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EMR - The Time is Now:Physician Alignment through IT
Panel DiscussionRichard Eshbach & Bill Moran
04/19/23 2
The President’s Bold Vision for HIT
“Every American will have access to an electronic health record by 2014”
04/19/23 3
–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
EMR and our Connected Care Community
04/19/23 4
Definition of an EMR
CPR
PHR
EMR
EHR
Are we all speaking the same language…..?
Cardiology/Pulmonary
Pharmacy
Care Giver Notes
Physician Notes
Scanned Images of Documents
History & Physical
Demographic Information
Prior Encounters
Laboratory
Radiology
Discharge Summary
Components of a Patient Record
Boxed Components are Unstructured Information
04/19/23 6
EMR Adoption Model Q2 2008
5%
04/19/23 7
Hospital involvement in community EMR Deployments
Hospitals will represent 38% of all EMR purchases Hospitals will represent 38% of all EMR purchases up from 11% in 2007 up from 11% in 2007
– – AC Group, Feb 2008AC Group, Feb 2008
04/19/23 8
Electronic Medical Record Industry – Only 22% of Hospitals across the country have successfully deployed an EMR
04/19/23 9
EMR Scores by Comparison
EMR Scores by Bed Size
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
EMR Scores by State
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
04/19/23 10
Who will take the lead?Who will take the lead?
How will we get there?How will we get there?
04/19/23 11
Electronic Medical Record
04/19/23 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
DecisionSupport
PhysicianOrder Entry
Clinical Documentation
Replacement of Order Entry and Ancillary Systems
Technical Infrastructure/Foundation
Increasing ValueOn Journey to
Patient Safety, Quality and Efficiency
Network
Wireless
Monitors
Single Sign On Hardware
Pharmacy
ED
Clinical Access
Cardiology
Rad Upg
Orders
Interdisciplinary Charting
Bar Coding - MAKLiveLive
6 months
>6 monthsPACs
eHIM
2008-09
2009-11
2009-10
2007
Computerized Patient Record JourneyPhases I-III
04/19/23 14
MSHA In/Out-Patient ApproachMountain States EMR consist of the following: (We are 75% deployed) An electronic Clinical Data Repository - √ Completed (Soarian Clinical Access)
− Contains 8 years of detailed clinical data An electronic Order Management System - √ Underway (New Soarian Orders) A Picture Archival Communication (PACs) System which allows the capture of medical images –
√ Completed (GE Radiology PACs and Siemens Cardiology PACs (echos, caths, nuclear studies…) An electronic flow sheets of vitals and I/O - √ Completed (Soarian Critical Care and MegaCare) An electronic Pharmacy System - √ Completed (Soarian Pharmacy) An electronic Radiology System - √ Completed (Siemens Radiology) An electronic Transcription System - √ Completed (Dolby with Voice Recognition) An electronic Laboratory System - √ Completed (Cerner Classic, replaced w/ SoftLab) An electronic Nursing/Ancillary documentation System - √ Completed (Soarian Clinical Team) An electronic Paper Medical Record - √ 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!”
04/19/23 15
MSHA In/Out Patient Approach
What’s 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 EMR’s•Deployment of Home Health Clinical Documentation
On-going enhancement of workflows as more clinical information is available and more clinicians are on-line
Timeframe for Implementation
Foundation Systems
2004-05 2006 2007 2008 2009 2010 2011-12
Replace Ancillaries
Physician Order Entry
Progress Notes
Plans of Care
Orders and Documentation
PharmacyMAKeHIMDictationEDPACs•Rad•EKG•Cardio
Clinical Repository
Monitors
Wireless
Single-sign-on
OrdersAlertsWorkflowsVital SignsAssessmentsDocumentationForms Clinical
Decision Support
04/19/23 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)
04/19/23 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
04/19/23 19
Electronic Medical Record
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 EMR’s
Complexity surrounding multiple EMR strategies – allows us to take advantage of true interoperability through Relay Health.
04/19/23 21
WHS EMR StrategiesInpatient / 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
04/19/23 22
Navigating through the technology
“Nobody said it would be easy”
Phase 1 PACS (AGFA), RIS (STAR), OR (HSM),PACS (AGFA), RIS (STAR), OR (HSM), Transcription/Dictatn.Transcription/Dictatn.
Phase 2 LAB (Cerner), Pharmacy (HMM), CardiologyLAB (Cerner), Pharmacy (HMM), Cardiology
Phase 3 Nursing Doc (HED), AdminRx (barcoding) Nursing Doc (HED), AdminRx (barcoding)
Phase 4 Horizon Lab, Anesthesia, ERHorizon Lab, Anesthesia, ER
Phase 4 Physician Office,Physician Office, CPOECPOE
Phase 5EMREMR
EMR evolution….
In Patient - EMR
04/19/23 24
EMR – In Patient Approach…
Wellmont’s EMR consist of the following: (We are 76% deployed) An electronic Order Management System - √ Completed (STAR HOM/Orders)
An Picture Archival Communication (PAC’s) System which allows the capture of medical images – √ Completed (PAC’s)
An electronic Pharmacy System - √ Completed (HMM)
An electronic Radiology System - √ Completed (Star RIS)
An electronic Transcription System - √ Completed (Cquence, Star/HPF, Lanier)
An electronic Laboratory System - √ Completed (Cerner Classic)
An electronic Nursing documentation System - √ Completed (HED)
An electronic Horizon Patient Folder Application - √ 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.
04/19/23 25
WHS EMR – What’s Next…
In order to have a “Completed” Electronic Medical Record, these components are scheduled for implementation:
−CPOE/Orders
−Physician Notes
− Integration to Physician Office EMR’s 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
Ambulatory Strategy and Solution Update
Ambulatory Strategy
Traditional Methods of Delivering Test Results/Transcriptions
Portal
Fax or Mail
HL7 Interfaces
Manual Process and Costly – Not Actionable
Passive Notification – Requires Provider to Search for Result – Not Actionable
IT Overhead- Costly to Maintain – Not Actionable
Point to Point Interfaces
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
Connectivity Through the RelayHealth Network
Physician-Physician-to-Physicianto-PhysicianNetworkingNetworking
Physician-Physician-to-Physicianto-PhysicianNetworkingNetworking
Referrals Patient care
collaboration
Hospital-Hospital-PhysicianPhysician
ConnectivityConnectivity
Hospital-Hospital-PhysicianPhysician
ConnectivityConnectivity
Electronic prescriptions
Renewals
Appointment scheduling
Billing questions and online payments
Physician-Physician-Patient AdminPatient Admin
InteractionInteraction
Physician-Physician-Patient AdminPatient Admin
InteractionInteraction
Test results webVisit consultations
Rx renewals Personal health
records
Physician-Physician-Hospital- Hospital-
Pharmacy-Patient Pharmacy-Patient Clinical Clinical
InteractionInteraction
Physician-Physician-Hospital- Hospital-
Pharmacy-Patient Pharmacy-Patient Clinical Clinical
InteractionInteraction
PayorsPayorsRetail RxRetail RxPatientsPatientsPhysiciansPhysicians Financial InstitutionsFinancial InstitutionsHospitalsHospitals
RelayHealth Connectivity RelayHealth Connectivity RelayHealth Connectivity RelayHealth Connectivity
Physician-Physician-Retail RxRetail Rx
ConnectivityConnectivity
Physician-Physician-Retail RxRetail Rx
ConnectivityConnectivity
Emergency Dept connectivity
Care mgmt Results
distribution
Connected and Actionable Network
RH Network
Specialist
Primary Care
Patient
Patient
HL7
Bi-directional Communication
04/19/23 31
Physician Practice EMR AdoptionPhysician Practice EMR Adoption
04/19/23 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
04/19/23 33
Stark Safe Harbors – “Rules of Engagement”Stark Safe Harbors – “Rules of Engagement”
04/19/23 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
Overview of the Regulations
• Permitted technology
• Minimum technology standards
• Permitted donors
• Permitted recipients
• Payment obligations
• Technology not duplicative
• Documentation
04/19/23 36
Regional Out-reach Programs/OpportunitiesRegional Out-reach Programs/Opportunities
04/19/23 37
Regional Out-Reach Programs/Opportunities
PayorPayor
PatientPatientHospitalHospital
PhysiciansPhysiciansPhysiciansPhysiciansConnected Community
Financial InstitutionFinancial Institution PharmacyPharmacy
04/19/23 38
Hospital involvement in community EMR Deployments
“…“…hospital organizations are trying to figure out how they are going to … hospital organizations are trying to figure out how they are going to … propel EMR solutions to community physicians” propel EMR solutions to community physicians” – – Jared Peterson, VP, ResearchJared Peterson, VP, Research
KLAS, June 2008, when asked about the biggest EMR trends in the next few yearsKLAS, June 2008, when asked about the biggest EMR trends in the next few years
04/19/23 39
• 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
Regional Connectivity Initiatives Gaining Momentum
04/19/23 40
QUESTIONS ?