Implementation of an Electronic Health Record

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Implementation of an Electronic Health Record

• Mark Ficker
• Vice President, Medical Group Services Chief
  Financial Officer

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Brown Toland Overview
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Mission
Leading organization of community and academic
physicians
Brown Toland Medical Group is a
leading organization of community and academic
physicians. We are committed to
providing superior, coordinated and comprehensive
medical services. Owned and governed by
physicians, we provide excellent healthcare,
product choice, and value to our patients through
clinical integration, innovation, and
technology.
Owned and governed by physicians
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Brown Toland Medical Group

• IPA with 195,000 Members
• 1,500 Physicians
• Product Offerings Services
• Financial Health
• Northern California Health Care Marketplace

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Key Business Objectives

• Enhance Clinical Integration Continue to
  develop processes and systems to clinically
  integrate care across the BTMG physician network.
  
• Health Improvement and Quality Improvement
  Continue to promote clinically integrated,
  comprehensive patient health care through health
  improvement and quality improvement programs.
• Organizational Cost Reductions Reduce
  organizational cost through improving the quality
  of patient care delivered and by continuing to
  implement administrative efficiencies.
• Network Diversification and Product
  Administration Provide a comprehensive, cost
  effective, high quality network of health care
  and administrative services for all competitive
  medical benefit plan models.
• Physician Services Provide administrative and
  point of care services that will efficiently
  manage the physicians practice and enhance the
  overall quality of care provided.
• Regulatory Compliance Continue to comply with
  all regulatory requirements.

• Develop disease management programs
• Develop an outcomes measurement program
• Improving health in the community
• Recognize, reward assist high quality,
  efficient, effective physician practices
• Improve physician office staff education programs

• Physician Office Services
• Network Management
• Product Development
• Information Technology
• Human Resources
• RX Management

• Claims administration eligibility
• Customer service
• Care management
• Quality improvement
• Finance
• Data Warehouse DSS

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Building a Strong Foundation
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Brown Toland Medical Group Characteristics
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Staged IT Strategy 2000 - 2008
Transformation
Differentiate

• HIPAA Remediation
• Web EMR Options Analysis System Selection
• Clinical Protocols Alerts
• Physician/Patient Connectivity
• Decision Support Reporting
• Medical/Disease Management Programs
• Evaluate CRM Options
• Expanded Network Services
• End User Device Standards
• Remote Access Control
• Operational Improvements

• Physician Services Integrated PMS EMR
• All Product Offering
• Sustainability and Competitive Advantage

Operational Efficiency Regulatory Risk
Assessment

• IDX Optimization Data Quality
• RACER Replacement
• Data Warehouse/Data Marts
• InterQual Implementation
• Web Foundations
• Portal Development eArchitecture
• HIPAA Risk Assessment
• Disaster Recovery Planning
• Help Desk

2004 - 2008
2000 - 2003
8 Million
10 - 12 Million
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Foundation for IT Success

• IT success depends on establishing a solid
  foundation to enable strategies and deliver
  expected outcomes benefits

User focus is typically at the surface on
their own expected benefits
User Benefits
How well systems provide these benefits depends
upon a solid, below the surface foundation
Reliable Information Management
Applications
Systems
Integration Control
Durable Infrastructure
and Sound Standards
Appropriate IT Leadership,
Shared IT Vision and Road Map
Skills, and Staffing Levels
Senior Management Support, Joint-Ownership,
and Communication of IT Strategic Vision and Plans
Appropriate Context and Confidence
Business Unit-wide Synchronization of Business
Plans, Processes and Systems
Clear and Sound Corporate Strategic Direction
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Physician Practice Solutions Strategy

• Business Needs

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Operational Reality
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Goals of the Services
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Nothing will ever be attempted if all possible
objections must first be overcome.Samuel
Johnson
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The Brown Toland View
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Provide Greater Efficiency to Physician Groups

• Patient Eligibility Benefit Plan Verification
• Direct Claims Submission Contract Rate
  Verification
• Reconcile Patient Schedule with Charge Capture
• Increase Coding Accuracy

• Increase turnaround time for authorizations and
  Referrals - Rules Integrated
• Decrease Charting Time Eliminate Dictation Cost
• Reduce Office Labor
• Decrease Record Storage

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Network Efficiency Cost Savings

• Patient Information Available at the Point of
  Care
• Network Diagnostic Results Reporting Shared
  Data between Primary Care Specialty Care
• Eliminate Unnecessary Duplication of Diagnostic
  Testing
• Increase Efficiency of Referrals and
  Authorizations
• Improve Patient Physician Satisfaction
• Reduce Medical Errors

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The Physicians Input

• Focus Group Discussions and Interview Results

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Interview Themes

• Large demand for billing services this will be
  a quick win with the physicians
• Critical to articulate the preferred cost
  structure and specific benefits to be gained by
  optioning BTMGs services
• EMR is essential to recruit younger physicians
  but will be resisted by older physician
  population that is less computer savvy
• Will need ability to deploy EMR modularly due to
  variances in adoption and practice preferences
• Contract with EMR vendor will need to be staged
  for growth
• EMR will support P4P reimbursement criteria
• Reliability is key a lot of dissatisfaction
  with current systems and vendor support
• Inefficiencies are prevalent in practices

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Interview Themes

• Common systems (especially PPMS) is a huge
  benefit can draw from a larger pool of
  experienced staff
• Several practices are already looking for new
  systems
• New systems must be physician friendly and easy
  to deploy
• Physicians will need to overcome residual
  mistrust of BTMG from previous de-install of PPMS
• System needs to be underwritten by BTMG
  (hardware, software, communications)
• Must be a good deal (less cost and more
  efficient) and a it imperative that the benefits
  are clearly articulated for buy-in
• Data conversions from existing PPM systems will
  be needed
• Resistance to EMR from older physicians expected
• Resistance to PPMS from entrenched billing
  managers expected

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Key Functional Priorities
Based on the stakeholder interviews the following
key functional priorities emerged

• EDI billing
• Contractual variances
• Insurance follow-up
• Tracking status of payments
• Effective date for co-pay
• Bubble forms for charge capture

• Flexible A/R reporting
• Collections module
• Multiple payor types/PPO products
• Contact capitation
• Using claims data for clinical research and
  assist with disease mgmt

Billing Reporting

• Flexible scheduling features
• Scanners for insurance cards

Scheduling

• Link with prior authorization

• Results reporting
• Workflow (refills)
• ePrescribing w/formulary
• Ease of charge capture
• Note entry
• Voice recognition
• Disease management

• Drug interactions
• Health maintenance
• Problem lists
• HEDIS measures
• Guidelines
• Clinical reporting , e.g. lipid values

Electronic Medical Record
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Physician Practice Solutions Strategy

• System Selection

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Brown Toland Medical Group Characteristics
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Vendor Evaluation Process
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BTMG Guiding Principles
Based on the stakeholder interviews the following
guiding principles emerged
Focus Area Guiding Principle
Risk Good reputation for solid vendor support State-of-the art software and forward-thinking company Stable company with solid track record
Technology Meets database platform standards Common (single) database between systems (PPMS/MCA/EMR) Enterprise master patient identification (EMPI) ability Lower cost of ownership supported through a browser-based front end
Implementation/ Support Minimize information technology infrastructure at individual physician offices Vendor independence through availability of client-based tools for customization Leverage internal IDX knowledge Ability to deploy EMR in modular manner to accommodate variability of use amongst practices
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Technology Vendor Options

• A Single Vendor Solution
• PPMS/MCA/EMR
• Single patient-centric database
• B Hybrid Solution multiple vendors
• IDX MCA
• Interfaced to PPMS/EMR
• Other Vendor
• PPMS/EMR
• Single patient-centric database
• C Hybrid Solution aligned vendors
• IDX PPMS/MCA
• Single patient-centric database
• Allscripts EMR
• Interfaced to PPMS

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BTMG will also provide sophisticated reporting
systems for physician use
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Physician Practice Solutions Strategy

• Implementation Overview

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Implementation Imperatives

• Solidify Early Adopters
• Flexible Critical Path
• Resource Management
• Enterprise Alignment

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Sharing InformationA Major Decision
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Clinical Results Reporting

• November 1, 2004 Go Live
• LabCorp
• 320 of 700 Physician Agreements in place
• Next Steps
• Additional Training Sessions increase adoption
• Additional Lab Vendors
• Radiology Results

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Clinical Results Reporting Lessons Learned

• 1 Physician 2-3 Staff
• Flexible Training Timetable Approach
• HIPAA Privacy Regulations
• Lab Vendors
• Physician Offices
• Building Trust Buy In

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Full EMR Adoption

• Focused on early adopters
• Slow ramp up
• 25 Physicians by end of 2005
• Build to core group over 2-3 year period
• Use experience and success of early adopters to
  move late adopters

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Full EMR Adoption Lessons Learned

• Demand greater than expected
• Larger groups appear to be early adopters
  although more interest than expected from solo
  practitioners
• Investment in experienced and focused deployment
  team has been invaluable in working through
  implementation issues and process changes
• Modular approach will facilitate adoption
• Physician champion in each office

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Physician Practice Solutions Strategy

• In Summary

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BTMGs IT Strategy Supports Key Business Drivers

• Physicians have not invested heavily in
  technology
• Physicians have not recognized ROI with existing
  systems
• Physicians have not had solid, coordinated IT
  Support
• Improve practices financial health through
  improved billing and reimbursements
• Strengthen ability to provide high quality care
  through the use of solid IT systems

• Known to BTMG throughout the enterprise
• Improve quality of care through patient-centric
  view of health record

• Need to recruit younger physicians
• Strengthen medical management
• Manage costs of care delivery through improved
  access to clinical data and use of best practices
• Recognize revenues from P4P through technology
  deployment
• Expand services to better meet business needs of
  BTMG physicians

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Three-Step Approach
Activities to Occur in Parallel

• Due Diligence
• IDX / Allscripts to provide BTMG with formal
  proposals
• To support proposed modules implementation
  approach timing
• Detail bid based on specific sizing staging of
  roll-out
• Conduct several reference calls to comparable
  vendor clients to discuss support, training,
  implementation and overall satisfaction.

• Implementation Planning Contracting
• Develop overall cost of ownership and revenue
  model for software and services
• Refine implementation approach and roll-out plans
• Determine key negotiating points and strategy
• Conduct negotiations

• Focus Groups
• Establish functional technical focus groups to
  perform detail due diligence
• Provide education on the features/functions
  offered with PPMS EMRs
• Conduct survey to determine key drivers for
  physicians
• Define key functional requirements and technical
  environment
• Define specific benefits to be achieved with the
  new software and BTMGs services

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Minimize Risks

• Setting expectations is critical
• BTMG offering will need to be better and cheaper
  than what I have today
• Ownership of data (especially clinical data)
  may present concerns over loosing control of
  their practices
• EMR Adoption
• Older physician population may not embrace new
  clinical technologies
• Contracting for best price but unknown
  participation will be a challenge
• Clear requirement for modular implementation to
  address various levels of interest

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Implementation Challenges

• Education is a MUST!!!
• Identifying a broad but focused group to drive
  implementation efforts will be critical
• Variability of practices will cause challenges
  with setup and maintenance of systems
• Process redesign will become a necessary
  component of improvements and may be resisted
• This will be more evident in EMR deployment
• Recognize and accommodate for go-live slow
  downs and reduced productivity

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Nothing will ever be attempted if all possible
objections must first be overcome.Samuel
Johnson