Carolyn P. Hartley Edward D. Jones, III
HIT Summit WestMarch 6, 2005
EHR Selection and Implementation
A Step by Step Guide
Healthcare Industry Convergence and TrendsEd Jones
SVP, FisaCure
Chair, WEDI Foundation
Convergence and Trends
Federal government shift from administrative to clinical standards
CHI Initiative Executive Order 13335 to create
ONCHIT Secretarial Summit to launch Decade of
Health Information Technology Framework for Strategic Action (4 goals)
Framework for Strategic Action Goal 1: Inform Clinical Practice. This
goal centers largely around effort to bring EHRs directly into clinical practice.Strategy 1. Provide Incentives for EHR
Adoption. Strategy 2. Reduce Risk of EHR
Investment. Strategy 3. Promote EHR Diffusion in
Rural and Underserved Areas.
Goal 2: Interconnect Clinicians Interconnecting clinicians will allow
information to be portable and to move with consumers from one point of care to another. This will require an interoperable infrastructure to help clinicians get access to critical health care information when their clinical and/or treatment decisions are being made. Strategy 1. Regional Collaborations. Strategy 2. Develop a National Health
Information Network. Strategy 3. Coordinate federal health
information systems.
Goal 3: Personalize Care
Consumer-centric information helps individuals manage their own wellness and assists with their personal health care decisions.Strategy 1. Encourage Use of
Personal Health Records. Strategy 2. Enhance Informed
Consumer Choice. Strategy 3. Promote Use of Telehealth
Systems.
Goal 4: Improve Population Health
Population health improvement envisions improved capacity for public health monitoring, quality of care measurement and bringing research advance more quickly into medical practice. Strategy 1. Unify Public Health Surveillance
Architectures. Strategy 2. Streamline Quality and Health
Status Monitoring. Strategy 3. Accelerate Research and
Dissemination of Evidence.
Convergence & Trends (cont’d) Accreditation and Certification of vendors Regional Health Information
Organizations Secretary of Health and Human Services
Michael Leavitt from Utah Health Savings Accounts (emerging
industry – medical banking) EHR standards development
Health Level Seven (HL7)
2-year draft standards for trial use (DTSU) pilot project.
• Announcement of pilot coincided with HHS Secretary Tommy Thompson’s launch of the “Decade of Health Information Technology.”
• What the pilot is not…• A messaging specification.
• An implementation specification.
• A conformance specification.
• An EHR specification.
• A conformance testing metric.
• An exercise in creating a definition for an EHR or EHR System
HL7 Pilot
What the pilot is…
An opportunity to test EHR
components, called functional descriptors, and to make comments to HL7 concerning specifics and relevancy to the conduct of business.
Convergence & Trends (cont’d)
Staff shortages Cultural attitudes about healthcare Upcoming generation of boomers’
demands for healthcare Personalized medicine
Electronic Health Records
MMAHIPAAHL7ONCHITStaff shortagesEHRsYou
YOU
ARE
HERE
Selection and Implementation
Carolyn P. Hartley
President, CEO
Physicians EHR, LLC
Moving into the EMR/EHR
Key Definitions Electronic Medical Records Practice Management Systems Electronic Health Records Personal Health Records Electronic Health Record Systems
Why EMRs Are Challenged With Integration
Push/Pull
Pull data Push data
NO!
Why RHIOs Might Be the Answer
Regional Health Information Organization
Central database Trusted resource Patient confidence Interoperability
EMR CategoriesLicensed software Hosted onsite
Own the software
IT Staff onsite
Investment over 5 years
ASP (Internet hosted) Hosted offsite
Subscription fee
Less initial investment
No IT staff
Blend Part Licensed software
Part ASP
What to Expect From an ASP
Possible hardware upgrades Secure and fully searchable data
448 bit encryption Automatic daily backup Own the data (format a concern) 24-hour support and free upgrades Training and implementation Ideal for “non-” or “semi-techies” $100/month to $thousands/month
What to Expect From Licensed Software Larger investment up front, less over
long haul Fixed costs, can be depreciated Onsite IT staff Hardware upgrades Investment in server Implementation, training, support $15,000 to $millions
What to Expect from a Blend
Move slower into EMRs through ASP, pay hosting fee
Own the software license 24 hour technical support Outpatient, ambulatory service center Training, implementation Bigger discounts Ideal for health community networks
201 Vendors queried
97
29
75
Licensed SoftwareASPBlend
January 2005 2010 Predictions
Your Wants and Needs(Your Primary Focus)
Prescriptions and referrals Analyze and share images Manage chronic diseases? Practice long distance medicine? Integrally linked to health care
community?
931 Flavors of EMR(How do you manage documentation?)
Type Dictation Voice recognition Handwriting recognition Scan documents Templates
What hardware do you like?
PDA Tablet PC Laptop Wireless Desktop computers Combination
Evaluation and Selection of EMRs
Narrow the field Determine delivery platform Determine number of users Integration and interoperability of
players Role of partners/stakeholders in
evaluation
The Role of Patients in Your EHR Selection
Many shapes of Personal Health Records (PHR)Thumb driveCell phonePDAsCredit/debit card
• Magnetic stripe• Mini processor
The Role of Colleagues in your EHR Selection
No EMR functions in isolation Evaluate your sphere of influence Increased buying power from
collaboration Case Study: Winona Health Role of IPAs, MSOs, RHIOs, Medical
Societies
Evaluation and Selection
Review online demonstrationswww.physiciansehr.com Demo Depot
Request in-person demonstration (often the point of sale)
Ask to solve a problem not in the salesperson’s repertoire
Companies that help you select an EMR
EMR Consultantwww.emrconsultant.com
EMR Institute, Incwww.emrinstitute.comEMR Finder™
Medical Records Institutewww. medrecinst.com
Purchasing and Negotiating
Ed Jones
Purchasing and Negotiation
Every contract has sections that are worth negotiating.
Purchasing and Negotiation
Due Diligence on the vendor/company Relationship with HL7? Participate in EHR Certification? How many practices of my size, type? How well do you work with IT
consultants? Ask about the strength of strategic
partners
Purchasing and Negotiation
Evaluate your current practice management system for integration
Submit an RFPSmall practices: 6 pagesCommunity networks: 6-25 pagesSet a deadline and stick to it
Purchasing and Negotiating
Leverage your existing IT investment Who manages system upgrades and
how often? Evaluate who is considered a user:
physicians only? Or all users? Costs of ASP, Licensed Software, or a
blend
Budgeting and Planning
Functions and features to look for:ASP, License, BlendAdd onsDocumentation costsStaffing costsCoding reimbursementReporting mechanisms (how are we
doing?)
Budgeting and Planning
What are the revenue enhancers? Clinical trialsCoding reimbursementMedical bankingIncreased patient interactionReduced insurance premiums
Implementation and Training
Ed Jones
Carolyn Hartley
Not At All Like Buying a Car
Like buying a car for your teenager. No point in purchasing an EMR
without training and implementation. Implementation plan begins with
understanding how your staff moves information.
Implementation
Workflow in a physicians practice
Before After
Implementation
Workflow in a hospital setting
Before After
Implementation: Integrated Healthcare Community
Hospital
PatientAssisted Living
Skilled nursingPrimary Care Physician
Specialist
Laboratories
Radiology
Hospice
payer
Pharmacy
Home care
Find the patient record.
Training
Understanding of how people learn There will be push-back – upsetting
the politics of “who has access” Need for internal coaches Role-based Understand level of training intensity Time span Ongoing support
www.physiciansehr.com
www.amapress.org
Available:
www.amazon.com
Product Demonstration
LabCorp
Product Demonstration
Allscripts
Product Demonstration
EMR company