An electronic health record (EHR) is a digital record of health information

1. EHR—Electronic Health Records
Why Should I Be Worried?

2. EHR—What Should I Know?
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What is the most important point?
 None of the EHR vendors currently meet the Federal
requirements for an EHR because one of the primary
requirements is an EHR must be interoperable with other
EHRs.
 Do you have specialists who can tell you what to do?

3. EHR—What Should I Know?
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What is the elephant in the room?

 Non-interoperable EHRs will further impede access by creating
proprietary information silos
To be of any value, EMRs must be interoperable & interconnected to
EHRs, both ambulatory and clinical
 EHRs must be interoperable & interconnected
 Without a web of EHRs, there are no Regional Health Information
Organizations (RHIOs)
 The RHIOs all have different architectures
 Without RHIOs there is no National Health Information Network (NHIN)

4. EHR—What Should I Know?
What is the Network Effect of Networked EHRs?
The network of EHRs could act as a value multiplier. Without a network
the value multiplier is zero.
 One EHR is worth nothing
 Two EHRs connected to each other are worth something
 A network of EHRs is very valuable.
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5. EHR—What Should I Know?
What is the elephant in the room?
 What does this mean—EHRs must be interoperable &
interconnected?
– Know before you buy—what connects to what?
– If EHRs aren’t connected, doctors will need electronic and paper files
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6. EHR—Exponential Problems
What must be connected? An N x M connection
must work for:
 Hospitals connecting to:
– Doctors
– Hospitals
– RHIOs
– Labs
– Pharmacies
– Imaging
– Electronic Health Records (1 x N)
 EHR to EHR
– Continuity of Care Record (CCR)
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7. EHR—Fail Safe Points
What are the EHR Fail Safe Points (FSPs)?
 EHR is healthcare’s Y2K time bomb.
 There a is concurrent national rollout of EHR; standards not
available until 2010.
 The costs are very high, so are the penalties
 1/3rd to 2/3rd of EHRs implemented have failed
 There may not be time to earn the incentives
 Nobody knows which applications will qualify for certification
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8. EHR—Fail Safe Points
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What are the other EHR FSPs?
 There aren’t nearly enough resources to do the work
– EHR vendors can’t staff for a national rollout
– Healthcare IT resources to support providers are 50% below the number
required
 Healthcare providers in-house IT department has:
– No experience with EHR
– Never built one
– Never bought one
– Never installed one

9. EHR—Ambulatory Practices
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I think it is advantageous for them to wait. Within 12-18
months they will likely have the opportunity to acquire a
plug-and-play EHR in-house or SaaS.
 Project management
 Selection
 Implementation
 Adapting workflows
 Training
 Support

10. Electronic Health Record (EHR)
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The need for change is real and mandated
In the US there are more than 20,000 healthcare transactions each minute.
In Canada, in the absence of a comprehensive EHR system, for every 1,000:
 Hospital admissions, 75 people will suffer an adverse drug event;
 Patients with an ambulatory encounter, 20 will suffer a serious drug
event;
 Laboratory tests performed, up to 150 will be unnecessary;
 Emergency room visits, 320 patients will have an information gap,
resulting in an average increased stay of 1.2 hours.

11. EHR is Wide Open
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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 (i.e., present in all clinical units),
 7.6% have a basic system (i.e., present in at least one clinicalunit).
 Computerized provider-order entry for medications has been
implemented in only 17% of hospitals.
 Respondents cited capital and maintenance
costs as the primarybarriers to implementation

12. EHR—Meaningful Use?
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From HHS: Must Zoom to read

13. EHR—Snail Paced Adoption
NEJM
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14. EHR Barriers—Magnitude of staffing
barrier is grossly underestimated
Barriers to Electronic-Records Adoption (NEMJ)
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15. EHR Facilitators—will not have the desired
impact
Facilitators of Electronic-Records Adoption (NEMJ)
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16. EHR Costs—to pass the interoperability
test are understated
The Cost of Change
Canada budgeted US $450 per person to implement EHR.
The US stimulus package allocates $20 billion for EHR, roughly US $60 per
individual. How large is the shortfall, and what or who will make up the
difference?
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17. EHR—if it doesn’t connect, it doesn’t work
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Just because EHR’s have been implemented,
doesn’t mean they’re of any value.
“I've witnessed more serious errors with the EHR than in my previous 25 years as a
physician. These are the errors in thinking and decision making: cases where the
physician was so distracted by the order tree that she forgot an important order;
cases where the fragmented, disordered thinking was imposed by the EHR.”
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 EHRs don’t operate beyond the walls of the building in which they
were implemented.

18. EHR—if this was reality TV, there’d be no
winners
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Foundational Elements of National EHR:
 Completing the baseline EHR info-structure for 100 percent of the
population
 Seamless communication across the continuum of care and into
community based settings. (The availability of electronic medical records,
for example, would integrate primary care physicians and specialists into
community care facilities)
 Extending order entry functionality and other decision-support elements
in acute care settings to support delivery of high quality care
 Empowering patients to manage their own care by creating patient
portals with self-care tools and basic personal health information

19. System Enablers of EHR
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The final components of EHR are the system enablers which leverage the
benefits of the investment:
 Redesigning the key business processes, along with change management
efforts, education and training
 Establishing common data, integration, and communication standards
 Applying appropriate legislative frameworks for privacy and patient
consent
EHR Enablers—who’s watching the
business processes?

20. EHR Readiness Methodology
Clinton Rubin’s
EHR
Readiness
Methodology
has a 6 phase
scorecard.

21. EHR Funding-show me the money
Clinton Rubin works with healthcare providers to successfully
navigate the federal EHR funding landscape regarding
maximizing incentives& grants and minimizing the penalties.
We have a number of former federal executives who work with
you to help your firm be approved for the “rebates” and to
avoid the “penalties”.

22. Enterprise Readiness Assessment
The Enterprise Readiness Assessment identifies gaps in:
 Change Management Readiness
 Technology Readiness
 Risk Management
 Standards Readiness

23. EHR Implementation Playbook
The Implementation Playbook defines a program or set of
projects the enterprise needs to execute in order to implement
EHR. Potential projects may include:
 Requirements
 SW selection
 Change Management
 Integration
 Policy, Procedure or Process
 Training

24. Enterprise Risk Assessment
The Enterprise Risk Assessment identifies potential
fatal EHR implementation risks:
 Interoperability
 Meaningful Use
 Certifiability

25. EHR Cost Benefit/Funding Analysis
The Cost Benefit Analysis identifies:
 The cost of implementation and the level of
funding necessary to successfully implement
EHR
 Funding sources such as grants or federal
government loans
 The short term costs and the long term
benefits
 ROI development and monitoring

26. EHR Implementation Management
Implementation Management oversees projects to
successfully implement each EHR project managing:
 Project task management
 Budget, Schedule, & ROI
 Issues tracking and resolution
 Staffing and skill requirements
 Project accountability and visibility

27. Healthcare Consulting
Clinton Rubin’s strengths include:
 Partners averaging 25+ years of Big 4 consulting experience
 Functional expertise that includes all aspects of healthcare consulting
 Healthcare PMO expertise
 Federal Healthcare sector expertise
www.clintonrubin.com
http://ehrstrategy.wordpress.com/
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