The Electronic Medical The Electronic Medical Record and the Practicing Record and the Practicing Ph sician an O moron?Ph sician an O moron?Physician: an Oxymoron?Physician: an Oxymoron?

Carol Steltenkamp M D MBACarol Steltenkamp M D MBACarol Steltenkamp, M.D., MBACarol Steltenkamp, M.D., MBAChief Medical Information OfficerChief Medical Information Officer

An Equal Opportunity UniversityAn Equal Opportunity University 22

ObjectivesObjectivesObjectivesObjectives

Discuss the role of the Electronic MedicalDiscuss the role of the Electronic MedicalDiscuss the role of the Electronic Medical Discuss the role of the Electronic Medical Record (EMR) in the office Record (EMR) in the office settingsetting

Identify what to look for in an Identify what to look for in an EMREMR

Review implementation challenges and Review implementation challenges and understand postunderstand post implementationimplementation outcomesoutcomesunderstand postunderstand post--implementation implementation outcomesoutcomes

Clinical Mission: AmbulatoryA multispecialty group practice A multispecialty group practice providing primary & specialty providing primary & specialty carecarecare care 106 106 Best DoctorsBest Doctors80 specialized clinics, 150 80 specialized clinics, 150 outreach programs outreach programs Provide services primarily in Provide services primarily in Lexington and Central and Lexington and Central and Eastern Kentucky Eastern Kentucky 400,000+ outpatient visits 400,000+ outpatient visits (2007) (2007)

at main campus localeat main campus localeppGreater than 1 million Greater than 1 million outpatient visits across the outpatient visits across the EnterpriseEnterprisepp

UK Chandler Hospital

Clinical Mission: InpatientClinical Mission: Inpatient

>800 beds>800 beds35 000 di h35 000 di h>35, 000 discharges>35, 000 discharges

Level 1 Trauma Level 1 Trauma C tC tCenterCenterCenters of Excellence Centers of Excellence in Cardiologyin Cardiologyin Cardiology, in Cardiology, Oncology, and Oncology, and NeurosciencesNeurosciencesNeurosciencesNeurosciencesKentucky Children’s Kentucky Children’s HospitalHospitalpp

Research MissionResearch Mission

$127.5 million grants & $127.5 million grants & contracts awarded at UK contracts awarded at UK College of Medicine*; College of Medicine*; $62.8 million in NIH$62.8 million in NIH$62.8 million in NIH $62.8 million in NIH fundingfunding

UK’s medical center UK’s medical center colleges account for colleges account for more than 55% of UK more than 55% of UK total research dollarstotal research dollarstotal research dollarstotal research dollars

Research figures Research figures prominently in quest for prominently in quest for p y qp y qTop 20 statusTop 20 status*2007

Educational MissionEducational MissionEducational MissionEducational MissionSix colleges:Six colleges:

MedicineMedicineMedicineMedicineNursingNursingPharmacyPharmacyDentistryDentistryHealth SciencesHealth SciencesPublic Health Public Health

1000 clinical faculty 1000 clinical faculty

500 physicians in 500 physicians in residencyresidencyresidencyresidency

WHY Health Information Technology (HIT)?WHY Health Information Technology (HIT)?Implementation of HIT is proposed as a way to Implementation of HIT is proposed as a way to provide additional information to clinicians to provide additional information to clinicians to facilitate a reduction in serious medical errors risingfacilitate a reduction in serious medical errors risingfacilitate a reduction in serious medical errors, rising facilitate a reduction in serious medical errors, rising healthcare costs and system inefficiencies. healthcare costs and system inefficiencies. (Thompson, (Thompson, 2004)2004)

Estimate annual $10.6 billion outpatient savings and Estimate annual $10.6 billion outpatient savings and $31.2 billion inpatient savings based on HIT $31.2 billion inpatient savings based on HIT

ffi i b fitffi i b fitefficiency benefits efficiency benefits ((GirosiGirosi, , MeiliMeili,& ,& ScovilleScoville, 2005), 2005)

President Bush State of the Union “we make wider President Bush State of the Union “we make wider use of electronic records and other HIT, to help use of electronic records and other HIT, to help control costs and reduce dangerous medical errors control costs and reduce dangerous medical errors (Jan 2006)(Jan 2006)

An Equal Opportunity UniversityAn Equal Opportunity University 88

Problem: Increased CostsProblem: Increased CostsIn 2003 U S health spending per capita was $5 635 ~ two andIn 2003 U S health spending per capita was $5 635 ~ two andIn 2003, U.S. health spending per capita was $5,635, two and In 2003, U.S. health spending per capita was $5,635, two and a half times more than the comparable median for industrialized a half times more than the comparable median for industrialized countries ($2,280 per capita). 15% of US GDP was spent on countries ($2,280 per capita). 15% of US GDP was spent on health care in 2003; other countries median was 8.4%health care in 2003; other countries median was 8.4% (Anderson et al, (Anderson et al, 2005)2005)

Higher medical care prices make health care unaffordable for Higher medical care prices make health care unaffordable for many Americans yet the extra dollars spent are not yieldingmany Americans yet the extra dollars spent are not yieldingmany Americans, yet the extra dollars spent are not yielding many Americans, yet the extra dollars spent are not yielding demonstrably better quality of care or patient satisfaction. demonstrably better quality of care or patient satisfaction. (Gerard (Gerard et al,2005)et al,2005)

U S d 2 1 ti h h lth C dU S d 2 1 ti h h lth C dU.S. spends 2.1 times as much on healthcare as Canada, U.S. spends 2.1 times as much on healthcare as Canada, France, Germany, Italy, Japan and the United Kingdom.France, Germany, Italy, Japan and the United Kingdom.

Healthcare spending grew “faster than growth in both theHealthcare spending grew “faster than growth in both theHealthcare spending grew faster than growth in both the Healthcare spending grew faster than growth in both the aggregate economy and employee compensation, which aggregate economy and employee compensation, which suggests an increasing burden on sponsors and employers”suggests an increasing burden on sponsors and employers”(Smith et al., 2005, p. 193).(Smith et al., 2005, p. 193).

An Equal Opportunity UniversityAn Equal Opportunity University 99

Problem: Problem: Information ExplosionInformation ExplosionInformation ExplosionInformation Explosion

If only 1% of new literature in Medline is If only 1% of new literature in Medline is healthcare related, if the clinician reads 2 healthcare related, if the clinician reads 2 articles daily for a year, they will be 5 years articles daily for a year, they will be 5 years b hi d th t t t f k l db hi d th t t t f k l dbehind the current state of knowledge. behind the current state of knowledge. ((MasysMasys, , 20022002))

Medline indexes >560 000 new articles andMedline indexes >560 000 new articles andMedline indexes >560,000 new articles, and Medline indexes >560,000 new articles, and Cochrane Central adds 20,000 new Cochrane Central adds 20,000 new randomized trials annuallyrandomized trials annuallyyy~ 1500 new articles and 55 new trials per ~ 1500 new articles and 55 new trials per day day ((GlasziousGlaszious and Haynes, 2005)and Haynes, 2005)

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yy (( y )y )

Institute of MedicineInstitute of MedicineInstitute of MedicineInstitute of Medicine“despite more than 30 years of work and millions of “despite more than 30 years of work and millions of p yp ydollars, patient care records are predominantly paper, dollars, patient care records are predominantly paper, which limits tools for effective decisionwhich limits tools for effective decision--making from the making from the bedside to national healthcare policy” bedside to national healthcare policy” (IOM, 1991).(IOM, 1991).p yp y ( , )( , )“ A highly fragmented delivery system that largely lacks “ A highly fragmented delivery system that largely lacks even rudimentary clinical information capabilities results even rudimentary clinical information capabilities results in poorly designed care processes characterized byin poorly designed care processes characterized byin poorly designed care processes characterized by in poorly designed care processes characterized by unnecessary duplication of services, and long waiting unnecessary duplication of services, and long waiting times and delaystimes and delays.” (IOM, 2001).” (IOM, 2001)Medical errors rising healthcare costs and qualityMedical errors rising healthcare costs and qualityMedical errors, rising healthcare costs, and quality Medical errors, rising healthcare costs, and quality problems are cited as widespread issues that need to be problems are cited as widespread issues that need to be addressed addressed (Institute of Medicine, 2001)(Institute of Medicine, 2001)

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Electronic Health RecordElectronic Health RecordElectronic Health RecordElectronic Health RecordThe IOM presented eight core functions that The IOM presented eight core functions that should be provided in an electronic health should be provided in an electronic health pprecord:record:

health information and data health information and data lt tlt tresults management results management

order entry/management order entry/management decision supportdecision supportdecision support decision support electronic communication and connectivity electronic communication and connectivity patient support patient support p ppp ppadministrative support reporting administrative support reporting population health management population health management (Institute of (Institute of Medicine 2003)Medicine 2003)

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Medicine, 2003). Medicine, 2003).

Current Issues in Ambulatory CareCurrent Issues in Ambulatory CareCurrent Issues in Ambulatory CareCurrent Issues in Ambulatory Care

Inability to find critical information quicklyInability to find critical information quicklyInability to find critical information quicklyInability to find critical information quickly30% of physician time spent searching, up to 30% of physician time spent searching, up to 81% of time information is still not found in81% of time information is still not found in81% of time information is still not found in 81% of time information is still not found in record. JAMArecord. JAMA

While quality of care is improvingWhile quality of care is improvingWhile quality of care is improving, While quality of care is improving, ambulatory care shows the least overall ambulatory care shows the least overall improvement (1 4% between 2003 andimprovement (1 4% between 2003 andimprovement (1.4% between 2003 and improvement (1.4% between 2003 and 2004). AHRQ 2004). AHRQ

An Equal Opportunity UniversityAn Equal Opportunity University 1313

Better Information = Better QualityBetter Information = Better Quality

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Percentage of officePercentage of office--based physicians using electronic based physicians using electronic medical records and using comprehensive electronic medical records and using comprehensive electronic

medical record systems: United States, 2001medical record systems: United States, 2001––2006 2006

Percentage of medical practices using electronic medical records Percentage of medical practices using electronic medical records and using comprehensive electronic medical record systems: and using comprehensive electronic medical record systems:

United States 2003United States 2003 04 through 200604 through 2006United States, 2003United States, 2003––04 through 2006 04 through 2006

Percentage of physicians using electronic medical Percentage of physicians using electronic medical records and using comprehensive electronic medical records and using comprehensive electronic medical

d t b ti i U it d St t 2006d t b ti i U it d St t 2006record systems by practice size: United States, 2006 record systems by practice size: United States, 2006

Estimated Percentage of OfficeEstimated Percentage of Office--Based Based ggPhysicians Using Selected Electronic Physicians Using Selected Electronic

Medical Record (EMR) FeaturesMedical Record (EMR) Features( )( )

National Ambulatory Medical Care Survey, United States, 2006

Percent distribution of physicians planning new or replacement electronic Percent distribution of physicians planning new or replacement electronic medical record systems within next 3 years by whether current system is medical record systems within next 3 years by whether current system is

fully or partially electronic: United States 2006fully or partially electronic: United States 2006fully or partially electronic: United States 2006fully or partially electronic: United States 2006

Barriers to AdoptionBarriers to AdoptionBarriers to AdoptionBarriers to Adoption

Capital costs*Capital costs*Capital costsCapital costsNot finding a system that meets their Not finding a system that meets their needs*needs*needs*needs*Uncertainty about return on investment*Uncertainty about return on investment*Concern that a system would become Concern that a system would become obsolete*obsolete*

DesRochesDesRoches, et. al., NEJM, July3, 2008, et. al., NEJM, July3, 2008

Facilitators of AdoptionFacilitators of AdoptionFacilitators of AdoptionFacilitators of Adoption

Financial incentives for purchaseFinancial incentives for purchasePayment for use of an electronic recordsPayment for use of an electronic recordsPayment for use of an electronic records Payment for use of an electronic records systemsystemProtecting physicians from personalProtecting physicians from personalProtecting physicians from personal Protecting physicians from personal liabilityliability

DesRochesDesRoches, et. al., NEJM, July3, 2008, et. al., NEJM, July3, 2008

Effect of Adoption of Electronic Effect of Adoption of Electronic Health Records SystemsHealth Records SystemsHealth Records SystemsHealth Records Systems

DesRoches, et. al., NEJM, July3, 2008

QuickStatsQuickStats: Estimated Percentage of: Estimated Percentage ofQuickStatsQuickStats: Estimated Percentage of : Estimated Percentage of OfficeOffice--Based Physicians Using Based Physicians Using Selected Electronic Medical RecordSelected Electronic Medical RecordSelected Electronic Medical Record Selected Electronic Medical Record (EMR) Features* (EMR) Features* ------ National National Ambulatory Medical Care SurveyAmbulatory Medical Care SurveyAmbulatory Medical Care Survey, Ambulatory Medical Care Survey, United States, 2006United States, 2006

Case for ChangeCase for Changegg

Case for Case for ChChChangeChange

If dIf dIf you can read If you can read it, how long did it it, how long did it t k tt k ttake you to take you to decipher the decipher the h d iti ?h d iti ?handwriting?handwriting?

A Moment in the Physician OfficeA Moment in the Physician OfficeA Moment in the Physician OfficeA Moment in the Physician OfficeWhile promoting medical quality and E/MWhile promoting medical quality and E/MWhile promoting medical quality and E/M While promoting medical quality and E/M

compliance, in compliance, in 15 minutes MD15 minutes MD must be able must be able to:to:

Perform and complete documentation of a Perform and complete documentation of a medically indicated, auditmedically indicated, audit--proof, level 4 or proof, level 4 or l l 5 i iti l ti t i it ith i di id li dl l 5 i iti l ti t i it ith i di id li dlevel 5 initial patient visit with individualized level 5 initial patient visit with individualized narrative information in all appropriate areas narrative information in all appropriate areas of the medical record including completion ofof the medical record including completion ofof the medical record including completion of of the medical record including completion of counseling the patient, ordering tests, counseling the patient, ordering tests, ordering treatment, and charge entry.ordering treatment, and charge entry.

The Cost/Benefit RatioThe Cost/Benefit RatioThe Cost/Benefit RatioThe Cost/Benefit Ratio

B fitCosts Benefits Improved quality of care

CostsCash outlay

quality of care

Improved throughput

High initialphysician time and g p

Charge capture

decreased patient volume

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Getting StartedGetting StartedGetting StartedGetting Started

Announce the goalAnnounce the goal-- even if it’s ambitiouseven if it’s ambitiousAnnounce the goalAnnounce the goal even if it s ambitiouseven if it s ambitiousTest big ideas on a small scaleTest big ideas on a small scaleFi d b t ti d thFi d b t ti d thFind best practices and use them as Find best practices and use them as measurements (internal and external)measurements (internal and external)Build the discipline and methods of Project Build the discipline and methods of Project Management into the workManagement into the work

ThomasThomas Nolan.TheNolan.The Pursuit Continues. Pursuing Perfection: Raising the Bar for HealthcarePursuit Continues. Pursuing Perfection: Raising the Bar for HealthcareThomas Thomas Nolan.TheNolan.The Pursuit Continues. Pursuing Perfection: Raising the Bar for Healthcare Pursuit Continues. Pursuing Perfection: Raising the Bar for Healthcare Performance. Performance. Modern HealthcareModern Healthcare, Feb 28, 2005., Feb 28, 2005.

Ambulatory Workflow Ambulatory Workflow OptimizationOptimization

Together with the progress in medicine, Together with the progress in medicine, which provides for an earlier diagnosis and which provides for an earlier diagnosis and p gp gintervention, healthcare information intervention, healthcare information technology for process optimization will be technology for process optimization will be gy p pgy p pthe prerequisite to further improve the the prerequisite to further improve the quality of care while reducing costsquality of care while reducing costsq y gq y g

EMR BarriersEMR BarriersEMR BarriersEMR BarriersImplementations are costlyImplementations are costlyp yp y

Start up, maintenance, workflow changesStart up, maintenance, workflow changesOrganizational influencesOrganizational influences

Level of integrationLevel of integration what user wants globallywhat user wants globally vsvs whatwhatLevel of integrationLevel of integration-- what user wants globally what user wants globally vsvs what what user expects personallyuser expects personallyTypes of practicesTypes of practicesL d hiL d hiLeadershipLeadership

High initial physician timeHigh initial physician timeCustomizationCustomizationCus o a oCus o a o

Miller & Miller & SimSim. Physician’s Use of Electronic Medical Records: Barriers and Solutions. . Physician’s Use of Electronic Medical Records: Barriers and Solutions. Health AffairsHealth Affairs. . VolVol 23, No 223, No 2

Why the reluctance by clinicians to adopt Why the reluctance by clinicians to adopt IT systemsIT systems

Ma partiall be a generational iss eMa partiall be a generational iss eMay partially be a generational issueMay partially be a generational issue

Main reason may be that so far EMR has not Main reason may be that so far EMR has not yydelivered time savings for physicians and delivered time savings for physicians and nurses, in fact, in many circumstances when nurses, in fact, in many circumstances when

t f ll d l d t tit f ll d l d t tinot fully deployed, costs timenot fully deployed, costs time

Main justification may be in addressing cost, Main justification may be in addressing cost, j y g ,j y g ,quality and safety issuesquality and safety issues

Electronic Medical RecordElectronic Medical Record

Source: Clinical Advisory Board interviews and analysis.

Leadership, Communication, Leadership, Communication, and Trainingand Training

Dealing with smaller staffsDealing with smaller staffsCooperation and input by all is a ‘must’Cooperation and input by all is a ‘must’JustJust--inin--time trainingtime trainingJustJust inin time trainingtime training

Current State WorkflowCurrent State WorkflowCurrent State WorkflowCurrent State Workflow

Customization for clinics is KeyCustomization for clinics is Key-- filters, lists, etc.filters, lists, etc.Role identificationRole identificationMaximize efficiency and clinician focus while patient Maximize efficiency and clinician focus while patient is in clinic. is in clinic. More chronic, episodic care in clinic More chronic, episodic care in clinic

3434

Patient Focused InteractionPatient Focused InteractionPatient Focused InteractionPatient Focused Interaction

Schedule appointmentSchedule appointmentSchedule appointmentSchedule appointmentRegisterRegisterIIIn roomIn roomPatient/clinician encounterPatient/clinician encounter

Clinical DocumentationClinical DocumentationImmunizationsImmunizationsPharmacopeiaPharmacopeia

CheckCheck--outoutCheckCheck outout

Scheduling and ArrivalScheduling and ArrivalScheduling and ArrivalScheduling and Arrival

Patient selfPatient self--Patient selfPatient selfschedulingschedulingRegistrationRegistrationggCompletion of intake Completion of intake informationinformation

Tracking BoardTracking Boardgg

In RoomIn RoomIn RoomIn RoomNot all “clinicians” are Not all “clinicians” are created equalcreated equal

What type of data entryWhat type of data entryConsiderations about dataConsiderations about dataConsiderations about data Considerations about data validityvalidity

Not all patients or Not all patients or clinicians are comfortableclinicians are comfortableclinicians are comfortable clinicians are comfortable with computer in roomwith computer in roomMatch hardware to Match hardware to clinician job clinician job

Patient/Clinician EncounterPatient/Clinician EncounterPatient/Clinician EncounterPatient/Clinician Encounter

Clinical DocumentationClinical DocumentationClinical DocumentationClinical DocumentationPatient Care OrdersPatient Care OrdersPh iPh iPharmacopeiaPharmacopeia

ImmunizationsImmunizationsMedicationsMedicationsPrescriptionsPrescriptions

CheckCheck--OutOut

Clinical DocumentationClinical DocumentationClinical DocumentationClinical Documentation

Phone note(s)Phone note(s)Phone note(s)Phone note(s)Dictation/transcription Dictation/transcription

or clinical documentationor clinical documentationor clinical documentationor clinical documentationCopy forwardCopy forwardAbility to access otherAbility to access otherAbility to access other Ability to access other clinical data clinical data Attestation statementsAttestation statementsAttestation statementsAttestation statements

Clinical DocumentationClinical DocumentationClinical DocumentationClinical Documentation

I can type anything in this text box.

Clinical DocumentationClinical DocumentationClinical DocumentationClinical Documentation

Automated Expansion of NoteAutomated Expansion of Note

Output of Structured NoteOutput of Structured Note

Attestation StatementsAttestation StatementsAttestation StatementsAttestation StatementsUK Physician Attestation Statements In the SoftMed Transcription PlatformUK Physician Attestation Statements In the SoftMed Transcription PlatformI was present for the key portions which were andI was present for the key portions which were andI was present for the key portions, which were _____________________________________ and I was present for the key portions, which were _____________________________________ and immediately available throughout the case. immediately available throughout the case. I was present for the entire case except for _______________________ and immediately I was present for the entire case except for _______________________ and immediately available throughout the case.available throughout the case.I was present for the entire procedure.I was present for the entire procedure.I saw the patient with the fellow I discussed the case with the fellow and agree with the fellow’sI saw the patient with the fellow I discussed the case with the fellow and agree with the fellow’sI saw the patient with the fellow. I discussed the case with the fellow and agree with the fellow s I saw the patient with the fellow. I discussed the case with the fellow and agree with the fellow s findings and plan as documented in the fellow’s note.findings and plan as documented in the fellow’s note.I saw and evaluated the patient. I discussed the case with the resident and agree with the I saw and evaluated the patient. I discussed the case with the resident and agree with the resident’s findings and plan as documented in the resident’s note.resident’s findings and plan as documented in the resident’s note.I saw the patient with the resident. I discussed the case with the resident and agree with the I saw the patient with the resident. I discussed the case with the resident and agree with the resident’s findings and plan as documented in the resident’s note.resident’s findings and plan as documented in the resident’s note.g pg pI have discussed the case with the resident and agree with the findings and plan as documented.I have discussed the case with the resident and agree with the findings and plan as documented.I saw the patient with the PAI saw the patient with the PA--C. I discussed the case with the PAC. I discussed the case with the PA--C and agree with the PAC and agree with the PA--C’s C’s findings and plan as documented in the PAfindings and plan as documented in the PA--C’s note.C’s note.This patient was seen by the PAThis patient was seen by the PA--C. I did not personally see the patient at this visit, but I have C. I did not personally see the patient at this visit, but I have reviewed and agree with the plan of treatment.reviewed and agree with the plan of treatment.g pg pI saw the patient with the ARNP. I discussed the case with the ARNP and agree with the ARNP’s I saw the patient with the ARNP. I discussed the case with the ARNP and agree with the ARNP’s findings and plan as documented in the ARNP’s note.findings and plan as documented in the ARNP’s note.This patient was seen by the ARNP. I did not personally see the patient at this visit, but I have This patient was seen by the ARNP. I did not personally see the patient at this visit, but I have reviewed and agree with the plan of treatment.reviewed and agree with the plan of treatment.I reviewed the Review of Systems and Past /Social/Family History obtained by the medical I reviewed the Review of Systems and Past /Social/Family History obtained by the medical e e ed e e e o Sys e s a d as /Soc a / a y s o y ob a ed by e ed cae e ed e e e o Sys e s a d as /Soc a / a y s o y ob a ed by e ed castudent and agree with the student’s note as documented. student and agree with the student’s note as documented.

Patient Care OrdersPatient Care OrdersPatient Care OrdersPatient Care Orders

Does this add value toDoes this add value toDoes this add value to Does this add value to the outpatient visit?the outpatient visit?

Future datedFuture datedLegal questionLegal question-- whowhoLegal questionLegal question who who can “take off order”can “take off order”“CPOE” in “CPOE” in C OC OAmbulatoryAmbulatoryOrder setsOrder sets

Medications and ImmunizationsMedications and ImmunizationsMedications and ImmunizationsMedications and Immunizations

Documenting med Documenting med administrationadministration

Central repository across Central repository across all locationsall locations

Sample managementSample management

Who entersWho entersPolicy for historical entryPolicy for historical entryReportsReports

PrescriptionsPrescriptionsPrescriptionsPrescriptions

PrescriptionsPrescriptions PHARMACYPrescriptionsPrescriptions--workflow is criticalworkflow is critical

R fill tR fill t

PHARMACY

Refill request Refill request processprocessWho can enter “onWho can enter “onWho can enter on Who can enter on behalf of”behalf of”

CheckCheck--outoutCheckCheck outoutSuperbillSuperbill (Fee Sheet)(Fee Sheet)

Patient NamePatient NameDate of serviceDate of serviceLevel of Level of service/procedure code(s)service/procedure code(s)DiagnosisDiagnosisDiagnosisDiagnosis

Goals:Goals:Interface with clinician Interface with clinician documentationdocumentationElectronic feed to billingElectronic feed to billing

Clinician WorkflowClinician WorkflowClinician WorkflowClinician WorkflowInbox/MailboxInbox/Mailbox

Results ReviewResults ReviewAlertsAlertsDocumentsDocumentsDocumentsDocumentsPrescriptionsPrescriptionsHealth MessagingHealth Messaging

St ffiSt ffiStaffing Staffing BillingBilling

Encounter ReconciliationEncounter ReconciliationEncounter ReconciliationEncounter ReconciliationReportsReports

Inbox/MailboxInbox/MailboxInbox/MailboxInbox/Mailbox

R l D lR l D l “ h BOOK”“ h BOOK”Results DelegatesResults Delegates-- “the BOOK”“the BOOK”AlertsAlertsDocumentsDocumentsRx RefillsRx RefillsRx RefillsRx RefillsHealth Messaging Health Messaging

Inbox/MailboxInbox/Mailbox

“The Book”“The Book”The BookThe Book

Labor intensiveLabor intensiveLabor intensiveLabor intensiveReRe--workworkEnd of day processEnd of day processEnd of day processEnd of day processSingle assigned taskSingle assigned taskMargin for errorMargin for errorMargin for errorMargin for error

Results DelegatesResults DelegatesResults DelegatesResults Delegates

RealReal--timetimeRealReal timetimeClinic centricClinic centricWho can beWho can beWho can be Who can be delegate?delegate?Protocols forProtocols forProtocols for Protocols for normal/abnormalnormal/abnormal

Alerts/Decision SupportAlerts/Decision SupportAlerts/Decision SupportAlerts/Decision Support

ManagementManagementManagementManagementAcknowledgementAcknowledgement“on behalf”“on behalf”on behalfon behalf

MaintenanceMaintenance

Documents, Rx Refills, MessagingDocuments, Rx Refills, Messaging

DocumentationDocumentationDocumentationDocumentationIncomplete Incomplete vsvs“complete” “complete”

Rx RefillRx RefillClinic protocolsClinic protocolsScope of practiceScope of practice

Appropriateness of Appropriateness of messagesmessages

Policy & procedurePolicy & procedure

StaffingStaffingStaffingStaffing

Scope of PracticeScope of PracticeScope of PracticeScope of PracticeRx refillsRx refills

Hardware ConsiderationsHardware ConsiderationsHardware ConsiderationsHardware ConsiderationsTypes of devicesTypes of devices

ffNumber of devicesNumber of devicesDevice locationDevice location

HardwareHardware

Capability required to be user’s main PC

mobilefixed moveable ultra mobilemobilefixed moveable ultra-mobile

Other ConsiderationsOther ConsiderationsOther ConsiderationsOther Considerations

Timing of implementationTiming of implementationDecisionDecision--making authoritymaking authorityg yg yBudget/ResourcesBudget/ResourcesFighting desire for ‘over customization'Fighting desire for ‘over customization'Fighting desire for over customizationFighting desire for over customization

ConclusionConclusionConclusionConclusion

"We can't solve"We can't solveWe can t solve We can t solve problems by using the problems by using the same kind of thinking same kind of thinking we used when we we used when we created them." created them." --Albert EinsteinAlbert Einstein

Common Common eHealtheHealth ProjectsProjectsHIT Grant Programs

Hub for Administrative

& Financial Transactions

Electronic Prescribing

Disease Reporting or Registries

Regional/State Health

Information Exchange

Medical and/or Drug History

Common Projects forR d L t

g

Projects for Statewide eHealthEfforts

Record Locator & Master

Patient IndexClinical

Messaging

An Equal Opportunity UniversityAn Equal Opportunity University

UK HealthCare Information Technology Services Guiding Principles

2010

2009

Services Accountability- Based PracticeAccess to Data at the Point of ServiceService Oriented CulturePatient Centric CarePatient

H l h Electronic

RHIO

2007

2008

Innovation is Rewarded

Data RepositoryData Warehouse

ClinicalDecisionSupport

HealthRecord

Physician Referral Secure Health

Messaging

ElectronicHealth Record

Pre 2007

ED Tracking ICU PredictorApache

Barcode Medication OR Management

PICIS

CPOE InterdisciplinaryDocumentation

AmbulatoryCare

CapacityCommand

Center

EMAR

Scanning

PortalsWeb

Enablers

Pathology Pharmacy CBORD

ElectronicEKG

ResultsTraceMaster

OB QS FetalMonitoring

System

EndoscopyProvation

Cardiology(Witt,

Phillips)

OtherAncillaryServices

PACS

(ED Manager) Apache Administration PICIS

Dictation/

Registry’s(Trauma, cancer,

OTTR, Tumor)

CenterPatient Tracking

Single Sign OnSentillion Citrix Device

IntegrationRemedy

Support Center RFIDBar-Coding

PatientIdentification

Mobile Devices(Hand held)(wireless)

RadiologySiemens

PathologyCerner

CoPathPlus

LaboratoryMysis

PharmacyMediware

Worx

Sunrise ClinicalViewer

PharmacyPyxis

CBORDDiet Office

Management

ServerBased

Infrastructure

Dictation/Transcription

Soft Med

Registration(PM)

McKesson

Patient AccountsMcKesson

MedicalRecordsSoft Med

SchedulingRSS

FinancialDecisionSupport(SDMS)

ERP/Inventory

Mgt.SAP

KMSFPhysician

Billing(SMS)

CaseManagement

Soft Med

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McKesson

Claims/Billing

SSI

PresidentPresident--Elect Elect ObamaObamaand Healthcare ITand Healthcare IT

$10 Billion/year for 5 years to help$10 Billion/year for 5 years to help$10 Billion/year for 5 years to help $10 Billion/year for 5 years to help physicians and other providers adopt physicians and other providers adopt healthcare IThealthcare IThealthcare IThealthcare ITAfter the first 5 years, phase in After the first 5 years, phase in requirements for providers to adopt ITrequirements for providers to adopt ITrequirements for providers to adopt ITrequirements for providers to adopt ITSmall providers and those serving rural Small providers and those serving rural

d d d l ti ldd d d l ti ldand underserved populations would and underserved populations would receive top priority for financial supportreceive top priority for financial support