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2011 State of the UnionEHR, ARRA and HITECHAnd Business Intelligence (BI)Mark R. Anderson, FHIMSS, CPHIMSCEO of AC Group, Inc.

Mark Anderson, FHIMSS, CPHIMSSHealthcare IT FuturistCEO of AC GroupNational Speaker on EHR > 800 sessions since 2001Semi annual report on Vendor product functionality and company viability36+ Years In Healthcare ITCIO Position at Three Multi Facility Regional IDNsInstalled over $1B in technologies since 1972Provided EHR information to over 25,000 PhysiciansOver 400 EHR Search and Selection Projects and 12 community HIE projects.Former CIO of a 2,300+ physician (500+ Practices) IPA

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BI Tools in HealthcareHealthcare organizations are overwhelmed with data. But without a program in place to target, gather, deliver and analyze the most relevant data, these organizations will continue to be data rich but information poor. Forward-thinking healthcare organizations realize that dataand, thus, business intelligence (BI)is at the center of informed and precise decision-making that will improve patient and service outcomes in addition to ensuring their organizations future. To achieve the full benefits of BI, organizations must take an enterprise-wide, strategic approach vs. tackling small tactical projects, and realize that the greatest efficiencies come from integrating data historically stored in silos of databases in financial, operational and clinical systems.

BI Tools in HealthcareA strategic focus is the difference between simply recognizing the value of managing key information for analytical purposes and transforming the culture to evidence-based decision-making at all levels at the point of care.Cost savings are the main driver for implementing BI in healthcare organizations, followed by the need to improve medical outcomes. But who actually receives the cost benefits? A strategic approach to BI, which cuts across the organization, requires buy-in from not only top executives but also physicians and clinical staff. Without buy-in and acceptance of the data, clinicians will not act of the BI intelligence.

The Genesis

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So where are we today?

8Http://www.acgroup.orgPage No: 8

Current View of Healthcare IT Marketplace

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Total Patient Encounters

Where is the data today?

Where is the source of the data?

EHR Trends

Why are Practices not using what they Purchased?

However, the use of EHR is still in question. The 2010 CDC/NCHS national Ambulatory Care Survey projects that almost 50% of physicians have already purchased some type of EHR product, but only around 10% are using the product as a fully functional EHR product.

Around 25% are using EHR as a basic systems. This means that 15% of all providers have purchased an EHR and are NOT using the product at all. Part of the reason is usability, identified slowdown in patient care, and many of these systems have crashed over time and data was lost. When this occurs, physicians lose trust in the EHR solution.14

Stage Functionality 20082011Meets MUStage 7 Complete EHR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP, BI Tools0.3%1.00%100.0%Stage 6 Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS0.5%2.80%75.0%Stage 5 Closed loop medication administration2.5%3.70%50.0%Stage 4 CPOE, Clinical Decision Support (clinical protocols)2.5%10.30%10.0%Stage 3 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology35.7%49.70%5.0%Stage 2 CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable31.4%15.40%0.0%Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed11.5%6.70%0.0%Stage 0 Lab, Radiology and Pharmacy not Installed 15.6%10.50%0.0%

Supply ChainHealth Information Management

Pharmacy/Medication Safety

Physician Clinical Practice

Care Management

Departmental/Support Services

Clinical Decision Support

Clinical DocumentationEnterprise Patient Access

Core Information Management Components

MedicationOrder EntryOutpatientPrescriptionsMARFormularyManagementDosingManagementSubstitution/CostManagementPhysicianOrder EntryResultsReviewOrder SetsRules andAlertsProviderDocumentationTask Lists/Workflow ToolsPatient History/Problem ListsPatient Locator/Patient ListsAmbulatoryPracticeManagementRoundingToolsPathwaysProtocolsUser Interface/PortalData Aggregation and Reporting ToolsDataWarehouseComparativeDatabaseAccessSeverityAdjustmentOutcomesMeasurementReport Writer

ResourceUtilizationProviderProfilingCredentialingAdmission/RegistrationEnterpriseSchedulingEligibilityVerificationRequest forAuthorizationConsumerPortalTechnicalDenialManagementPatientAssessmentI & OVital SignsFlowsheetsCare Plans

Solution ComponentsSolution SetsRobotInterfacePositivePatientIdentificationDrugInteractionsAccess toDrugDatabasesKardexTransitionPlanningCritical CareDocumentationTask ListsNon-MDOrdersInterfacesto MonitorsSpecialtyDocumentationPatientEducationPatientSupplyChargesTracking &ReconciliationSupport forProductStandardsInterface toERP SystemPrecertificationAuthorizationPayorCommunicationand NotesSocialServicesSupportInitial &ConcurrentReviewInterQualSupport for LOCPost AcutePlacementDischargePlanningWork ListsReadmitAlertsClinicalDenialManagementPathwaysDiseaseManagementChartManagement(Deficiencies)Transcription/DictationDocumentImagingCodingSupportElectronicSignatureMRNManagementand MergeRelease ofInformationCDMP (?)WorkflowToolsMaster PersonIndex (MPI)ClinicalDataRepositoryResearchRepositoryCommonMedicalVocabulariesOrderEntryDecisionSupportRepositoryRulesEngineSecurityToolsIntegrationToolsConsumerContentPDASupportStandardCDMLabPathologyBlood BankRadiology/PACSEmergencyDepartmentOtherDepartmentalSystemsCardiologySurgeryHospital functionality

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Connecting PhysiciansDelivers the Connected Community

In-patient Clinicals & Physician PortalPhysician Office SolutionsBroad CommunityConnectivityPatients

Payors & PBMs

Retail Pharmacy

HomecareProviders

Employers

Physicians

Hospitals

Ancillary Departments

Hospitals are best positioned and best served to lead the way to a connected care community

17McKessons Connecting Physicians strategy, often referred to as our hospital-out strategy, has been our core strategy and approach to this market place.

We believe that hospitals are best positioned and best served to lead the way to a connected care community.

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It shouldn't take a brain surgeon to design one patient centric community EHR with BI tools

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The Focus is People

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EHR Information Overload

Be Prepared for the Ice Age

Confidential information provided by AC Group, Inc.21

Separate, but united

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We need to allow choice but move everyone in one direction

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The Problem TodayReferral tracking is paper basedPatients must register each time they see a new PhysicianPatients must provide each provider duplicate information:Social History, Medical History, Family HistoryWhat Medications are you on?Physicians do not have adequate and timely information about the patientBusiness Intelligent Tools (BI) only works when you have data.

What the community needs is a new way of connecting and sharing timely patient information.

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DRT Enabled EHRsWhat is DRT?

Allows the provider to use the EHR for viewing of patient clinical information.After the physical exam, the provider dictates their note like they have the past 20+ years.The dictated report is sent to a transcription service for transcription or via DragonThe Software takes the dictation, creates a clearly defined patient note and then automatically populates the EHR with practice specific discrete recordable and reportable data directly into the practices EHR.

DRT is Discrete Reportable Transcription

Confidential information provided by AC Group, Inc.26

Data Entry Time

Number of seconds for data entry of discrete clinical dataSource: 573 Patient chartsSeconds

First lets start by looking at the time it takes to collect the information.Confidential information provided by AC Group, Inc.27

American Recovery & Reinvestment Act

Health Information Technology for Economic and Clinical Health (HITECH) Act

Confidential information provided by AC Group, Inc.

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ARRA/HITECH ACTFeb 17, 2009 ARRA/HITECH Acts signed into law$19.5 billion for health IT adoption, EHR and HIEGoal (forecast) is adoption and meaningful use of EHR by 90% of physicians and 70% of hospitals by 2015Bulk of funds appropriated go towards incentive payments to eligible providers (EPs) and eligible hospitals (EHS)

HITECT RequirementsIn order to qualify for the incentive payments, both physicians and hospitals have to prove three things: 1. Use of a certified EHR product with ePrescribing capability that meets current HHS standards. 2. Connectivity to other providers to improve access to the full view of a patients health history. 3. Ability to report on their use of the technology to HHS. The second area is meaningful use

Confidential information provided by AC Group, Inc.30

Whats in it for the Physicians?

$44,000 to $69,000

Confidential information provided by AC Group, Inc.

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What does an EHR Cost

Page No: 33Cost? What Cost?AcquisitionImplementation and TrainingMaintenance and UpgradeLost ProductivityPersonal Cost (The Pain & Suffering)Inappropriate Physician Tasks

EHRs cost to much?

Three way interaction

Who do physicians Trust?

Sample of 3,215 Physicians

Technology Decisions

National Surveys and CertificationONC 2011 Certified Products 499 VendorsCCHIT 2011 Products 89 VendorsRegional Extension Centers (REC) 35 VendorsKLAS top 10 EHR vendors 10 VendorsBlack Book 15 VendorsAC Group 35 VendorsTop selling vendors 10 Vendors

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Page No: 39EHR Failure rate Through 2012, the EHR failure rate continues to increase.When asked, 1 year of EHR installation, are you seeing 80% of your patients using the EHR for charting, ROS, HPI, Evaluation, coding, orders and results reporting.73% of the physicians (3,245) indicated that no, they were NOT using the EHR for 80% of their patients.18% replaced or were not using EHRWhy, are 73% of the physicians NOT fully utilizing the EHR after 1 year?So why are there so many failures?

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Take Home MessageCreate a culture of accountability as part of the deployment of dashboards and balanced scorecards.Prepare stakeholders that a long period of data preparation and cleansing may be necessary before applications can roll out.Improve capabilities to track patients, costs, and assets.Incorporate information from business systems and clinical systems.Involve physicians and other key stakeholders in the planning process.Obtain a highly motivated stakeholder to create an immediate win that will generate enthusiasm throughout the organization for evidence-based decision-making

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For More InformationMark R. Anderson, FHIMSS, CPHIMSCEO and Healthcare FuturistAC Group, Inc.118 Lyndsey DriveMontgomery, TX 77316(281) 413-5572eMail: mra@acgroup.orgWeb Site: www.acgroup.org

Confidential information provided by AC Group, Inc.41

Questions?

Chart112533812532020012040

New PatientsEstablished Patients

Sheet1New PatientsEstablished PatientsDicate125334036.83.21,614.4026.91Handwrite81254036.83.21,179.2019.65EHR3202004036.83.28,384.00139.73DRT EHR120404036.83.21,856.0030.93To resize chart data range, drag lower right corner of range.

Chart10.150.20.20.350.350.80.850.87

Trust

Sheet1TrustEHR Vendors?15%Government ?20%Internet Blogs?20%Medical Society35%Magazine Articles?35%EHR Consultants?80%Local Billing Companies?85%Other Providers?87%