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CSM 2012 – HPA Tech SIG Feature Presentation	




 Electronic Health Records	
     healthcare system chicken soup or rotten egg?	

                  Daniel J. Vreeman, PT, DPT, MSc	
           Assistant Research Professor, Indiana University School of Medicine	
                       Research Scientist, Regenstrief Institute, Inc	

                    Matt Elrod, PT, DPT, MEd, NCS 	
                         Associate Director, APTA Practice Department	

                 Robert “Bob” Latz, PT, DPT, GCFP	
               Corporate Director of Technology Integration, Select Rehabilitation	

                     Steven G. Wilkinson, PT, PhD	
                           Manager, St Luke's-Elks Rehab - Meridian	
                                              	
02.11.2012	
                                                                           © 2012
Overview	
    1.        Why EHRs matter	
    2.        Selecting an EHR	
    3.        Mobile devices and other hardware	
    4.        Case study	
    5.        Implementation considerations	
    6.        Open discussion	

photo via Vernio77
We are not
    alone	
Why are we here?
The Future	
Great Scott!
Complete,
longitudinal
information that
follows the consumer
Care that is
value-based and
coordinated
across settings	

                    photos via meddygarnet and brykmantra
Health decisions made
with information tools that
assist and guide	

                   Have you
                   considered…
Results	
Fewer errors, waste, variations	
Consumer-centered care	
Lower spending
Meanwhile, back
on planet Earth…
Patients move
faster and further
than their health
information
Growing Recognition	
1960’s	
            1991	
           2003	
•  1st studies of   •  IOM says      •  HHS promotes
   computers in        EHR’s are        widespread
   healthcare	
        essential	
      use of HIT
Resolved, at the American Physical
erapy Association supports the use of
electronic health record systems (EHRs)
and promotes the widespread adoption
of interoperable EHRs in all physical
therapy practice settings.
“   e rst priority in realizing
    the bene ts of health IT is to
    achieve nationwide adoption
    of EHRs and widespread
    information exchange.
CMS EHR Incentive
    Program
 a.k.a. “Meaningful Use”
EHR “Meaningful Use”
Reimbursement incentives for
eligible providers who
become “meaningful users” of
certified EHR technology
EHR “Meaningful Use”
PTs, OTs, SLPs are
NOT eligible providers
“Meaningful Use”
drug-drug checks
structured lab results in your EHR
clinical decision support
exchange key clinical info
report on quality measures
Do PTs today
really use EHRs?	
     good question…
APTA 2010 Member Survey	

           Got EMR?	
           1%	

                             Yes, all
                     28%	
   electronic	
38%	
                        Yes, part paper,
                             part electronic	
                             No	

                  33%	
      Don't know
APTA 2010 Member Survey	

                       EMR Use	
           Fully implemented	

  Implementation in progress	

Aquired, but not implemented	

     Plan to aquire within 1yr	

     Plan to acquire but > 1yr	

          No plans to acquire	


                                   0	
   10	
   20	
   30	
   40
Most common
 complaint?	
     anecdotal
Where’s the
Rehab stuff???
3 Ways EHRs can Help
Accelerate that Vision	
Data reuse	
Decision support	
Canopy computing
Collect once. Use many.	




practice management, quality reporting,
accreditation, public health, research…
EHR Decision Support        me	

A computer-generated
suggestion about care for
an individual patient
The secret sauce of the
HIT chicken soup	



                      photo via liber
e rain forest canopy is a
  seamless web through which
  arboreal creatures efficiently
     move to reach the edible
   fruits without any attention
      to the individual trees.
McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329.	
   photo via nosha
Only way to corral the
              infinite indiosyncracies
                 is with standards.	


photo via pfarrell95
Data standards are like
telephones.

They require a critical mass of
users before they become useful.
	
              - Clem McDonald, MD 1998	



                                     photo via iboy_daniel
Indiana Network For Patient Care
     A Unified Patient Record
An EHR is a suite of
applications.

WAY more than just
electronic
documentation
8 Core EHR Functions	
   Population              Results	
                                               Orders	
     Health	




Administrative	
                               Decision
                                               Support	


       Patient support	
           Communication
Where’s the evidence?	
                    photo via paskukaru76
Evidence for Health IT	


            92% 	
           of 154 studies
1968!
“   is review suggests that EHRs have
    potential bene ts for physical therapists.
Benefits of EHRs	
12	

10	

 8	

 6	

 4	

 2	

 0	
       Improved       Improved       Improved        Improved
       Reporting	
   Operational   Communication	
 Data Accuracy	
                      Efficiency
Barriers to Implementing EHRs	
6	

5	

4	

3	

2	

1	

0	
      Behavior or         Software or         Staff Training	
       Workflow        Hardware Inadequacy	
      Modification
Success Factors in Implementing EHRs	
9	
8	
7	
6	
5	
4	
3	
2	
1	
0	
         End-user           Data         Adequate Staff   Incorporating
      Participation in Standardization	
    Training	
     Workflow
       Development	
                                        Analysis
Key Lesson
of Today	

             photo via IMLS DCC
or	

photo via Robert Couse-Baker and Nina Matthews Photography
Computer
   +       Human	
 Human
2012 02  11 EHRs - healthcare system chicken soup or rotten egg

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2012 02 11 EHRs - healthcare system chicken soup or rotten egg

  • 1. CSM 2012 – HPA Tech SIG Feature Presentation Electronic Health Records healthcare system chicken soup or rotten egg? Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Indiana University School of Medicine Research Scientist, Regenstrief Institute, Inc Matt Elrod, PT, DPT, MEd, NCS Associate Director, APTA Practice Department Robert “Bob” Latz, PT, DPT, GCFP Corporate Director of Technology Integration, Select Rehabilitation Steven G. Wilkinson, PT, PhD Manager, St Luke's-Elks Rehab - Meridian 02.11.2012 © 2012
  • 2. Overview 1.  Why EHRs matter 2.  Selecting an EHR 3.  Mobile devices and other hardware 4.  Case study 5.  Implementation considerations 6.  Open discussion photo via Vernio77
  • 3. We are not alone Why are we here?
  • 6. Care that is value-based and coordinated across settings photos via meddygarnet and brykmantra
  • 7. Health decisions made with information tools that assist and guide Have you considered…
  • 8. Results Fewer errors, waste, variations Consumer-centered care Lower spending
  • 10.
  • 11. Patients move faster and further than their health information
  • 12. Growing Recognition 1960’s 1991 2003 •  1st studies of •  IOM says •  HHS promotes computers in EHR’s are widespread healthcare essential use of HIT
  • 13. Resolved, at the American Physical erapy Association supports the use of electronic health record systems (EHRs) and promotes the widespread adoption of interoperable EHRs in all physical therapy practice settings.
  • 14.
  • 15. e rst priority in realizing the bene ts of health IT is to achieve nationwide adoption of EHRs and widespread information exchange.
  • 16. CMS EHR Incentive Program a.k.a. “Meaningful Use”
  • 17. EHR “Meaningful Use” Reimbursement incentives for eligible providers who become “meaningful users” of certified EHR technology
  • 18. EHR “Meaningful Use” PTs, OTs, SLPs are NOT eligible providers
  • 19. “Meaningful Use” drug-drug checks structured lab results in your EHR clinical decision support exchange key clinical info report on quality measures
  • 20. Do PTs today really use EHRs? good question…
  • 21. APTA 2010 Member Survey Got EMR? 1% Yes, all 28% electronic 38% Yes, part paper, part electronic No 33% Don't know
  • 22. APTA 2010 Member Survey EMR Use Fully implemented Implementation in progress Aquired, but not implemented Plan to aquire within 1yr Plan to acquire but > 1yr No plans to acquire 0 10 20 30 40
  • 25. 3 Ways EHRs can Help Accelerate that Vision Data reuse Decision support Canopy computing
  • 26. Collect once. Use many. practice management, quality reporting, accreditation, public health, research…
  • 27. EHR Decision Support me A computer-generated suggestion about care for an individual patient
  • 28. The secret sauce of the HIT chicken soup photo via liber
  • 29. e rain forest canopy is a seamless web through which arboreal creatures efficiently move to reach the edible fruits without any attention to the individual trees. McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329. photo via nosha
  • 30. Only way to corral the infinite indiosyncracies is with standards. photo via pfarrell95
  • 31. Data standards are like telephones. They require a critical mass of users before they become useful. - Clem McDonald, MD 1998 photo via iboy_daniel
  • 32. Indiana Network For Patient Care A Unified Patient Record
  • 33. An EHR is a suite of applications. WAY more than just electronic documentation
  • 34. 8 Core EHR Functions Population Results Orders Health Administrative Decision Support Patient support Communication
  • 35. Where’s the evidence? photo via paskukaru76
  • 36. Evidence for Health IT 92% of 154 studies
  • 37. 1968!
  • 38. is review suggests that EHRs have potential bene ts for physical therapists.
  • 39. Benefits of EHRs 12 10 8 6 4 2 0 Improved Improved Improved Improved Reporting Operational Communication Data Accuracy Efficiency
  • 40. Barriers to Implementing EHRs 6 5 4 3 2 1 0 Behavior or Software or Staff Training Workflow Hardware Inadequacy Modification
  • 41. Success Factors in Implementing EHRs 9 8 7 6 5 4 3 2 1 0 End-user Data Adequate Staff Incorporating Participation in Standardization Training Workflow Development Analysis
  • 42. Key Lesson of Today photo via IMLS DCC
  • 43. or photo via Robert Couse-Baker and Nina Matthews Photography
  • 44. Computer + Human Human