milwaukeesend 10 09 2009

EMR Use in the Age of Healthcare Reform

C. Martin Harris, M.D.Chief Information Officer, Cleveland ClinicExecutive Director, eCleveland Clinic

• On February 17, President Barack Obama signed the $787 billion American Recovery and Reinvestment Act of 2009.

• The “Act” includes $140 billion for “comprehensive healthcare reform.”

• A net overall investment of $19.2 billion, will be used to promote Health Information Technology adoption and implementation.

• Physicians and hospitals are eligible to receive portions of these funds based on:

– Having an integrated electronic medical record system in place by January 1, 2011.

– Demonstrating EMR “meaningful use”

New Opportunities: HIT Stimulus

American Reinvestment and Recovery Act HIT Directives

Framework(HIT Adoption, Quality

Management, and Interoperability)

Secretary, Health and Human

Services

HIT Policy Committee

HIT Standards Committee

Definition of Meaningful Use

StandardsDefinition

MeasuresDefinition

Stimulus-related (Funding)

• HIT-related Programs

– Definition of “Meaningful Use”

An enterprise-wide eHealth services program that is presently

changing the paradigm of medical practice by applying Health

IT solutions to improve patient care, enhance operational and

administrative efficiency, reach out to patients and

community physicians, and create new knowledge through

ongoing research and education initiatives.

eAnalytics and Research:

Research Standardization

eAnalytics and Research:

Research Standardization

Dr.Connect:Improved

Communication; Improved Care

Dr.Connect:Improved

Communication; Improved Care

MyPractice:Electronic Medical

Record System

MyPractice:Electronic Medical

Record System

MyPractice●

Community

MyPractice●

Community

eHealth ServiceseHealth Services

VirtualVisit:Patient/Physician

Interaction Globally

VirtualVisit:Patient/Physician

Interaction Globally

MyConsult:Your First Choice for

a Second Opinion

MyConsult:Your First Choice for

a Second Opinion

MyChart:Your Personal

Health Connection

MyChart:Your Personal

Health Connection

MyMonitoring:Ongoing Condition

Reporting from Home

MyMonitoring:Ongoing Condition

Reporting from Home

ProvidersProviders PatientsPatients

MyPractice:Electronic Medical

Record System

MyPractice:Electronic Medical

Record System

MyPractice Electronic Medical Record

Patients

Front Desk

NursesPhysicians

Schedulers

Residents

Researchers

Physicians = 6,004Residents / Fellows = 850Pharmacists = 364Other End Users = 38,608Patients in the EMR = 5,707,792

Prescriptions = 42,472,788Orders = 126,649,261Encounters = 24,174,250Total Results = 484,072,179

Cleveland Clinic User and Encounter Statistics(Through August, 2009)

Ambulatory Functionality• Messaging

• Schedule

• Results

• Documentation

• Physician Order Entry

• Best Practice Alerts

Electronic Medical Record Electronic Medical Record

Inpatient Functionality• Inpatient census

• All results

• Medication administration record

• Vital signs and I&O

• Documentation

• Computerized PhysicianOrder Entry (CPOE)

Electronic Medical Record Electronic Medical Record

Results

On-Line Documentation

Computerized Physician Order Entry

DRUGS:COUMADIN TABLET 2 MG POZOLOFT 50 MG POSIGNIFICANCE LEVEL. Very High

DRUGS:COUMADIN TABLET 2 MG POZOLOFT 50 MG POSIGNIFICANCE LEVEL. Very High Can override and

accept the interaction

Can override and accept the interaction

Drug Interaction Alert

Age, Gender, and Diagnosis SpecificHealth Maintenance Alerts

eAnalytics and Research:

Research Standardization

eAnalytics and Research:

Research Standardization

Dr.Connect:Improved

Communication; Improved Care

Dr.Connect:Improved

Communication; Improved Care

MyPractice:Electronic Medical

Record System

MyPractice:Electronic Medical

Record System

MyPractice●

Community

MyPractice●

Community

eHealth ServiceseHealth Services

VirtualVisit:Patient/Physician

Interaction Globally

VirtualVisit:Patient/Physician

Interaction Globally

MyConsult:Your First Choice for

a Second Opinion

MyConsult:Your First Choice for

a Second Opinion

MyChart:Your Personal

Health Connection

MyChart:Your Personal

Health Connection

MyMonitoring:Ongoing Condition

Reporting from Home

MyMonitoring:Ongoing Condition

Reporting from Home

ProvidersProviders PatientsPatients

MyChart:Your Personal

Health Connection

MyChart:Your Personal

Health Connection

MyChart

Patient Services• View medical information

• View health reminders

• View schedule

• Appointment request

• Prescription renewal request

s a l l y i

x

eAnalytics and Research:

Research Standardization

eAnalytics and Research:

Research Standardization

Dr.Connect:Improved

Communication; Improved Care

Dr.Connect:Improved

Communication; Improved Care

MyPractice:Electronic Medical

Record System

MyPractice:Electronic Medical

Record System

MyPractice●

Community

MyPractice●

Community

eHealth ServiceseHealth Services

VirtualVisit:Patient/Physician

Interaction Globally

VirtualVisit:Patient/Physician

Interaction Globally

MyConsult:Your First Choice for

a Second Opinion

MyConsult:Your First Choice for

a Second Opinion

MyChart:Your Personal

Health Connection

MyChart:Your Personal

Health Connection

MyMonitoring:Ongoing Condition

Reporting from Home

MyMonitoring:Ongoing Condition

Reporting from Home

ProvidersProviders PatientsPatients

MyMonitoring:Ongoing Condition

Reporting from Home

MyMonitoring:Ongoing Condition

Reporting from Home

eEnabled Chronic Care Management Model

Connectivity

eEnabled Chronic Care Management Model

,,,,

,

Patient’s Blood Pressure Measures from Home

MyPractice: Physician Results View

Connectivity

MyChart

eEnabled Chronic Care Management Model

Dear Patient,I recommend the following:Begin spironolactone 25mg once daily. I sent this as a secure ePrescription to your preferred pharmacy.Stop Norvasc (amlodipine), but do not discard.Decrease potassium to 20mEq once dailyStop by the lab for blood potassium test 2-3 weeks after making these changes.

Message me if you have additional questions.

eAnalytics and Research:

Research Standardization

eAnalytics and Research:

Research Standardization

Dr.Connect:Improved

Communication; Improved Care

Dr.Connect:Improved

Communication; Improved Care

MyPractice:Electronic Medical

Record System

MyPractice:Electronic Medical

Record System

MyPractice●

Community

MyPractice●

Community

eHealth ServiceseHealth Services

VirtualVisit:Patient/Physician

Interaction Globally

VirtualVisit:Patient/Physician

Interaction Globally

MyConsult:Your First Choice for

a Second Opinion

MyConsult:Your First Choice for

a Second Opinion

MyChart:Your Personal

Health Connection

MyChart:Your Personal

Health Connection

MyMonitoring:Ongoing Condition

Reporting from Home

MyMonitoring:Ongoing Condition

Reporting from Home

ProvidersProviders PatientsPatients

MyPractice●

Community

MyPractice●

Community

Connectivity / Interoperability

MyPractice Community database pre-loaded with:• 100+ million data elements • Insurance information for all major payors

MyPractice Community connected to:• Laboratories

– Cleveland Clinic Health System– Quest Diagnostics

• Retail Pharmacies• Acme ● Sam’s Club• CVS ● Walgreens• Giant Eagle ● WalMart• RITE AID

• Transcription Companies• MedQuist ● Precis ● Premier• Spheris ● Cymed ● Chase

1. Independent Physician’s Office

2. Independent commercial pharmacy,labs, and patient at home

3. Cleveland Clinic Ambulatory sites

4. Cleveland Clinic Inpatient

Meaningful UseOperating Model

Operating Model

Process to Achieve Meaningful Use

Objectives

“The ultimate vision is one in which all patients are fully engaged in their healthcare, providers have real-time access to all medical

information and tools to help ensure the quality and safety of the care provided while

also affording improved access and elimination of health care disparities.”

“Meaningful Use: A Definition” Recommendations from the Meaningful Use Workgroup

to the Health IT Policy Committee June 16, 2009