EHR Practicalities

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EHR Practicalities

• Richard Vaughn MD
• Medical Director SSM Project Beacon

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Goals for this EHR talk

• Understand the current EHR market including
  government initiatives to support adoption
• High level roadmap to EHR
• Provide resources for further evaluation and
  investigation everything is hyperlinked
• Time is too short for many details more
  questions than answers

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EHR Benefits

• Safety
• Reduced drug errors
• Quality
• Preventative care
• Follow up of orders
• Better decisions with more information (P4P)
• Efficiency
• Inbox functionality for phone, refills
• No chart pulls 5-7 per pull
• Multiple users in the chart at the same time
• Improved coding and reimbursement
• Remote access
• Satisfaction

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EHR Risks

• Cost - uncertain ROI
• Change management real challenge!
• Time production will return to normal
• Training penny wise/pound foolish
• Operational costs increases overhead
• Unstable market consolidation in progress
• Hardware maintenance (network, server, PC)
• Standards evolving
• Interoperability!! Yeah, right!

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President Bush 2004 Speech

• In other words, medicine ought to be using modern
  technologies in order to better share
  information, in order to reduce medical errors,
  in order to reduce cost to our health care system
  by billions of dollars.
• And so you say, how do we do this? Well, first
  you set a goal. Within ten years, every American
  must have a personal electronic medical record.
  That's a good goal for the country to achieve.
  The federal government has got to take the lead

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Uncle Same Wants EHR!

• ONCHIT Office of the National Coordinator for
  Health Information Technology
• NHIN National Health Information Network
• E-prescribing Medicare Modernization Act
• CCHIT Certification Commission for Healthcare
  Information Technology
• CCR Continuity of Care Record
• DOQ-IT Doctors Office Quality Project

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ONCHIT Executive Order

• Ensures that appropriate information to guide
  medical decisions is available at the time and
  place of care
• Improves health care quality, reduces medical
  errors, and advances the delivery of appropriate,
  evidence-based medical care
• Reduces health care costs resulting from
  inefficiency, medical errors, inappropriate care,
  and incomplete information
• Promotes a more effective marketplace, greater
  competition, and increased choice through the
  wider availability of accurate information on
  health care costs, quality, and outcomes
• Improves the coordination of care and information
  among hospitals, laboratories, physician offices,
  and other ambulatory care providers through an
  effective infrastructure for the secure and
  authorized exchange of health care information
  and
• Ensures that patients' individually identifiable
  health information is secure and protected.

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Uncle Sam Wants EHR!

• Federal Government
• Evaluate additional standards to fully enable
  e-prescribing and coordinate with CCHIT
• Consider guidance regarding additional state
  preemption based on evidence of State laws that
  are barriers to e-prescribing
• Continue to develop EHR adoption strategies
  through Community work group
• Health IT Industry
• Adopt NCPDP SCRIPT and install in the existing
  install base/physician offices
• Get EHRs certified to meet key interoperability
  and functionality requirements
• Physician Organizations
• Communicate benefits of e-prescribing to members
  include the need for software upgrades that will
  enable true connectivity to pharmacies and PBMs
• Access implementation support from DOQ-IT,
  HITNRC, PERC, and regional organizations
• Health Plans
• Continue to offer incentives for improved quality
  through use of health IT
• Ensure compliance with regulated standards for
  e-prescribing under Part D
• Pharmacies
• Small and independent pharmacies without
  capability to receive an electronic prescription
  should work with vendors and wholesalers to
  enhance existing software capabilities

http//www.hhs.gov/healthit/documents/m20060117/eP
rescribingDiscussion.pdf
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http//www.hhs.gov/healthit/documents/m20060117/eP
rescribingDiscussion.pdf
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CCR Continuity of Care Record
http//www.medrecinst.com/pages/about.asp?id54
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DOQ-IT

• Through Doctor's Office Quality-Information
  Technology (DOQ-IT), Primaris offers primary care
  physicians free consultation regarding how to
  select and implement the correct Electronic
  Health Records (EHR) for their office. For those
  already utilizing an EHR, we will help you
  maximize system results. This includes quality
  improvement and pay for performance functions.
• FAQ file

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Small to mid size vendors

• Amazing charts
• Soapware
• E-clinical works
• E-MDs
• Medtuity
• Practice Partner
• NextGen
• Allscripts Healthmatics
• GE Centricity

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Big Vendors
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Due Diligence Culture

• Do the physicians want an EHR?
• Are you sure they want an EHR?
• Do they even know what an EHR is?
• Can they mouse, type, fax, surf?
• What do they think an EHR will do for them?
• How much will they spend today?
• How much will they spend annually?
• Can they make the change to an EHR?
• Its all or none!

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Warning to the wise -

• Culture ..
• Eats strategy for breakfast

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Due Diligence Data management

• Risk assessment
• PMS system interface vs. replace
• Lab/rad interface has it been done before?
• Hospital integration not likely!
• Document scanning a must, who will do it?
• Reorganizing around new processes
• Security/HIPAA
• Contracting (service levels, support, training,
  upgrades, customization)

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Due Diligence - Services

• Risk assessment (cont)
• E-prescribing
• Fax server
• Transcription current vs. future state
• Coding current vs. future state
• Billing current vs. future state
• Pay for performance
• Legal/risk
• Availability, back-up and recovery

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Due Diligence - Workflow

• Chart transfer how will you do this?
• Results overdue how to manage?
• Open telephone messages
• System safety warnings
• Cross coverage vacation
• Taxonomy, structured data entry
• Eric Rose - The physician perspective JHIM vol
  17, no 1

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Due Diligence

• Form an EHR committee it cant just be one
  person
• List your goals and metrics
• Obtain your baseline metrics
• Do a risk/readiness assessment
• Consider DOQ-IT or other consultants
• Evaluate the vendor market carefully Caveat
  Emptor! Know how to use a demo to your benefit!
• Sign a contract as an informed consumer
• Consider changes to overhead and production
  policy
• Stick to your plan!!!

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More resources

• CCI Readiness Assessment
• AAFP Center for Healthcare Information Technology
• EHR Central

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temet nosce Know Thyself
Know what you want to do before you do it