EHR—Electronic Health Records

Why Should I Be Worried?

EHR—What Should I Know?

What is the most important point?

None of the EHR vendors currently meet the Federal requirements for an EHR because one of the primary requirements is an EHR must be interoperable with other EHRs.

Do you have specialists who can tell you what to do?

2

EHR—What Should I Know?

What is the elephant in the room?

Non-interoperable EHRs will further impede access by creating proprietary information silos

To be of any value, EMRs must be interoperable & interconnected to EHRs, both ambulatory and clinical

EHRs must be interoperable & interconnected Without a web of EHRs, there are no Regional Health Information

Organizations (RHIOs) The RHIOs all have different architectures Without RHIOs there is no National Health Information Network (NHIN)

3

EHR—What Should I Know?

What is the Network Effect of Networked EHRs?

The network of EHRs could act as a value multiplier. Without a network the value multiplier is zero.

One EHR is worth nothing Two EHRs connected to each other are worth something A network of EHRs is very valuable.

4

EHR—What Should I Know?

What is the elephant in the room?

What does this mean—EHRs must be interoperable & interconnected?– Know before you buy—what connects to what?– If EHRs aren’t connected, doctors will need electronic and paper files

5

EHR—Exponential Problems

What must be connected? An N x M connection must work for:

Hospitals connecting to:– Doctors– Hospitals– RHIOs– Labs– Pharmacies– Imaging– Electronic Health Records (1 x N)

EHR to EHR– Continuity of Care Record (CCR)

6

EHR—Fail Safe Points

What are the EHR Fail Safe Points (FSPs)?

EHR is healthcare’s Y2K time bomb. There a is concurrent national rollout of EHR; standards not

available until 2010. The costs are very high, so are the penalties 1/3rd to 2/3rd of EHRs implemented have failed There may not be time to earn the incentives Nobody knows which applications will qualify for certification

7

EHR—Fail Safe Points

What are the other EHR FSPs?

There aren’t nearly enough resources to do the work– EHR vendors can’t staff for a national rollout– Healthcare IT resources to support providers are 50% below the number

required Healthcare providers in-house IT department has:

– No experience with EHR– Never built one– Never bought one– Never installed one

8

EHR—Ambulatory Practices

I think it is advantageous for them to wait. Within 12-18 months they will likely have the opportunity to acquire a plug-and-play EHR in-house or SaaS.

Project management Selection Implementation Adapting workflows Training Support

9

Electronic Health Record (EHR)

The need for change is real and mandated

In the US there are more than 20,000 healthcare transactions each minute.

In Canada, in the absence of a comprehensive EHR system, for every 1,000: Hospital admissions, 75 people will suffer an adverse drug event; Patients with an ambulatory encounter, 20 will suffer a serious drug

event; Laboratory tests performed, up to 150 will be unnecessary; Emergency room visits, 320 patients will have an information gap,

resulting in an average increased stay of 1.2 hours.

10

EHR is Wide Open

New England Journal of Medicine (NEJM) received responses from 63.1% of hospitals surveyed:

Only 1.5% of U.S. hospitals have a comprehensive electronic-records

system (i.e., present in all clinical units), 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been

implemented in only 17% of hospitals. Respondents cited capital and maintenance

costs as the primary barriers to implementation

11

EHR—Meaningful Use?

From HHS: Must Zoom to read

12

EHR—Snail Paced Adoption

13

NEJM

EHR Barriers—Magnitude of staffing barrier is grossly underestimated

14

Barriers to Electronic-Records Adoption (NEMJ)

EHR Facilitators—will not have the desired impact

15

Facilitators of Electronic-Records Adoption (NEMJ)

EHR Costs—to pass the interoperability test are understated

The Cost of Change

Canada budgeted US $450 per person to implement EHR.

The US stimulus package allocates $20 billion for EHR, roughly US $60 per individual. How large is the shortfall, and what or who will make up the difference?

16

EHR—if it doesn’t connect, it doesn’t work

17

Just because EHR’s have been implemented, doesn’t mean they’re of any value.“I've witnessed more serious errors with the EHR than in my previous 25 years as a physician. These are the errors in thinking and decision making: cases where the physician was so distracted by the order tree that she forgot an important order; cases where the fragmented, disordered thinking was imposed by the EHR.”Christine A. Sinsky, MD

"...our system for delivering medical care is clearly in crisis...At the heart of the problem is the fragmented nature of the way health information is created and collected,"Bill Gates

Most EHRs don’t operate beyond the walls of the building in which they were implemented.

EHR—if this was reality TV, there’d be no winners

18

Foundational Elements of National EHR: Completing the baseline EHR info-structure for 100 percent of the

population Seamless communication across the continuum of care and into

community based settings. (The availability of electronic medical records, for example, would integrate primary care physicians and specialists into community care facilities)

Extending order entry functionality and other decision-support elements in acute care settings to support delivery of high quality care

Empowering patients to manage their own care by creating patient portals with self-care tools and basic personal health information

System Enablers of EHR

The final components of EHR are the system enablers which leverage the benefits of the investment:

Redesigning the key business processes, along with change management efforts, education and training

Establishing common data, integration, and communication standards Applying appropriate legislative frameworks for privacy and patient

consent

EHR Enablers—who’s watching the business processes?

19

EHR Readiness Methodology

EHRReadiness Methodologyhas a 6 phase scorecard.

Enterprise Readiness Assessment

The Enterprise Readiness Assessment identifies gaps in:

Change Management Readiness Technology Readiness Risk Management Standards Readiness

EHR Implementation PlaybookThe Implementation Playbook defines a program or set of projects the enterprise needs to execute in order to implement EHR. Potential projects may include:

Requirements SW selection Change Management Integration Policy, Procedure or Process Training

Enterprise Risk Assessment

The Enterprise Risk Assessment identifies potential fatal EHR implementation risks:

Interoperability Meaningful Use Certifiability

EHR Cost Benefit/Funding AnalysisThe Cost Benefit Analysis identifies:

The cost of implementation and the level of funding necessary to successfully implement EHR

Funding sources such as grants or federal government loans

The short term costs and the long term benefits ROI development and monitoring

EHR Implementation Management

Implementation Management oversees projects to successfully implement each EHR project managing:

Project task management Budget, Schedule, & ROI Issues tracking and resolution Staffing and skill requirements Project accountability and visibility

Healthcare Consulting

Strengths include: Partners averaging 25+ years of Big 4 consulting experience Functional expertise that includes all aspects of healthcare consulting Healthcare PMO expertise Federal Healthcare sector expertise

http://ehrstrategy.wordpress.com/

26