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EMR Presentation - The Time is Now
- 1. EMR – The Time is NOW… Right? Presented by: Scott Benson 704.501.6039 scott.benson@clinicalds.org
- 2. Objectives • Provide you with an overview of EMR market trends and direction • Offer you guidelines for evaluating an EMR solution • Review the current incentive packages – PQRI (P4P) – E-prescribing – “Stimulus”
- 3. EMR – Trends and Market Direction
- 4. Large & Troubled . . . Our U.S. Healthcare Scorecard $2.2 Trillion Spent in Healthcare $700 Billion in Waste 98,000 Deaths from Medical Errors 1.5 Million Injuries 7,000 Deaths from Medication Errors
- 5. A Big Part of the Problem
- 6. Market Adoption Source: CDC, 2006* Practices by Number of Providers 1-5 213,327 6 - 10 19,680 11 -… 6,282 20 + 2,683 0 50,000 100,000 150,000 200,000 250,000 Source: SK&A *Hing ES, Burt CW, Woodwell DA. Electronic medical record use by office-based physicians and their practices: United States, 2006. Advance data from vital and health statistics; no 393. Hyattsville, Maryland: National Center for Health Statistics. 2007.
- 7. Before you Buy… “Choosing an EMR is a career-defining decision,” -Sue Hertlein, Senior Consultant - The Coker Group
- 8. 10 Things to Consider • Take ownership of the decision. • Determine your own requirements • Get the right EMR for your specialty • Integrate practice management • Focus on ease-of-use • Assess support and upgrades • Consider vendor viability • Be smart about your budget • Consider your deployment strategy • Don’t forget the technology
- 9. Return on Investment • The return you get from the system – # of chart pulls a day (including those that call in) – Transcription (20-100%) – Refill requests (15 min per) – Under coding (3-15%) • The return you get from the Stimulus – PQRI – E-prescribing – “Stimulus”
- 10. EMR – Stimulus – What It Means to You
- 11. “It's an investment that will take the long overdue step of computerizing America's medical records, to reduce the duplication and waste that costs billions of healthcare dollars and medical errors that cost thousands of lives each year. ... We have done more in 30 days to advance the cause of healthcare reform than this country has done in an entire decade.“ -President Barack Obama February 17, 2009
- 12. An Overview • The Bill aims to accomplish four major goals: – Health information technology infrastructure with interoperability in place – Standards building upon CCHIT by 2010 – Saving the government $12 billion – Strengthening Federal privacy and security law • Congressional Budget Office estimates that 90% of doctors and 70% of hospitals using comprehensive EHR by 2020
- 13. A Closer Look • The American Recovery and Reinvestment Bill signed • $790 billion • Approximately $59 billion within the Bill is allocated towards the improvement of healthcare in some form – Health IT – Training for more primary care physicians – Research on chronic diseases – Community Health Centers – “Comparative Effectiveness” research • The Health Information Technology for Economic and Clinical Health Act (‘‘HITECH“) includes $19 billion for health information technology
- 14. What is in the $19 Billion?! $17 billion Physician Incentives Incentive Bonuses from Medicare/Medicaid + $2 billion HHS Discretionary Funds (For Use = $19 billion By National Coordinator of Health IT) Standards Development, Grants (AHRQ, HRSA, CMS), HIE Infrastructure, Loans to the States for HHS = Health and Human Services EHR, Regional HIT Resource AHRQ = Agency for Healthcare Research and Quality Centers, Telemedicine, New Community HRSA = Health Resources and Services Administration CMS = Centers for Medicare and Health Centers Medicaid Services
- 15. Understanding The Federal Incentives If you start now… EHR PQRI ePrescribe + + Stimulus Incentive Incentive Funding $44,000 over $3,000-5,000/yr. $3,000-5,000/yr. 5 yrs. estimate estimate PQRI = Physician Quality Reporting Initiative
- 16. Watch Your Timeline! • Funding is Front Loaded – $30,000 (close to 70% of the funding) comes in the first two years. – It decreases significantly every year thereafter. • You Need to Demonstrate Meaningful Utilization – Purchase and Implementation are not enough. You must use it. – Steps include: evaluate your workflows, develop your selection criteria, select a vendor, develop your implementation plan, install your EHR, connect to other providers and have your MDs fully functional. – A lot to do in a short period of time. • Funding is Time Stamped – Funding starts in 2011, decreases over time and goes away after 2016. – Penalties begin in 2015.
- 17. Summary • Provide you with an overview of EMR market trends and direction • Offer you guidelines for evaluating an EMR solution • Review the current incentive packages – PQRI (P4P) – E-prescribing – “Stimulus”
- 18. Other Resources • www.mgma.com/economy • http://www.himss.org/EconomicStimulus/ • http://www.cms.hhs.gov/EPrescribing • www.recovery.gov
Editor's Notes
- Automating your office’s workflow with an EMR can deliver enormous benefits, eliminating repetitive tasks, streamlining billing, and freeing more physician time to focus on patient-centered care. But it’s also a major undertaking for which practices — and the administrator in charge — must prepare with research, staff involvement, and a strong commitment to making it workTake ownership of the decision. Your EMR software will impact how you practice medicine, so this is not a process that should be delegated to back-office staff or the local “computer guy.” While your staff should play a key role in selection, this process demands medical expertise and leadership that only the physician can provide. What if your computer guy selected a system based on an underlying database he liked, but failed to recognize that the system forces you into rigid workflows that change how you interact with your patients? Take ownership of the selection process to avoid buying the wrong EMR! Determine your own requirements. Too many physicians let software salesmen drive the selection process. Only you know how you should practice medicine. Therefore, it’s critical to map out your ideal workflow and how you interact with office staff to complete a patient visit. Do you want to limit the system to electronic charting, or do you want and end-to-end solution that extends all the way to claim management? At the same time, realize that your interactions with software vendors are good opportunities to learn new best practices and workflows that could improve the way you work. Based on your initial requirements and those that arise during the selection process, build a comprehensive list of features and then prioritize them based on what will provide the most value to your practice. Realize that you can phase in new modules over time. Structured data entry. Structured data entry (also called discrete data entry) allows the EMR to manage and retrieve information by forcing the user to document key components of an encounter -- from the history and physical through the diagnosis and treatment plan -- by choosing descriptors from preset lists. Clinicians who feel strongly about maintaining their own documentation style may feel constricted by this process. However, the more they deviate from the structure, the more difficult it is to capture and reliably analyze clinical performance. Choosing an EMR that allows you to customize the lists of clinical descriptors will help ease the transition to structured data entryGet the right EMR for your specialty. Most EMR products are designed to serve a wide range of medical practices while others are designed for specialties. There are benefits and drawbacks to each approach. The narrow focus of a specialty EMR vendor allows them to design their systems around the unique needs of physicians within their target market. For example, an OB/GYN EMR would have special screens designed for ante partum visits. This results in a more familiar workflow for the specialist and less customization of the software. At the same time, specialty vendors may be challenged to generate enough revenue enough to support the wide range of ongoing development required by client demand, government mandates and device integration. Large, broadly-focused vendors may have more resources and broader reach, but may not offer specialty features and workflows. Integrate practice management. In addition to EMR functionality, consider how you want your system to support medical billing, patient scheduling and practice management. Do you want all of these functions in one complete suite, or should your EMR interface with existing systems? There are advantages to managing clinical and practice management functions in a single system. For example, an integrated coding engine can help physicians to develop more accurate claims during the encounter, reducing the need to “down code” or have staff scrub the claim later. Meanwhile, health alerts made available during scheduling ensure a higher quality of care and patient compliance. On the other hand, many practices have already made significant investments in their existing practice management systems or third party billing services. Simple integration may suffice. Focus on ease-of-use. Medicine is complex enough without software making things more difficult. Therefore, it’s critical to find a system that makes each encounter easier, not harder. The system must be highly intuitive and easy-to-use. The simplest way to evaluate ease-of-use is to use a demo copy yourself. Try to manage a common process such as documenting a frequent diagnosis. Did you figure it out right away? These days, the right software should make it easy. Features that can augment ease-of use include on-line help functions, tablet or stylus interfaces and voice recognition. Ease-of-use will be especially important when staff turns over and you need a new employee up-to-speed quickly. Assess support and upgrades. You’ll need them. Leading vendors provide support 24 hours a day / 7 days a week. You’ll most certainly want weekend support if you work like most physicians, and you might want nighttime support too, even if only while reviewing records. Consider also how that support is delivered. Are you up for talking to foreign call center staff? Do you want help on-site? And remember, when it comes to software, support isn’t just technical assistance; support often includes access to new features, bug fixes and major upgrades. Assess the vendor’s track record in delivering consistently high quality new releases of their software. After all, you’ll likely pay for them annually. Consider vendor viability. An EMR isn’t all you’re buying. You’re also entering into a long-term software vendor relationship. It’s critical to assess the software company’s viability - not just if they survive, but how… Sure, healthy margins in the software business keep most established vendors afloat, but what about the vendor’s “strategic viability” in a market that is poised for dramatic consolidation? Can and will they invest in new development? Will they continue to meet regulatory requirements and support new standards? Will they sell out to a larger company that soon thereafter “sunsets” their product? All of these situations could have big implications for you. Make sure you assess the vendor’s reputation, financial well-being and their vision for the future. Be smart about your budget. With EMR prices ranging from $1,000 to $100,000, you can quickly narrow down your software search based on price. However, this approach will more than likely limit your ability to find the right system. While software does not have to be expensive to be good, never buy on price alone. The more sophisticated buyer will consider the value of the system (as measured by return on investment), rather than thinking in absolute dollars. More expensive systems typically meet the latest standards (e.g. CCHIT), offer more sophisticated features and integrate with third party devices such as heart monitors and imaging systems. They may also include very sophisticated decision support protocols to standardize care across large groups or delivery networks. Consider your deployment strategy. With faster Internet connections and new technologies, it’s now possible to access your medical records entirely over the web. These software as a service (SaaS) or Application Service Provider (ASP) options lower up-front costs, simplify maintenance and provide the ease-of-use of a web application. SaaS vendors have invested heavily in security, HIPPA compliance and data redundancy to provide a highly secure EMR platform. At the same time, a SaaS system requires a consistent, high-speed Internet connection. If the connection is slow, the practice will be less efficient. If the connection goes down, so too will the ability to access patient records. Think hard about the tradeoffs between a SaaS solutions and the more traditional path of installing and maintaining your own IT infrastructure. There are tradeoffs either way. Don’t forget the technology. We put this last for a reason. We do not think that development languages and databases should drive a software selection process in health care or any other industry. Instead, we advocate that you assess underlying technology from a defensive standpoint. For example, reimbursement procedures and regulatory requirements change often. So a system must be built on technology that is flexible and enables the vendor to release frequent, quality updates. It is also important to assess the support requirements of systems with questionable “architecture.” Acquired and interfaced solutions may require redundant databases, while preventing seamless integration. Avoid purchasing an EMR with exceedingly rigid or soon-to-be-obsolete technology.