services: tests, subspecialty Traditional Family Practice Technical interaction with PMS System Bidirectional PMS from same or different vendor Same vendor Practice standard, minimal Personal or Practice Standards customization 15 Form-factor for EHR use Thick client (PCs), monitor
  • 16. Sports Medicine & Orthopedics of Birmingham Sports Medicine & Practice Metrics Ortho, AL Year of Implementation 2003 Davies Winner Year 2005 Number of Physicians/Mid- levels 4 Number of Others 15 Number of Sites 1 Method of Paying for Initial Costs Loan/60 mos low interest Go-live Team old roles MD, RN Big Bang (100% of users Go-live Approach and visits) Go-live Schedule/Patient Flow 2 weeks at 50%, back to Planning 100% at 6 weeks Expanded Services: tests, subspecialty Digital X-ray Technical interaction with PMS System Bidirectional PMS from same or different vendor Different vendor Personal or Practice Standards Personal Notebook docked outside 16 Form-factor for EHR use exam rooms - unreliable wireless.
  • 17. Village Sports Common Threads for "why did VA OK Health medicine Womens Arthritis Partners, & Ortho, you do it?" TX AL If NOT for Access in office, remote, everywhere“meaningful Quality of Documentation, organization, completeness, defensibility use”, then MU Information Exchange outside the practice WHY? Patient Safety, including care management, deliquencies MU Monitoring of in-house adherence to clinical guidelines and metrics Reduce costs or be more efficient with staff, transcription, supplies, space Forward-thinking planning MU Point of Care clinical support and planning Customer service and communication (patient and/or referral sources) 17 Practice and individual user "happiness quotient"
  • 18. Degree of success, based Common Threads for "why did VA OK Village Health Sports Medicine on “why”: you do it?" Womens Arthritis Partners, TX & Ortho, AL Access in office, remote, everywhereNailed Quality of Documentation, organization, completeness, defensibility it! Information Exchange outside the practice Patient Safety, including care management, Not deliquencies Monitoring of in-house adherence to clinicalquite! guidelines and metrics Reduce costs or be more efficient with staff, transcription, supplies, space Forward-thinking planning Point of Care clinical support and planning Customer service and communication (patient and/or referral sources) 18 Practice and individual user "happiness quotient"
  • 19. Talking Points• The EHR world ‘before and without ARRA’ – What’s different – What’s the same• Highlights from Davies Ambulatory winners – Practices ‘like yours’ – Common reasons to adopt – Degrees of success• Some insights and reflections 19
  • 20. 23 HIMSS Winners and Incentive $$$ ?• Family Practice/Internal Medicine = 7, YES• Multi-specialty = 3, YES• Cardiology = 2, YES• Ortho/Sports Medicine = 1, NO• OB/Gyn = 3, (1 Y, 2 N)• Peds = 5, NO• Rheumatology = 1, YES• Diabetes = 1, NO 20
  • 21. On the ‘lighter’ side, from these winners:• EHR implementation is a commitment to a process, not necessarily to perfection (Craig Carson MD, OK Arthritis)• It was difficult to accept failure and financial burden of the unused technology. Knowing when to quit was a challenge. (Kay Stout MD, VA Women’s)• I was finishing my MBA in May, 2003. My wife was expecting our first child a few months later in September. Everything had to be done in-between. (Chris Crow MD, Village Partners, TX)• In spite of recommendations from others, the Managing Physician refused to reduce the schedule. The number of patients scheduled at implementation was not adjusted significantly. This would later be a decision that we regretted. (Sam Goldstein MD, Sports Med & Ortho, AL) 21
  • 22. And Some Questions for Your Practice:• What are your ‘right’ reasons and how will you know?• It’s too expensive to change your mind, so are you prepared for a long- term arrangement?• How well do you (and your practice) handle course corrections? 22
  • 23. In spite of incentives, you must find YOUR “right reason” 23
  • 24. Talking Points• The EHR world ‘before and without ARRA’ – What’s different – What’s the same• Highlights from Davies Ambulatory winners – Practices ‘like yours’ – Common reasons to adopt – Degrees of success• Some insights and reflections• Discussion 24
  • 25. Discussion?  Barbara Drury  Pricare Inc. bdrury28@earthlink.net  303-681-3117 25
  • 26. Please fill out your evaluations on this talk and leavethe completed form in the box next to the doorbefore you leave today.Please send any questions or comments to:Email address of authorThank You! THANK YOU! 26

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