DRT- enabled EHRs DRT- enabled EHRs

Presented by:Presented by:Mark R. Anderson, FHIMSS, CPHIMSMark R. Anderson, FHIMSS, CPHIMS

CEO, AC GroupCEO, AC Group

Mark Anderson, FHIMSS, CPHIMSSMark Anderson, FHIMSS, CPHIMSSHealthcare IT FuturistHealthcare IT Futurist

CEO of AC GroupCEO of AC Group

– Conducted > 300 Technology Software Conducted > 300 Technology Software Searches for Hospital and Physician Searches for Hospital and Physician OrganizationsOrganizations

– National Speaker on EHR > 450 sessions since National Speaker on EHR > 450 sessions since 20002000

– Semi annual report on Vendor product Semi annual report on Vendor product functionality and company viabilityfunctionality and company viability

36+ Years In Healthcare IT36+ Years In Healthcare IT

– CIO Position at Three Multi Facility Regional CIO Position at Three Multi Facility Regional IDN’sIDN’s

– Installed over $1B in technologies since 1972Installed over $1B in technologies since 1972

– Former CIO of a 2,300+ physician (500+ Former CIO of a 2,300+ physician (500+ Practices) IPAPractices) IPA

Http://www.acgroup.orgHttp://www.acgroup.org Page No: Page No: 22

The GenesisThe Genesis

The Focus is PeopleThe Focus is People

HITECT RequirementsHITECT Requirements

In order to qualify for the incentive payments, In order to qualify for the incentive payments, both physicians and hospitals have to prove both physicians and hospitals have to prove three things: three things:

–   1. Use of a 1. Use of a certified certified EHR product with EHR product with ePrescribingePrescribing capability capability that meets current HHS standards. that meets current HHS standards.

–   2. 2. ConnectivityConnectivity to other providers to improve access to the full to other providers to improve access to the full view of a patient’s health history. view of a patient’s health history.

–   3. Ability to 3. Ability to reportreport on their use of the technology to HHS. on their use of the technology to HHS.

The second area is “meaningful use”The second area is “meaningful use”

Value of EHRsValue of EHRsEHRs save you timeEHRs save you time– EHRs have proven to save nursing and clerical time EHRs have proven to save nursing and clerical time – but it takes much longer to enter the informationbut it takes much longer to enter the information– On average – 9 times longer to enter the dataOn average – 9 times longer to enter the data

The information is readableThe information is readable– True, but the clinical note as expanded from 1 page to 5 True, but the clinical note as expanded from 1 page to 5

pages pages – The critical information is lost in the extensive detailThe critical information is lost in the extensive detail

You have more discrete dataYou have more discrete data– yes, over 700 data elementsyes, over 700 data elements– but you only use about 3% of these data elementsbut you only use about 3% of these data elements

Value of EHRsValue of EHRs

E & M coding improvesE & M coding improves– In theory, but many EHR vendors have no 3In theory, but many EHR vendors have no 3rdrd party party

validation studies.validation studies.– For many specialists, less than 20% of their actual For many specialists, less than 20% of their actual

revenues comes from the Basic E & M codesrevenues comes from the Basic E & M codes

EHRs provide orders and alertsEHRs provide orders and alerts– You can get the same results with a DRT enabled EHR.You can get the same results with a DRT enabled EHR.

EHRs reduce errors and improve Quality of CareEHRs reduce errors and improve Quality of Care– We assume this is true, but with a 4% adoption rate, We assume this is true, but with a 4% adoption rate,

the actual results are still pending.the actual results are still pending.

Why are Practices not using what Why are Practices not using what they Purchased?they Purchased?

Source: AC Group Annual Survey of buying patternsNew England Journal of Medicine

Why have EHRs Failed?Why have EHRs Failed?

Cost average over $60,000 per provider over 5 years.Cost average over $60,000 per provider over 5 years.

Data entry time increases 9 fold with an EHR.Data entry time increases 9 fold with an EHR.

Data is not shared between providers, treating the Data is not shared between providers, treating the same patient.same patient.

Training is technical, not operationalTraining is technical, not operational

Simple 1 page note now become 5 pagesSimple 1 page note now become 5 pages

More failures (73%) than successes (27%)More failures (73%) than successes (27%)

Changes the way the physician practices medicineChanges the way the physician practices medicine ..

So what the answer?So what the answer?

DRT Enabled EHRsDRT Enabled EHRs

What is DRT?

Allows the provider to use the EHR for viewing of patient clinical Allows the provider to use the EHR for viewing of patient clinical information.information.

After the physical exam, the provider dictates their note like they have After the physical exam, the provider dictates their note like they have the past 20+ years.the past 20+ years.

The dictated report is sent to a transcription service for transcription or The dictated report is sent to a transcription service for transcription or via Dragonvia Dragon

The Software takes the dictation, creates a clearly defined patient note The Software takes the dictation, creates a clearly defined patient note and then automatically populates the EHR with practice specific and then automatically populates the EHR with practice specific discrete recordable and reportable data directly into the practice’s EHR.discrete recordable and reportable data directly into the practice’s EHR.

DRT is Discrete Reportable Transcription

Data Entry TimeData Entry Time

Number of seconds for data entry of discrete clinical data

Source: 573 Patient charts

Data Entry TimeData Entry Time

The average physician spends 33 seconds dictating an The average physician spends 33 seconds dictating an establish office visitestablish office visit

92% of all office visits are established92% of all office visits are established

If the average physician sees 40 patients a day, total If the average physician sees 40 patients a day, total dictation time of 30 minutes plus time to search for the dictation time of 30 minutes plus time to search for the data.data.

Using a traditional EHR application, the same number of Using a traditional EHR application, the same number of patients would require 140 minutes of data entry time.patients would require 140 minutes of data entry time.

Physicians are not willing to spend an additional 90 Physicians are not willing to spend an additional 90 minutes per day for data entry.minutes per day for data entry.

(40 X 92% x 33 seconds) + (40 x 8% x 125) = < 30 minutes per day

Estimated Reduction Estimated Reduction in Transcription Costsin Transcription Costs

Actual Reduction in Transcription Costs by Quarter if you use one of the top EHR products

Estimated Reduction Estimated Reduction in Transcription Costsin Transcription Costs

Actual Reduction in Transcription Costs by Quarter if you use one of the top EHR products

EHR Vendor Marketing

So How does an DRT So How does an DRT enabled EHR Help a enabled EHR Help a

Physician?Physician?

DRT Enabled EHRDRT Enabled EHR

Allows the physician to continue their Allows the physician to continue their current process for chartingcurrent process for charting

Allows the practice to collect Allows the practice to collect – family history, family history, – social history, social history, – medical history,medical history,– Current MedsCurrent Meds– AllergiesAllergies– Vital SignsVital Signs

DRT Enabled EHRDRT Enabled EHR

Allows the physician to interact with the Allows the physician to interact with the patient regarding:patient regarding:– ROSROS– HPIHPI– AssessmentAssessment– OrdersOrders

Some Physicians have allow their staff to enter ROS and HPI following approved clinical protocols

DRT Enabled EHRDRT Enabled EHR

Physician conducts their physical examPhysician conducts their physical exam

Physician dictates their PE and their assessment and Physician dictates their PE and their assessment and then places orders.then places orders.

The dictated wave file is sent to transcription for typing.The dictated wave file is sent to transcription for typing.

The typed paragraph is sent to the physician for review.The typed paragraph is sent to the physician for review.

Once approved, the transcription section is auto placed Once approved, the transcription section is auto placed in the specific section of the EHR.in the specific section of the EHR.

Additionally, the transcription section runs through Additionally, the transcription section runs through natural language processing technology enabling natural language processing technology enabling discrete and reportable data to be capture and auto discrete and reportable data to be capture and auto populated into the EHR.populated into the EHR.

DRT Enabled EHRDRT Enabled EHR

Disadvantages:Disadvantages:– Does not eliminate all transcription right away Does not eliminate all transcription right away

But what EHR vendor is eliminating TranscriptionBut what EHR vendor is eliminating Transcription

– No E & M CodingNo E & M Coding But a 20% reduction in productivity offsets any E But a 20% reduction in productivity offsets any E & M coding enhancement& M coding enhancement

– You only capture 70% of the discrete dataYou only capture 70% of the discrete dataBut the average practice only uses 3 – 6% of the But the average practice only uses 3 – 6% of the EHR discrete data today. EHR discrete data today.

Natural Language ProcessingNatural Language Processing

Search tools to optimize both sensitivity and specificity

Analyzing the DataAnalyzing the Data

Clinical elements are extracted to support both process and outcomes measures.

NAME: XXXXXX

DOB: XXXXXX

MR#: XXXXXX

DATE: XXXXXX

CHIEF COMPLAINT: TYPE 2 DIABETES, HYPERTENSION, AND HYPERLIPIDEMIA.

SUBJECTIVE: THE PATIENT'S BLOOD SUGARS ARE WELL CONTROLLED. WE DISCUSSED HIS GOAL OF MAINTAINING HIS A1C TO REDUCE RISK OF DIABETIC COMPLICATIONS.

DIABETES TREATMENT REGIMEN: DIET AND EXERCISE

FREQUENCY OF HOME GLUCOSE MONITORING: TWICE-WEEKLY

BLOOD GLUCOSE RANGE: 96-178

DIABETIC FOOT EXAM: NO ABNORMALITIES NOTED.

ANNUAL OPHTHALMOLOGIC EXAM: RETINAL EYE EXAM PERFORMED ON 1/1/06, WITH NORMAL EXAM.

OBJECTIVE: VITALS: WEIGHT 198 POUNDS, BLOOD PRESSURE 140/78, PULSE 68

THE PATIENT'S BLOOD PRESSURE IS UNCONTROLLED. WE DISCUSSED THE IMPORTANCE OF MAINTAINING HIS BLOOD PRESSURE TO REDUCE HIS RISK OF HEART ATTACK, STROKE, AND KIDNEY DYSFUNCTION. WE DISCUSSED THERAPEUTIC OPTIONS AVAILABLE FOR IMPROVING HIS BLOOD PRESSURE CONTROL. WE WILL PLAN ON ADDING HCTZ 25 MG TO THE LISINOPRIL 40 MG DAILY THAT HE CURRENTLY TAKES FOR HYPERTENSION. THE PATIENT'S CHOLESTEROL IS WELL CONTROLLED ON LOVASTATIN 40 MG DAILY.

LABORATORY: WE REVIEWED LABS FROM OCTOBER 31, 2006.

HEMAGLOBIN A1C = 6.0 ON 10/31/06. LDL = 95 ON 2/28/06. MICROALBUMIN = 30 ON 6/20/06.

ASSESSMENT: TYPE 2 DIABETES, CONTROLLED. HYPERTENSION, UNCONTROLLED. HYPERLIPIDEMIA, CONTROLLED.

PLAN: PATIENT IS TO CONTINUE CHECKING HIS BLOOD SUGARS TWICE WEEKLY. WE WILL SWITCH THE PATIENT'S LISINOPRIL 40 MG DAILY TO LISINOPRIL/HCTZ 20/12.5 MG TWO TABLETS DAILY FOR BLOOD PRESSURE.

ELECTRONICALLY VERIFIED AND SIGNED BY JACK SMITH MD

NAME: XXXXXX

DOB: XXXXXX

MR#: XXXXXX

DATE: XXXXXX

CHIEF COMPLAINT: TYPE 2 DIABETES, HYPERTENSION, AND HYPERLIPIDEMIA.

SUBJECTIVE: THE PATIENT'S BLOOD SUGARS ARE WELL CONTROLLED. WE DISCUSSED HIS GOAL OF MAINTAINING HIS A1C TO REDUCE RISK OF DIABETIC COMPLICATIONS.

DIABETES TREATMENT REGIMEN: DIET AND EXERCISE

FREQUENCY OF HOME GLUCOSE MONITORING: TWICE-WEEKLY

BLOOD GLUCOSE RANGE: 96-178

DIABETIC FOOT EXAM: NO ABNORMALITIES NOTED.

ANNUAL OPHTHALMOLOGIC EXAM: RETINAL EYE EXAM PERFORMED ON 1/1/06, WITH NORMAL EXAM.

OBJECTIVE: VITALS: WEIGHT 198 POUNDS, BLOOD PRESSURE 140/78, PULSE 68

THE PATIENT'S BLOOD PRESSURE IS UNCONTROLLED. WE DISCUSSED THE IMPORTANCE OF MAINTAINING HIS BLOOD PRESSURE TO REDUCE HIS RISK OF HEART ATTACK, STROKE, AND KIDNEY DYSFUNCTION. WE DISCUSSED THERAPEUTIC OPTIONS AVAILABLE FOR IMPROVING HIS BLOOD PRESSURE CONTROL. WE WILL PLAN ON ADDING HCTZ 25 MG TO THE LISINOPRIL 40 MG DAILY THAT HE CURRENTLY TAKES FOR HYPERTENSION. THE PATIENT'S CHOLESTEROL IS WELL CONTROLLED ON LOVASTATIN 40 MG DAILY.

LABORATORY: WE REVIEWED LABS FROM OCTOBER 31, 2006.

HEMAGLOBIN A1C = 6.0 ON 10/31/06. LDL = 95 ON 2/28/06. MICROALBUMIN = 30 ON 6/20/06.

ASSESSMENT: TYPE 2 DIABETES, CONTROLLED. HYPERTENSION, UNCONTROLLED. HYPERLIPIDEMIA, CONTROLLED.

PLAN: PATIENT IS TO CONTINUE CHECKING HIS BLOOD SUGARS TWICE WEEKLY. WE WILL SWITCH THE PATIENT'S LISINOPRIL 40 MG DAILY TO LISINOPRIL/HCTZ 20/12.5 MG TWO TABLETS DAILY FOR BLOOD PRESSURE.

ELECTRONICALLY VERIFIED AND SIGNED BY JACK SMITH MD

Search Technology

- Finds clinical elements within the document

- Populates the structured database

- Ability to create/modify searches

Key BP BP Date A1C Value A1C Date …

231 140/78 12/1/06 6.0 10/31/06 …

Proven ResultsProven Results62% Reduction in Transcription costs – day 162% Reduction in Transcription costs – day 1

No change in interaction with patientNo change in interaction with patient

Ability to capture discrete data via transcriptionAbility to capture discrete data via transcription

Populate EHR via dictation instead of physician data Populate EHR via dictation instead of physician data entry.entry.

70% of discrete data with 18% of the effort70% of discrete data with 18% of the effort

Transcription costs decreases on follow-up visits by 82%.Transcription costs decreases on follow-up visits by 82%.

Note looks and sounds professional versus the 5 page Note looks and sounds professional versus the 5 page computer generated note that does not sound like a computer generated note that does not sound like a professional ever read it.professional ever read it.

DRT DisadvantagesDRT Disadvantages

Does not eliminate all transcription right away Does not eliminate all transcription right away

– But what EHR vendor is eliminating TranscriptionBut what EHR vendor is eliminating Transcription

No E & M CodingNo E & M Coding

– But a 20% reduction in productivity offsets any E & M But a 20% reduction in productivity offsets any E & M coding enhancementcoding enhancement

You only capture 30% of the discrete dataYou only capture 30% of the discrete data

– But the average practice only uses 3 – 6% of the EHR But the average practice only uses 3 – 6% of the EHR discrete data today. discrete data today.

The ChallengeThe Challenge

So which EHR product are DRT enabled today ?

Which Vendors Offer DRTWhich Vendors Offer DRTAll vendors can offer a DRT enabled EHRAll vendors can offer a DRT enabled EHR

Vendors need to realize that the Vendors need to realize that the EHR is NOT EHR is NOT the the solution.solution.

Vendors need to realize that the Vendors need to realize that the EHR is just a tool EHR is just a tool to to help generate a clear and concise note that can be help generate a clear and concise note that can be shared between common providers of care.shared between common providers of care.

A combination of Transcription and EHR is the best A combination of Transcription and EHR is the best model for true universal adoption.model for true universal adoption.

The EHR vendor that can best enable Transcription The EHR vendor that can best enable Transcription in their EHR will in their EHR will WIN!!!WIN!!!

Take Home MessageTake Home MessageEHRs Can Improve Patient Service and Provide EHRs Can Improve Patient Service and Provide Financial Benefits.Financial Benefits.

HITECT will require “Meaningful Use”HITECT will require “Meaningful Use”

DRT Enabled EHRs is the easiest way to meet DRT Enabled EHRs is the easiest way to meet “meaningful use”.“meaningful use”.

EHR Implementation is a “Bet the Practice” EHR Implementation is a “Bet the Practice” Proposition That Requires Adequate Resources Proposition That Requires Adequate Resources and Investments to Achieve Success. and Investments to Achieve Success.

The DRT Enabled EHRs provide the best Value The DRT Enabled EHRs provide the best Value todaytoday

For More InformationFor More InformationMark R. Anderson, FHIMSS, CPHIMSMark R. Anderson, FHIMSS, CPHIMS

CEO and Healthcare FuturistCEO and Healthcare Futurist

AC Group, Inc.AC Group, Inc.

118 Lyndsey Drive118 Lyndsey Drive

Montgomery, TX 77316Montgomery, TX 77316

(281) 413-5572(281) 413-5572

eMail: mark.anderson @ acgroup.org eMail: mark.anderson @ acgroup.org

www.acgroup.orgwww.acgroup.org