Getting IT into Doctors Offices

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Getting IT into Doctors Offices

• Dr. Bill Cavers October, 2005

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The Patient Visit

• S Subjective
• O Objective
• A Assessment
• P Plan

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IT the Patient Visit

• Subjective No effect
• Objective No effect
• Assessment Huge potential
• Plan Huge potential

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IT Effect on Patient Visit Assessment

• Access to coordination of Dx information
• Lab Current values Hx trends
• Diagnostic Imaging
• E-mS Transferable Core Data Set Shared Care
• Clinical Decision Support
• Access to Clinical Protocols Guidelines

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IT Effect on Patient Care Plan

• Access to shared information
• Electronic Medical Summaries
• Previous investigations, values and trends in
  searchable data base
• Clinical Decision Support
• E-Rx
• Access to current historical medication usage
• Access to adverse reactions
• Clinical Decision Support

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Benefits of IT

• Increased Patient Safety
• Canadian EHR- 29M fewer adverse drug events
• (Source Booz, Allen and Hamilton. Canada Health
  Infoways 10 Year Investment Strategy, March
  2005)
• Improved Patient Care
• Improved coordination of investigations,
  treatments
• Improved provision of guideline care, shared care

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Benefits of IT

• Reduction of Costs
• Canadian EHR-reduced duplication could save
  10.4B over 20 years
• Canadian EHR-reduction of adverse drug events
  would save 48.3B over 20 yrs
• Source Booz, Allen and Hamilton. Canada Health
  Infoways 10 Year Investment Strategy, March
  2005)
• More appropriate Rxing, reduced Rx errors, costs
• GPs with computerized decision-making support are
  18 less likely to inappropriately prescribe
• (Source Robyn Tamblyn et al. The medical
  office of the 21st Century effective-ness of
  computerized decision making support in reducing
  in appropriate prescribing in primary care, CMAJ
  Sept 16, 2003.)

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Benefits of IT

• Reduction of Costs (contd)
• Widespread use of EHRs will save U.S. health care
  system 77.8 billion annually (5 of total
  expenditures)
• (Source U.S. Centre for Information Technology
  Leadership 2005)
• Improved CDM could reduce burden of future
  illness

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Distribution of IT Benefits

• SYSTEM BENEFITS
• Improved Patient Safety
• Reduction of Costs
• Reduction of Illness Burden
• SHARED BENEFITS
• Improved Patient Safety
• Improved Patient Outcomes
• PHYSICIAN BENEFITS
• Improved Access/Organization of Lab
• Improved Access/Organization of DI
• Improved Access/Organization of Referrals/Shared
  Care
• Improved Access/Organization of Rx

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Benefits to Physicians

• To benefit individual physicians, IT must
• Increase efficiency of patient-doctor visit, or
• Have neutral effect, but with increased ease
• Have neutral effect with improved care outcomes
• Have negative time/efficiency impact with
  improved financial or other recognition of
  increase in time complexity of physicians
  workflow

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Low Hanging Fruit

• Lab
• Diagnostic Imaging
• E-Prescribing
• CDM Organization
• e-MS
• I have my standards. If you dont like them, I
  have others
• Groucho Marx

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Barriers

• Standards, Interoperability
• Connectivity
• Privacy and Security of Information
• Patient
• Provider
• Site
• Costs
• Vendor Security
• Change Management
• Technical Support and Training
• Redesign of Workflow

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Barriers Costs (The Foothills)

• Hardware
• 1 computer/screen per exam room
• 1 computer/screen per receptionist
• 1 computer/screen per doctor office
• 1 computer/screen per extra work stations
• Servers
• Printer Servers
• Wiring office
• Software
• User licenses
• Medical software
• Firewall
• Antivirus
• Microsoft Office
• Connectivity
• Support

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Barriers Costs (The Foothills)

• Example My Own Office
• Recent purchase of 6 computers, flat screens, 1
  server and 3 printer serrvers 14,500
• For full computerization require extra 9-10
  terminals for exam rooms, staff working
  terminals, or wireless system with 5 to 6
  wireless laptops/tablets

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Significant Costs

• Health Affairs Article (2005)
• Average initial costs to implement EHR per FTE
  provider in physician office 44,000 U.S. (52k
  Cdn)
• Average ongoing costs 8,500 (U.S) per provider
  per year (10k Cdn)
• Software (incl. training and installation),
  hardware, maintenance/support costs, etc
• (Source Health Affairs, Volume 24, Number 3 The
  Value of Electronic Health Records in Solo or
  Small Group Practices, Sept/Oct 2005)

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Barriers Data Entry (Mountains)

• Data Entry
• Initial Entry Blood, Toil, Sweat, Tears
• Ongoing Entry Time
• Changes to workflow
• Initial increased workloads
• Increased Staff needs to input data

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Key Challenges BCs Health IT System

• Developing Common Standards to build an IT
  Infrastructure
• Ensuring Personal Health Information is
  Adequately Protected
• Creating Incentives to Encourage Adoption of IT
  Systems
• Developing Guidelines dealing with the Secure
  Transfer of Information

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Key Challenges BCs Health IT System

• Assembling Evidence to Demonstrate the
  Effectiveness and Usefulness of IT Systems
• Improving Integration among various Information
  Systems
• Enhancing IT Training Opportunities available for
  Providers
• Ensuring Practising Physician Input into the
  Development of Systems
• (Source BCMA. Getting IT Right Patient Centred
  Information Technology. January 2004.)

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Significant Costs

• Infoway 10 Year Investment Strategy
• 10 year total cost of Canada-wide EHR (incl.
  acquisition and ongoing costs) 22.7 billion
• 2.5b for physician practice systems
• Average MD acquisition cost
• 26,000 with yearly costs of 4,000 per physician
• Cost varies according to practice size larger
  practices benefit from economies of scale
• (Source Booz, Allen and Hamilton. Canada Health
  Infoways 10 Year Investment Strategy, March 2005)

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Significant Costs

• U.S. Study
• Achieving a National Health Information Network
  (NHIN) would cost 156 billion in capital costs
  over five years with 48b in annual operating
  costs (total 400b over five years)
• 2/3 of costs would go towards acquiring
  functionalities and 1/3 toward interoperability
• (Source Rainu Kaushal et al. The Costs of a
  National Health Information Network, Ann of
  Intern Med. August 2005).

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Benefits of Electronic RecordsPatient Safety

• "Paper records and prescriptions kill. Mistakes
  made by depending on and using paper keep
  happening the thing is, they're avoidable.
  Everyday that we don't act, people will continue
  to die unnecessarily."
• Former U.S. House Speaker Newt Gingrich
• Remarks at 2004 Frontiers of Health Care
  Conference at Brown University June 22, 2004

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Benefits of Electronic Records
"Electronic health records have the potential to
help reduce medical errors, lower costs and
empower patients. However, without the widespread
adoption of electronic health records by small
and medium physician practices and the
requirements for achieving the interconnectivity
necessary to allow for the effective exchange of
health related information, the benefits of
information technology cannot be fully
realized." Carol Diamond, MD,Managing Director
at the Markle Foundation and Chair of Connecting
for Health October 22, 2004
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Thank you for your time . Questions?