may 29, 2013 rome, italy electronic medical record adoption...
TRANSCRIPT
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Sotto l’Alto Patronato del Capo dello Stato ,Presidenza della Repubblica Italiana
FORUM PA and HIMSS present
e-Health ConferenceMay 29, 2013Rome, Italy
PATRONAGES SPONSORS SUPPORTING PARTNER MEDIA PARTNER
Electronic Medical Record Adoption Rates:
Italy, Europe, United States, Middle East, Asia Comparisons
John P. HoytExecutive Vice President HIMSS Analytics
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e-Health ConferenceMay 29, 2013Rome, Italy
Learning Objectives
• Understand the HIMSS Analytics EMR Adoption Model (EMRAM)
• Compare Italy to other leading nations in EMRAM
• Understand some of the benefits of advanced EMR adoption
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Stage Short Description Europe
Stage 7 Complete EMR; CCD to share data; Data warehousing for quality assurance, and business intelligence; Data continuity with ED 0.1%
Stage 6 Physician documentation with CDSS, Closed loop medication administration 1.4%
Stage 5 Radiology PACS, filmless 14.9%
Stage 4 CPOE (i.e. ePrescribing); CDS based on clinical protocols 2.8%
Stage 3 Nursing/clinical documentation PACS available outside Radiology 4.0%
Stage 2 Clinical Data Repository (CDR) Clinical Decision Support (CDS) for basic conflict checking 27.2%
Stage 1 Ancillaries – Lab, Radiology, Pharmacy – All Installed OR processing LIS, RIS, PHIS data output online from external service providers 18.8%
Stage 0 All Three Ancillaries (LIS, RIS, PHIS) Not Installed OR Not processing Lab, Radiology, Pharmacy data output online from external service providers 30.7%
Institutions with valid EMRAM score (based on data from last 24 months, status as of Q1/2013) 1,354
HIMSS Analytics European EMR Adoption Model
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e-Health ConferenceMay 29, 2013Rome, Italy
Why Does HIMSS Analytics Collect IT Adoption Data?
• Thought Leadership• Research on maturity vs. QSAE (quality,
safety, efficiency)• Predict where the market is going• Serve vendors, consultants• Inform government policy decisions
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e-Health ConferenceMay 29, 2013Rome, Italy
Why Does HIMSS Analytics Collect IT Adoption Data?
• “Push the Market”• Participating Hospitals Practices receive:
• Their EMR Adoption Model Score • Access to the HIMSS Analytics Benchmarking
tool consisting of peer comparison reports assists in: • IS strategy development• Identifying opportunity for investment• Improving competitiveness
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Data from HIMSS Analytics® Database ©
Cross Regional EMRAM Score Distribution, 1st Q, 2013
Stage Asia Pacific Middle East United States Canada Europe
Stage 7 0.2% 0.0% 1.9% 0.0% 0.1%
Stage 6 2.2% 7.1% 9.1% 0.5% 1.4%
Stage 5 5.3% 14.2% 16.3% 0.3% 14.9%
Stage 4 3.0% 5.3% 14.4% 2.2% 2.8%
Stage 3 0.4% 19.5% 36.3% 33.6% 4.0%
Stage 2 26.0% 19.5% 10.1% 26.9% 27.2%
Stage 1 6.1% 13.3% 4.2% 14.8% 18.8%
Stage 0 56.9% 21.2% 7.8% 21.7% 30.7%
N = 508 N = 113 N = 5,441 N = 640 N = 1,354
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Data from HIMSS Analytics® Database ©
Cross Country EMRAM Score Distribution 1st Q, 2013
Stage United States Canada Germany Poland Portugal Spain Netherlands Italy
Stage 7 1.9% 0.0% 0.3% 0.0% 0.0% 0.5% 0.0% 0.0%
Stage 6 9.1% 0.5% 0.0% 0.0% 0.0% 4.3% 3.8% 0.6%
Stage 5 16.3% 0.3% 8.3% 0.0% 26.1% 40.9% 34.6% 6.6%
Stage 4 14.4% 2.2% 1.9% 0.7% 4.3% 6.7% 3.8% 1.8%
Stage 3 36.3% 33.6% 8.3% 0.0% 21.7% 1.9% 1.9% 3.4%
Stage 2 10.1% 26.9% 34.9% 10.3% 4.3% 18.8% 55.8% 26.7%
Stage 1 4.2% 14.8% 0.6% 13.0% 4.3% 9.6% 0.0% 41.4%
Stage 0 7.8% 21.7% 45.7% 76.0% 39.1% 17.3% 0.0% 19.5%
N = 5,441 N = 640 N = 324 N = 146 N = 23 N = 208 N = 52 N = 498
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Data from HIMSS Analytics® Database ©
Cross Country EMRAM Score Distribution 1st Q, 2013
Stage United States Australia Malaysia Singapore United Arab
EmiratesSaudi Arabia Italy
Stage 7 1.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
Stage 6 9.1% 0.0% 0.5% 57.1% 12.8% 3.0% 0.6%
Stage 5 16.3% 3.7% 4.7% 14.3% 14.9% 13.6% 6.6%
Stage 4 14.4% 0.9% 2.8% 14.3% 4.3% 6.1% 1.8%
Stage 3 36.3% 0.5% 0.5% 0.0% 6.4% 28.8% 3.4%
Stage 2 10.1% 51.6% 1.9% 14.3% 25.5% 15.2% 26.7%
Stage 1 4.2% 4.6% 1.4% 0.0% 21.3% 7.6% 41.4%
Stage 0 7.8% 38.7% 88.2% 0.0% 14.9% 25.8% 19.5%
N = 5,441 N = 217 N = 212 N = 7 N = 47 N = 66 N = 498
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COUNTRY COMPARISON - NURSING DOCUMENTATION
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COUNTRY COMPARISON - eMAR
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COUNTRY COMPARISON -ePRESCRIBING
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COUNTRY COMPARISON - CPOE
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COUNTRY COMPARISON - PHYSICIAN DOCUMENTATION
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COUNTRY COMPARISON - PHARMACY BAR CODING
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COUNTRY COMPARISON – DATA WAREHOUSING - CLINICAL
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CLOSED LOOP MEDICATION ADMINISTRATION
Big Challenge Outside U.S.A.
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e-Health ConferenceMay 29, 2013Rome, Italy
1. Physician enters the medication order directly –allows for CDSS interaction
2. Pharmacist verifies the order3. Pharmacist dispenses a bar coded unit dose
medication or prepared compound4. Positive patient ID – barcode on wristband or
RFID5. Positive medication ID with bar code on the unit
dose medication6. Verification of the “five rights”
The Closed Loop Medication Administration Process
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CLOSED LOOP MEDICATION ADMINISTRATION
18
CPOE
2 Medication orders that pass CDSS flow to Pharmacy
3 Pharmacy validates order and dispenses medication to ADM or floor
ADM
Nurse retrieves medication from ADM and takes it to patient
4, 5, 6 Nurse scans patient ID and medication for “five rights”CDSS
POCAdministration
EMAR
eMAR is updated and available for review
Pharmacy
1
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AND WHAT VALUE IS DERIVED?
• 60% of errors from prescribing & transcribing1
• 26% of errors from administration1
• 14% of errors from dispensing1
1 D W Bates, D J Cullen, N Laird, et al., “Incidence of Adverse Drug Events and Potential Adverse Drug Events: Implications for Prevention”, JAMA, 247 (1995), pp. 29-34
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e-Health ConferenceMay 29, 2013Rome, Italy
Other Citations• With bedside scanning rates of 87%+, an academic medical center in
the U.S. decreased their medication errors from 1.2 to 0.3 errors per 1,000 patient days, a 75% reduction1.
• With the implementation of CPOE, pharmacist verification and CLMA, order-to-administration times of IV antibiotics experienced a reduction of 1.18 hours (p < 0.0001) per order2.
• CPOE, electronic dispensing and barcode patient identification reduced prescribing errors by 47% and MAEs by 37%, and increased time spent on medication-related tasks.3
1 http://www.healthleadersmedia.com/content/QUA-251798/Hospital-Nearly-Doubles-Medication-Scanning-Rates
2 http://www.ajhp.org/content/69/16/1423.abstract?sid=f86b4fb8-8a05-4d36-84b5-a87d0d7fedf0
3 http://qualitysafety.bmj.com/content/16/4/279.short
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CLOSED LOOP MEDICATION ADMINISTRATION - A KEY ELEMENT OF PATIENT SAFETY IMPROVEMENT
Source: Effect of Bar-Code Technology on the Safety of Medication Administration; Poon, Keohane, Bates, Lipsitz, et al, New England Journal of Medicine, 2010;362:1698-707, May 6, 2010
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e-Health ConferenceMay 29, 2013Rome, Italy
Summarization• Use technology to create a culture of performance excellence• Design performance improvement goals into the
implementation – Define the problems you are trying to solve• Standardize care using “best practices” built into documentation
and order sets for specific high risk diagnoses• “Management by walking around”
• Get out onto the wards to see systems in use, listen to users
• Encourage, encourage, encourage• Measure before & after
• This is your only chance to measure the effects of system implementation