the future of health information technology necessary evil or blessing in disguise

The Future of Health The Future of Health Information TechnologyInformation Technology

Necessary Evil or Necessary Evil or Blessing in DisguiseBlessing in Disguise

Mark R. Anderson, FHIMSS, CPHIMSMark R. Anderson, FHIMSS, CPHIMSAC Group, Inc.AC Group, Inc.

Mark Anderson, FHIMSS, CPHIMSSMark Anderson, FHIMSS, CPHIMSSHealthcare IT FuturistHealthcare IT Futurist

34+ Years In Healthcare IT34+ Years In Healthcare IT

IDN ExpertiseIDN Expertise– CIO Position at Three Multi Facility Regional IDN’sCIO Position at Three Multi Facility Regional IDN’s– Executive Team Member at 5 Different IDN’sExecutive Team Member at 5 Different IDN’s– Worked In 158 Hospitals and 21 Payer OrganizationsWorked In 158 Hospitals and 21 Payer Organizations

Physician ExpertisePhysician Expertise– Managed 50 Physician Practices in the Late 1980’sManaged 50 Physician Practices in the Late 1980’s– Former CIO of a 2,300+ physician (500+ Practices) IPAFormer CIO of a 2,300+ physician (500+ Practices) IPA– Currently Conducting EHR Searches for > 100 PracticesCurrently Conducting EHR Searches for > 100 Practices– National Speaker on EHR - > 380 sessions since 2001National Speaker on EHR - > 380 sessions since 2001– Negotiated more than 100 EHR contractsNegotiated more than 100 EHR contracts

Installed over $1B in technologies since 1972Installed over $1B in technologies since 1972

DisclosureDisclosure

Speaking at numerous professional associations Speaking at numerous professional associations and at vendor meetings and at vendor meetings (over 100/Year)(over 100/Year)

White Papers on the use of technologyWhite Papers on the use of technology

Serve on numerous conference boardsServe on numerous conference boards

EHR Search and Selections EHR Search and Selections (> 100 Practices)(> 100 Practices)

DOQ-IT and CMS EHR Selection ToolDOQ-IT and CMS EHR Selection Tool

NONO Revenue from any vendor based on any Revenue from any vendor based on any Sales or increase in RevenuesSales or increase in Revenues

Why is this session importantWhy is this session important

In 2006, the healthcare industry saw an In 2006, the healthcare industry saw an explosion in interest in the ambulatory EHR explosion in interest in the ambulatory EHR marketplace marketplace

Partially driven by quality indicators, P4P, and a Partially driven by quality indicators, P4P, and a relaxing in the Stark law that prohibited hospitals relaxing in the Stark law that prohibited hospitals from funding community EHR initiatives. from funding community EHR initiatives.

What does this mean for the average Physician What does this mean for the average Physician Practice?Practice?

TopicsTopics

How will EHR initiatives are changing the way practices How will EHR initiatives are changing the way practices look technology decisions?look technology decisions?

What is the government’s involvement in EHRs?What is the government’s involvement in EHRs?

How are hospitals leveraging EHR projects to increase How are hospitals leveraging EHR projects to increase physician bonding?physician bonding?

How with EHR affect your revenue stream?How with EHR affect your revenue stream?

Why do systems fail?Why do systems fail?

How the EHR vendors are rated and why many will not How the EHR vendors are rated and why many will not survive?survive?

VisionVision

“Technology is simply a catalyst that will empower providers to drive meaningful changes in care.”

“ People love progress … but hate change”

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What issues are physicians What issues are physicians interested in?interested in?

Maintain or improve QualityMaintain or improve Quality

More timely and accurate More timely and accurate payments from carriers.payments from carriers.

Save time and money.Save time and money.

Allow them to see more patients Allow them to see more patients per day. per day.

More productive organization's.More productive organization's.

Provide information about their Provide information about their organization's.organization's.

The Thing About the Future…The Thing About the Future…

……You Hate Getting It Wrong!You Hate Getting It Wrong!

And Big Surprises Aren’t Much BetterAnd Big Surprises Aren’t Much Better!!

With Only the Past for a Compass…With Only the Past for a Compass…Who will guide you?Who will guide you?

Patterns Must Lead to ActionPatterns Must Lead to ActionSuccess = Teamwork Success = Teamwork

The Digital Medical OfficeThe Digital Medical Office of the Future of the Future


C C R

Post Exam

Appointment Scheduling

Check-in

• Update patient demographics• Scan Insurance cards/• Scan Driver’s license• Sign consent forms

• Receive Appointment Request• Schedule/Reschedule Appointments• Perform eligibility check

• Perform Treatment Procedures• Draw specimen for Diagnostic Procedures• Fax/Transmit Rx and Diagnostic Orders

Charge Codes

Billing

• Take patient picture• Collect Co-pay• Create Encounter

Exam

Pre-exam

• Document PFSH• Document ROS• Take Vitals

• Review PFSH/ROS/Vitals/ Diagnostic Reports

• Perform Physical Exam• Document Assessment• Order Rx/Diagnostic

Procedures/Treatment Procedures• Provide Patient Education

Check-out• Schedule follow-up

appointment• Perform referral

authorization• Obtain Referral

appointment• Collect payments

Refer out

Refer in

C C D

The EHR Process

Information OverloadInformation Overload

% who already have implemented % who already have implemented EHR ApplicationsEHR Applications

What is the government’s What is the government’s involvement in EHRs?involvement in EHRs?

Free EHR - VistaFree EHR - VistaCongress – What till 2009Congress – What till 2009Personal Health Record InitiativesPersonal Health Record InitiativesSetting Standards – CCHITSetting Standards – CCHITCMS and P4PCMS and P4PSetting Guidelines - HIESetting Guidelines - HIERelaxation in Stark Law Relaxation in Stark Law

WirelessTablet

WirelessAccess Point

EMR/PMApplication

WirelessTablet


EMR/PMApplication

Enabling Responsive Local Patient CareEnabling Responsive Local Patient Care

WirelessTablet


CCD DataCCD Data

Patient DemographicsPatient InsuranceMedicationsAllergiesHealth Maint AlertsLab ResultsDictated ReportsVital SignsDX and CPT codes

Patient DemographicsPatient InsuranceMedicationsAllergiesHealth Maint AlertsLab ResultsDictated ReportsVital SignsDX and CPT codes

EMR/PMApplication

Physician at Home

Patient’sHome

Practice 1 Practice 2 Practice 3

Connecting PhysiciansConnecting PhysiciansDelivers the Connected CommunityDelivers the Connected Community

In-patient Clinical & Physician Portal

Physician Office Solutions

Broad CommunityConnectivity

PatientsPatients Payers & PBMsPayers & PBMs

Retail Retail PharmacyPharmacy

HomecareHomecareProvidersProviders

EmployersEmployers PhysiciansPhysicians

HospitalsHospitals Ancillary Ancillary DepartmentsDepartments

HIE Technology is best positioned to lead the way to a connected care

community

It shouldn't take a brain surgeon to design one patient centric community

EHR


ResultsPrinting

•Auto-route to the office• Auto-print to the office

$30-$50

Clinical Access

•Physician Portal•Results Viewing•Messaging and Alerts

$50-$70

Level 1 Practice Support

•eRX •Orders•Results

$55-$100

Level 2 Practice Support

•EMR Light•Charge capture•Hlth Maint Plan•Referral Management

$500-$700

Level 3Practice Support

•Fully functional EMR•CDS•KBS

$700-$1,000

EHR/Interoperability

Offering Physicians ChoicesA Flexible and ModularPath to EMR

Http://www.acgroup.orgHttp://www.acgroup.org Page No: Page No: 2222

Hospital BenefitsHospital BenefitsPhysician BondingPhysician Bonding

ER has access to extensive information about patients (prior Meds, ER has access to extensive information about patients (prior Meds, allergies, lab results, chronic issues, health maintenance alerts)allergies, lab results, chronic issues, health maintenance alerts)

Single source Enterprise Wide documentationSingle source Enterprise Wide documentation

– Nursing, PT, OT, Dietary, Social WorkersNursing, PT, OT, Dietary, Social Workers

Reduce errors by up to 78%Reduce errors by up to 78%

Nursing has access to prior patient clinical information in a summary Nursing has access to prior patient clinical information in a summary format and detailed data by dateformat and detailed data by date

35% of nursing documentation is auto generated35% of nursing documentation is auto generated

Physician Order Entry adoption based on best practicesPhysician Order Entry adoption based on best practices

No change in registration, scheduling, and billingNo change in registration, scheduling, and billing

Auto generation of HPI and Discharge SummaryAuto generation of HPI and Discharge Summary

98% reduction in HPI and Discharge Transcription Costs98% reduction in HPI and Discharge Transcription Costs


Physician BenefitsPhysician BenefitsHospital SponsorshipHospital Sponsorship

Help with cost (Relaxation in the Stark Law)Help with cost (Relaxation in the Stark Law)

One system for all chartingOne system for all charting

One system for ordersOne system for orders

Reduce charting while in the hospital by 73%Reduce charting while in the hospital by 73%

Auto Charge Capture for physician office visitsAuto Charge Capture for physician office visits

Hospital Lab results delivered 87% fasterHospital Lab results delivered 87% faster

Access to hospital data from home (with security)Access to hospital data from home (with security)


Benefits to the PhysicianBenefits to the Physician

Clinical IntegrationClinical Integration

Reduce operating cost > 8%Reduce operating cost > 8%

Improve Revenue Capture > Improve Revenue Capture > 3%3%

Lower costs = 40% reductionLower costs = 40% reduction

Monthly fixed costs with local Monthly fixed costs with local supportsupport

Pay-for-performance - Pay-for-performance - $5K-10K$5K-10K

Interfaces to all sourcesInterfaces to all sources

Data exchange between Data exchange between Primary Care, Specialists, Primary Care, Specialists, and Hospitalsand Hospitals

Contract terms and Contract terms and conditionsconditions

P4PP4P


Potential Business BenefitsPotential Business BenefitsClinician time savings of between 19% and 26% of non direct Clinician time savings of between 19% and 26% of non direct pt. care timept. care time

MA/Nurse time savings of between 20% and 28% of daily MA/Nurse time savings of between 20% and 28% of daily activitiesactivities

Medical Record cost reduction of between 64% to 74%Medical Record cost reduction of between 64% to 74%

Transportation cost reduction of between 80% and 92%Transportation cost reduction of between 80% and 92%

Paper cost reduction of between 61% and 68%Paper cost reduction of between 61% and 68%

Transcription costs reduction of between 73% and 87%Transcription costs reduction of between 73% and 87%

Billing costs reduction of between 6% and 12%Billing costs reduction of between 6% and 12%


Potential Business BenefitsPotential Business BenefitsCharge capture and coding costs reduction of between 84% and 90%Charge capture and coding costs reduction of between 84% and 90%

Reception costs reduction of between 10% and 14%Reception costs reduction of between 10% and 14%

Lab handling costs reduction of between 61% and 70%Lab handling costs reduction of between 61% and 70%

Rx handling costs reduction of between 57% and 64%Rx handling costs reduction of between 57% and 64%

Scheduling costs reduction of between 6% and 12%Scheduling costs reduction of between 6% and 12%

EOB Posting costs reduction of between 61% and 68%EOB Posting costs reduction of between 61% and 68%

Collection costs reduction of between 4% and 8%Collection costs reduction of between 4% and 8%

QA Reporting costs reduction of between 46% and 60%QA Reporting costs reduction of between 46% and 60%

ER costs decrease by 31% since the ED physicians has access to ER costs decrease by 31% since the ED physicians has access to prior clinical records and results.prior clinical records and results.


Benefit to the patientBenefit to the patientAnswer questions one timeAnswer questions one time

Centralized Patient RecordCentralized Patient Record

Reduced potential errorsReduced potential errors

Improved clinical quality and outcomesImproved clinical quality and outcomes

Reduced unnecessary tests by 73%Reduced unnecessary tests by 73%

Reduce costs by reducing waste in the clinical processReduce costs by reducing waste in the clinical process

ER has access to data at the point of careER has access to data at the point of care


Why systems FAIL!Why systems FAIL!


EHR Failure rate EHR Failure rate

Through 2007, the EHR failure rate continues Through 2007, the EHR failure rate continues to increase.to increase.

When asked, “1 year of EHR installation, are When asked, “1 year of EHR installation, are you seeing 80% of your patients using the EHR you seeing 80% of your patients using the EHR for charting, ROS, HPI, Evaluation, coding, for charting, ROS, HPI, Evaluation, coding, orders and results reporting”.orders and results reporting”.

– 73% of the physicians (3,245) indicated that no, they 73% of the physicians (3,245) indicated that no, they were NOT using the EHR for 80% of their patients.were NOT using the EHR for 80% of their patients.

– 18% replaced or were not using EHR18% replaced or were not using EHR

– Why, are 73% of the physicians NOT fully utilizing Why, are 73% of the physicians NOT fully utilizing the EHR after 1 year?the EHR after 1 year?

So why are there so many failures?So why are there so many failures?

Http://www.acgroup.orgHttp://www.acgroup.orgPage No: Page No: 3030

Poor planningPoor planning Unrealistic expectationsUnrealistic expectations Lack of physician and provider supportLack of physician and provider support Flawed selection processFlawed selection process Mismanagement of workflow and staffing Mismanagement of workflow and staffing

changeschanges Poor Contract TermsPoor Contract Terms Workflow redesign - COTWorkflow redesign - COT

Why do Implementations Fail?Why do Implementations Fail?

Organizational and Clinical Organizational and Clinical TransformationTransformation


Delivery Model – Levels of Delivery Model – Levels of Value DeliveryValue Delivery

Install: EMR Usage

Implement: EMR Process Change

Transform: Maximum Value Realization


Roles & ResponsibilitiesRoles & ResponsibilitiesEMR VendorEMR Vendor TransformationTransformation PracticePractice

Deliver Technology ProductDeliver Technology Product Ensure Value Delivery & Ensure Value Delivery & Facilitate ExchangeFacilitate Exchange

Adopt & Perform with New Adopt & Perform with New SolutionSolution

Provide EMR Best PracticesProvide EMR Best Practices Strategy – Goal AlignmentStrategy – Goal Alignment Provide SponsorshipProvide Sponsorship

Tech System AssessmentTech System Assessment Assess ReadinessAssess Readiness Commit ResourcesCommit Resources

Build Technology InterfaceBuild Technology Interface Create Program StructureCreate Program Structure Make DecisionsMake Decisions

Present Standard TemplatesPresent Standard Templates Program CommunicationsProgram Communications Steering CommitteeSteering Committee

Train Super UsersTrain Super Users Program Planning & ManagementProgram Planning & Management Practice Management LiaisonPractice Management Liaison

Train UsersTrain Users Process DevelopmentProcess Development Clinical Liaison Clinical Liaison

Configure SoftwareConfigure Software Benefit TrackingBenefit Tracking Administrative Workflow TeamAdministrative Workflow Team

Load SoftwareLoad Software Change Management ActivityChange Management Activity Clinical Staff Workflow TeamClinical Staff Workflow Team

Test SupportTest Support Vendor ManagementVendor Management Provider Workflow TeamProvider Workflow Team

Respond to Change RequestsRespond to Change Requests Roll Out ManagementRoll Out Management Billing Workflow TeamBilling Workflow Team

Integrate LessonsIntegrate Lessons Technical Workflow TeamTechnical Workflow Team

What are Practices PurchasingWhat are Practices Purchasing

Source: AC Group annual survey of buying patterns

When will Physicians PurchaseWhen will Physicians Purchase


When will Physicians PurchaseWhen will Physicians Purchase


Implementation Gap

Who will be purchasingWho will be purchasing% of sales by Service% of sales by Service

AC Group annual survey of buying patterns

How the EHR vendors are rated and How the EHR vendors are rated and why many will not survive?why many will not survive?

Too many vendors to countToo many vendors to count

Too many vendor promising the worldToo many vendor promising the world

Too many failuresToo many failures

How do you tell them apart?How do you tell them apart?

What are you looking for?What are you looking for?

How do you evaluate them?How do you evaluate them?

Market Change over timeMarket Change over timeOver 380 vendors claiming to sell EHRs

Selecting the wrong vendor

could cost you over $50K per provider

EMR/EHR Selection ToolEMR/EHR Selection Tool

AC Group conducted extensive AC Group conducted extensive evaluation of the EHR marketplaceevaluation of the EHR marketplace

– 9th report 9th report

– Completed in October 2007Completed in October 2007

– Included over 3,000 functional Included over 3,000 functional questionsquestions

– 48 categories of functionality48 categories of functionality

– 26 subcategories of charting 26 subcategories of charting functionalityfunctionality

114 Vendors have participated114 Vendors have participated

EMR/EHR Selection ToolEMR/EHR Selection Tool

Charting VendorsCharting Vendors

EMR Light VendorsEMR Light Vendors

EMR VendorsEMR Vendors

EHR VendorsEHR Vendors

CHR VendorsCHR Vendors

Combined PMS/EHRCombined PMS/EHR

FQHCFQHC

Mental HealthMental Health

AC Group Product EvaluationsAC Group Product Evaluations

EHR Functionality OnlyEHR Functionality OnlyPMS – EHR Functionality OnlyPMS – EHR Functionality Only

– End-User End-User SatisfactionSatisfaction

KLASKLAS

AAFPAAFP

AC GroupAC Group

Total Company RatingTotal Company Rating

– Company StabilityCompany Stability RevenuesRevenues CCHITCCHITTotal Ambulatory RevenuesTotal Ambulatory RevenuesClient BaseClient BaseTechnologyTechnology


Certification Commission for Healthcare Certification Commission for Healthcare Information TechnologyInformation Technology

CCHIT is the recognized certification authority for CCHIT is the recognized certification authority for electronic health records and their networks, and an electronic health records and their networks, and an independent, voluntary, private-sector initiative. independent, voluntary, private-sector initiative.

The mission is to accelerate the adoption of health The mission is to accelerate the adoption of health information technology by creating an efficient, credible information technology by creating an efficient, credible and sustainable product certification program.and sustainable product certification program.

Http://www.acgroup.orgHttp://www.acgroup.orgPage No: Page No: 4444

CCHIT Certified EHR VendorsCCHIT Certified EHR VendorsCertification is good for 3 years – but!!!!!Certification is good for 3 years – but!!!!!

2006 Certified vendors will need to renew again in 2007

As of Feb 1, 2008 only 13 vendors have passed the 2007 CCHIT

Top EMR/EHR Vendor ApplicationsTop EMR/EHR Vendor ApplicationsPractices with > 100 PhysiciansPractices with > 100 Physicians

Based on 2,750 Functional Questions Divided Between 46 Categories

GE does not want their ranking published

Top EMR/EHR Vendor ApplicationsTop EMR/EHR Vendor ApplicationsPractices with 20 to 99 PhysiciansPractices with 20 to 99 Physicians


Bottom LineBottom Line

What does it take to thrive?What does it take to thrive?

BOTTOM LINEBOTTOM LINE

Physicians need help when it comes to Physicians need help when it comes to technologytechnology

Physicians need local supportPhysicians need local support Physicians need help with contracts and Physicians need help with contracts and

pricingpricing The community needs to share dataThe community needs to share data 80% of the data is in the office80% of the data is in the office Lets empower the physicianLets empower the physician

For More InformationFor More InformationMark R. Anderson, FHIMSS, CPHIMSMark R. Anderson, FHIMSS, CPHIMS

CEO and Healthcare FuturistCEO and Healthcare Futurist

AC Group, Inc.AC Group, Inc.

118 Lyndsey Drive118 Lyndsey Drive

Montgomery, TX 77316Montgomery, TX 77316

(281) 413-5572(281) 413-5572

eMail: mark.anderson @ acgroup.org eMail: mark.anderson @ acgroup.org

www.acgroup.orgwww.acgroup.org

QuestionsQuestions

the future of health information technology necessary evil or blessing in disguise

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