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Title: EMR - The Time is Now: Physician Alignment through IT


1
EMR - The Time is NowPhysician Alignment
through IT
Richard Eshbach Bill Moran
  • Panel Discussion

2
The Presidents Bold Vision for HIT
3

EMR and our Connected Care Community
  • What is our Definition of an Electronic Medical
    Record
  • WHS and MSHA Current/Future State of the EMR
  • In-Patient
  • Out-Patient
  • Stark Safe Harbors
  • Regional Out-reach Programs/Opportunities

4
Definition of an EMR
  • CPR

EMR
Are we all speaking the same language..?
EHR
PHR
5
Components of a Patient Record
Scanned Images of Documents
History Physical
Physician Notes
Demographic Information
Care Giver Notes
Prior Encounters
Pharmacy
Cardiology/Pulmonary
Discharge Summary
Laboratory
Boxed Components are Unstructured Information
Radiology
6
EMR Adoption Model Q2 2008
5
7
Hospital involvement in community EMR Deployments
Hospitals will represent 38 of all EMR purchases
up from 11 in 2007 AC Group, Feb 2008
8
Electronic Medical Record Industry Only 22 of
Hospitals across the country have successfully
deployed an EMR
9
EMR Scores by Comparison
EMR Scores by Bed Size
EMR Scores by State
2008 Mean Median n
0-100 beds 1.5413 2.0150 2,487
101-200 beds 2.3996 2.2380 996
201-300 beds 2.6460 3.0710 629
301-400 beds 2.7443 3.1240 406
401-500 beds 2.8539 3.1470 209
501-600 beds 3.0859 3.2475 140
600 beds 3.1114 3.2440 181
State Mean Median n
Alabama 2.0785 2.1980 98
Georgia 2.2465 2.2250 152
Kentucky 2.1391 2.1460 105
North Carolina 2.5061 2.3190 117
South Carolina 2.3467 2.2620 66
Tennessee 2.3367 2.2100 137
Virginia 2.6719 3.1390 83
West Virginia 1.9575 2.0995 50
10
How will we get there?
Who will take the lead?
11
Electronic Medical Record
12
MSHA EMR Strategies
  • Inpatient / Outpatient EMR
  • In 2003, strategic EMR initiative launched to
    build upon a new integrated technology solution
    powered by a workflow engine
  • 40 million committed by MSHA Board for a
    multi-year implementation
  • Physician Office EMR
  • Implemented Misys EMR in practices in 2005 and
    now offering as an MSO hosted service to
    non-employed physician practices
  • Regional Integration
  • Varying levels of integration with physician
    practice EMRs depending on their status of EMR
    adoption
  • Exploiting CCHIT compliant inter-operability
    tools
  • Collaboration in regional connectivity
    initiatives such as CareSpark RHIO

10/20/2013
12
13
Computerized Patient Record JourneyPhases I-III
Increasing Value On Journey to Patient Safety,
Quality and Efficiency
2009-11
2009-10
Bar Coding - MAK
Live
2008-09
Interdisciplinary Charting
6 months
ED
Rad Upg
PACs
gt6 months
2007
Pharmacy
Cardiology
Orders
eHIM
Network
Monitors
Clinical Access
Wireless
Single Sign On
Hardware
14
MSHA In/Out-Patient Approach
  • Mountain States EMR consist of the following (We
    are 75 deployed)
  • An electronic Clinical Data Repository - v
    Completed (Soarian Clinical Access)
  • Contains 8 years of detailed clinical data
  • An electronic Order Management System - v
    Underway (New Soarian Orders)
  • A Picture Archival Communication (PACs) System
    which allows the capture of medical images
  • v Completed (GE Radiology PACs and Siemens
    Cardiology PACs (echos, caths, nuclear studies)
  • An electronic flow sheets of vitals and I/O - v
    Completed (Soarian Critical Care and MegaCare)
  • An electronic Pharmacy System - v Completed
    (Soarian Pharmacy)
  • An electronic Radiology System - v Completed
    (Siemens Radiology)
  • An electronic Transcription System - v Completed
    (Dolby with Voice Recognition)
  • An electronic Laboratory System - v Completed
    (Cerner Classic, replaced w/ SoftLab)
  • An electronic Nursing/Ancillary documentation
    System - v Completed (Soarian Clinical Team)
  • An electronic Paper Medical Record - v Completed
    (Soarian HIM)
  • eHIM helps you fill gaps in areas throughout your
    hospitals, where you do not have electronic
    functionality by scanning, storing and retrieving
    the paper medical record. Also allows on-line
    abstraction, coding and completion management and
    signature by physicians from any location.
  • electronic workflow engine is listening to any
    care event or condition and can be automatically
    triggered to pro-actively monitor, notify and
    escalate steps in the care process across all
    caregivers.
  • Hardwired process workflows minimize lag-time
    between care handoffs and eliminate dropping the
    ball!

10/20/2013
14
15
MSHA In/Out Patient Approach
  • Whats Next..
  • In order to have a Completed Electronic Medical
    Record, these components are scheduled for
    implementation
  • Nursing Plans of Care
  • CPOE/ Physician Orders
  • Physician Progress Notes
  • Continued/Enhanced Integration to Physician
    Office EMRs
  • Deployment of Home Health Clinical Documentation
  • On-going enhancement of workflows as more
    clinical information is available and more
    clinicians are on-line

10/20/2013
15
16
Timeframe for Implementation
Foundation Systems
Clinical Repository Monitors Wireless Single-sign-
on
Replace Ancillaries
  • Pharmacy
  • MAK
  • eHIM
  • Dictation
  • ED
  • PACs
  • Rad
  • EKG
  • Cardio

Orders and Documentation
Plans of Care
Orders Alerts Workflows Vital Signs Assessments Do
cumentation Forms
Physician Order Entry
Clinical Decision Support
2004-05 2006 2007 2008 2009 2010 2011-12
17
MSHA Ambulatory Approach
  • Physician Office EMR
  • Over a decade of utilizing the Misys office
    management system in all physician practices and
    providing as contracted MSO service
  • Implemented Misys EMR in practices in 2005 and
    now offering as a service to private physician
    practices (under Stark Safe Harbor guidelines)

18
MSHA Connectivity Approach
  • Regional Integration
  • Varying levels of integration with physician
    practice EMRs depending on their status of EMR
    adoption
  • Exploiting CCHIT compliant inter-operability
    tools
  • Collaboration in regional connectivity
    initiatives such as CareSpark RHIO

19
Electronic Medical Record
20
EMR Approach
  • Understanding how WHS EMR Strategies
  • In-Patient EMR (76 completed)
  • Our In-patient EMR consists of several software
    applications that make up the chemistry of a
    EMR. 
  • Out Patient EMR
  • Our Out reach (out-patient) EMR currently
    consists of a purchased package AllScripts
    product 
  • Ancillary Strategies around EMRs
  • Complexity surrounding multiple EMR strategies
    allows us to take advantage of true
    interoperability through Relay Health.

21
WHS EMR Strategies
  • Inpatient / Outpatient EMR
  • 99.2 of Positive adoption through our
    WHS/Physician Portal our connectivity tool for
    our Physicians.
  • Over 1,000 Physician Population
  • Our Physician voice is critical in shaping our
    outcomes.
  • Physicians decide how our electronic medical
    record is defined through Physician Technology
    Committees.
  • Board initiative to commit information technology
    and the exchange of health record exchange for
    the improvement of patient care within our
    community.
  • Physician Office EMR
  • Today we have over 60 physician clinics/offices
    affiliated with Wellmont. We currently
    Implemented Misys practice management EMR, and
    currently have installed AllScripts as our out
    patient clinical EMR solution.
  • Regional Integration
  • Continued education and participation in sharing
    health exchange information to every
    town/city/and region within our community
  • Regional Quarterly IT collaboration initiatives
  • Hosting service, regional/industry benchmarking,
    best practices
  • Establishing a Chime/HIMSS chapter within our
    Region

10/20/2013
21
22
Navigating through the technology
Nobody said it would be easy
23
EMR evolution.
Phase 5 EMR
In Patient - EMR
Phase 4 Physician Office, CPOE
Phase 4 Horizon Lab, Anesthesia, ER
Phase 3 Nursing Doc (HED), AdminRx (barcoding)
Phase 2 LAB (Cerner), Pharmacy (HMM), Cardiology
Phase 1 PACS (AGFA), RIS (STAR), OR (HSM),
Transcription/Dictatn.
24
EMR In Patient Approach
  • Wellmonts EMR consist of the following (We are
    76 deployed)
  • An electronic Order Management System - v
    Completed (STAR HOM/Orders)
  • An Picture Archival Communication (PACs) System
    which allows the capture of medical images v
    Completed (PACs)
  • An electronic Pharmacy System - v Completed (HMM)
  • An electronic Radiology System - v Completed
    (Star RIS)
  • An electronic Transcription System - v Completed
    (Cquence, Star/HPF, Lanier)
  • An electronic Laboratory System - v Completed
    (Cerner Classic)
  • An electronic Nursing documentation System - v
    Completed (HED)
  • An electronic Horizon Patient Folder Application
    - v Completed (HPF)
  • HPF helps you fill gaps in areas throughout your
    hospitals, where you do not have electronic
    functionality. This application allow scanned
    documents and having them back available in
    REAL-TIME electronically.

25
WHS EMR Whats Next
  • In order to have a Completed Electronic Medical
    Record, these components are scheduled for
    implementation
  • CPOE/Orders
  • Physician Notes
  • Integration to Physician Office EMRs and
    Clinician Care Plans
  • Cardiology products have to be fully integrated
    (90 done)
  • Emergency Departments need to be fully integrated
  • Anesthesia needs to be fully integrated

10/20/2013
25
26
Ambulatory Strategy and Solution Update
Ambulatory Strategy
27
Traditional Methods of Delivering Test
Results/Transcriptions
Fax or Mail
Manual Process and Costly Not Actionable
Portal
Passive Notification Requires Provider to
Search for Result Not Actionable
Point to Point Interfaces
HL7 Interfaces
IT Overhead- Costly to Maintain Not Actionable
28
Interoperability through RelayHealth
  • RelayHealth provides an intelligent network that
    enables constituents across healthcare to connect
    interactively, share information, and collaborate
    to improve the quality and efficiency of care.
  • Improves clinical communication,
  • Enhances business performance
  • Facilitates the delivery of high-quality care

29
Connectivity Through the RelayHealth Network
RelayHealth Connectivity
Physician-Hospital- Pharmacy-Patient Clinical
Interaction
Physician-Patient AdminInteraction
Physician-Retail RxConnectivity
Hospital-PhysicianConnectivity
Physician-to-PhysicianNetworking
  • Emergency Dept connectivity
  • Care mgmt
  • Results distribution
  • Electronic prescriptions
  • Renewals
  • Appointment scheduling
  • Billing questions and online payments
  • Test results
  • webVisit consultations
  • Rx renewals
  • Personal health records
  • Referrals
  • Patient care collaboration

30
Connected and Actionable Network
Patient
Specialist
Bi-directional Communication
HL7
RH Network
Primary Care
Patient
31
Physician Practice EMR Adoption
10/20/2013
31
32
Congress Passes Medicare Bill with e-Prescribing
Incentives (July 15, 2008)
  • Medicare physicians who use e-prescribing
    technology will be eligible for incentive
    payments
  • 2 in fiscal year 2009 and 2010
  • 1 in 2011 and 2012
  • 0.5 in 2013
  • Physicians participating in Medicare who do not
    e-prescribe
  • 1 payment cut in 2012
  • 1.5 payment cut in 2013
  • 2 in subsequent years
  • Provision exempts physicians who infrequently use
    prescriptions

33
Stark Safe Harbors Rules of Engagement
10/20/2013
33
34
Stark Long-awaited Regulatory Relief
  • On August 8, 2006, the U.S. Department of Health
    and Human Services (HHS) published the final
    rules regarding provisions in the Medicare
    Modernization Act.
  • Facilitate the distribution and adoption of HIT
    related to electronic prescribing and electronic
    health records (EHRs)
  • Rules address ambiguity in current prohibitions
    to physician self-referral (known as the Stark
    laws) and anti-kickback statutes

35
Overview of the Regulations
  • Permitted technology
  • Minimum technology standards
  • Permitted donors
  • Permitted recipients
  • Payment obligations
  • Technology not duplicative
  • Documentation

36
Regional Out-reach Programs/Opportunities
10/20/2013
36
37
Regional Out-Reach Programs/Opportunities
Hospital
Patient
Connected Community
Physicians
Payor
Financial Institution
Pharmacy
38
Hospital involvement in community EMR Deployments
hospital organizations are trying to figure out
how they are going to propel EMR solutions to
community physicians Jared Peterson, VP,
ResearchKLAS, June 2008, when asked about the
biggest EMR trends in the next few years
39
Regional Connectivity Initiatives Gaining Momentum
  • Integration with existing physician EMRs at
    various levels
  • Encouraging the adoption by physician practices
  • Offering EMR hosting (within SSH guidelines)
  • Adoption of CCHIT standards and exchange
    technologies
  • Charter involvement in CareSpark (RHIO)
    initiative

10/20/2013
39
40
  • QUESTIONS ?
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