electronic health record / electronic medical record concept and challenges november 16, 2007

© Copyright IBM Corporation 2007

Electronic Health Record / Electronic Medical Record

Concept and Challenges

November 16, 2007


Most Commonly Used Definition of EHR/EMR

Electronic Health Record (EHR)

“a secure, real-time, point-of-care, patient-centric information resource for clinicians.

The EHR aids the clinicians’ decision-making by providing access to patient health record information when they need it and incorporates evidence-based decision support.

The EHR automates and streamlines the clinicians’ workflow, ensuring all clinical information is communicated and ameliorates delays in response that result in delays or gaps in care.

The EHR also supports the collection of data for uses other than clinical care, such as billing, quality management, outcomes reporting, and public health disease surveillance and reporting.”

Source: http://www.himss.org/content/files/ehrattributes070703.pdf


Technology Infrastructure

Basic Order Entry and Results Reporting System

Clinical Documentation

Clinical Decision Support Tools

Technology Tools for User Interface

Electronic Medical Record (EMR) is a building block process

and the Clinical System is a major foundation block …. and the Clinical System is a major foundation block ….


Current State of Systems

Outpatient EMROutpatient EMR

Health SystemHealth System

Inpatient EMRInpatient EMR


New state level healthcare environment can reallocate services and funding to improve health care outcomes and reduce costs

HHS

FDA

AHRQ

CDC

CMS

VA

MHS

Private Grants

Grants/Bids• CDC Biosurvelliance• NHIN 2• Midcare Modernization

Medicaid/Insurance Companies

Wellness, Disease Management, Claims Analysis, PHR, Exercise Programs

State Employees Insurance Fund

Wellness, Disease Management, Claims Analysis, PHR, Exercise Programs

Hospitals and ClinicsNHIN 2, Relief from uninsured

PatientPortal, PHR, Medical Home, Wellness

PhysiciansHealth Home, Bridges to Excellence, HTS, Portal, Hosted PHR

Network/NHIN


Forces driving information transformation in provider healthcare

Increasing costs and changing reimbursement

Maturing adoption of IT but still ISV dominated

Market drivers / Demographic shifts

Public reporting cost and quality

information

More informedconsumers

Changing demographics

Stark Law relief for IT

IT System & Standard Adoption

Hospitals must report patient-satisfaction data for Medicare reimbursement

Effective 2007

Growing Pay4 Performance

Bonus paid for each claim meeting specific quality

criteria

Nonpayment for Performance - Medicare’s New Reimbursement Rule

Effective 10/2007

Departmental automation

Hospital-based EMR

Enterprise analytics & integration


Healthcare Organizations are data rich but Information poor……Challenges• Brittle Applications• Infrastructure complexity• Information Islands• Fragmented knowledge management• Performance and bottlenecks• Application and development silos• Rising cost of meeting business needs• Volume and complexity of data


Vendor Market


Product Life Cycles and Vendors

Eclipsys 7000

NewPilot sites completedNew sales acceleratingHigh investment in development

SunsetLittle investmentin supportNo new client sales

DecliningDeclining investment in enhancementsFew new client sales

CompetitiveStrong new client sales. Relatively heavy investment in enhancements

Pre-ReleaseMajor development underway Pilot sites being installed

CernerClassic

SiemensSoarian

SiemensInvision

MeditechC/S &Magic

CernerMillennium

EclipsysSCM

EpicEpicCare

Eclipsys SunriseXA

GE CentricityEnterprise

McKessonHorizon

McKessonParagon


KLAS 2007 Mid-Year Category Leaders


Case Studies


Selection of Electronic Health Record

Governance• Making sure everyone that needs to be involved participates in the

process

Structured and effective process• Structured process• Recognizing when it needs to be tweaked

The Decision• Commitment to make the decision


Selection process included four key milestones …… Decision Days

Finalization of Key Requirements and Guiding Principles

Finalization of the solution

components for a core clinical

information system

Approval of Vendor Short List

Selection of three vendors with solutions

appropriate and suitable for

CSHS

Approval of Vendor Finalists

Top two vendors whose solutions could

potentially meet the future state needs of

CSHS

Approval of Vendor of Choice

The solution most suitable for CSHS – believed to provide

the best functionality, technical capabilities, and market leadership

Decision Day #1January 2007

Decision Day #2March 2007

Decision Day #3June 2007

Decision Day #4august 2007


Vendor Comparison Categories

Functionality Functionality

Evaluation based on the key requirements1 from future state sessions

Clinical Documentation Orders Management Medication Management Pharmacy Clinical Decision Support Results Review Usability Health Analytics

1 Key Requirements are in Attachment B

Functionality Functionality

Evaluation based on the key requirements1 from future state sessions

Clinical Documentation Orders Management Medication Management Pharmacy Clinical Decision Support Results Review Usability Health Analytics

1 Key Requirements are in Attachment B

Technology Technology

Evaluation based on the technical requirements identified in the process

Integration with CSHS environment (intra-operability) Scalability Speed and Reliability

Technology Technology

Evaluation based on the technical requirements identified in the process

Integration with CSHS environment (intra-operability) Scalability Speed and Reliability

Company Company

Evaluation based on market intelligence and experiences

Vendor Vision Company Viability Ability to Execute Customer Service Focus Vendor Culture and Goals alignment with CSHS

Company Company

Evaluation based on market intelligence and experiences

Vendor Vision Company Viability Ability to Execute Customer Service Focus Vendor Culture and Goals alignment with CSHS


Comparative Approach

Overwhelmingly recognized as the leader – second to none.

Generally recognized as a leader - could be tied with one other.

Considered equivalent to others – tied with two or more.

Needs improvement – More than three other vendors considered materially better.

Not generally available – may be building it but doesn’t have it today.

Comparative Scale:

Each vendor was scored according to the following scale:

Note: Vendors are presented in alphabetic order throughout

G

R


Connectivity Between Inpatient and Outpatient EMR


Guiding Principles

Physician needs must be met- Maintaining or improving existing functionalities - Implementing process improvements to enhance the quality of care

Patient safety and quality of care will be improved

Regulatory requirements will be satisfied (e.g. JCAHO, etc.)

The revenue structure may only be positively affected

Use the applications as designed, and coordinate business practices to optimize the software


Thank You

electronic health record / electronic medical record concept and challenges november 16, 2007

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