electronic healthrecords health records user experience user
TRANSCRIPT
Electronic Health Records User Experience
October 5, 2010
Electronic Health Records User Experience
October 5, 2010
Tina BuopCIO, Muir Medical Group IPA,., Inc
Debra SpindelVP, Nautilus Healthcare Management Group, LLC
EHR 2.0 Collaboration
Agenda
• Introduction• Fully Functional EHR• Meaningful Use• Connectivity & HIE• Common Processes• Differences• Lessons Learned• Q& A
2
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Introduction
Two separate large groups (IPAs/MSOs) implemented Practice Management
and Electronic Health Record Solutions without collaboration…..
• Shared Findings• Distinct Differences• Common Lessons Learned
3
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Introduction ‐
MMG
The Muir Medical Group IPA, Inc. (MMG) is an Independent Practice Association
located in the San Francisco East Bay. MMG provides services to over 600+
Physicians & Mid‐level Providers
• MMG provides clinical and technical leadership, solutions and support to
automate the independent practices and to connect them to an integrated
eCommunity.
• 108 Providers Implemented
• 28 Practices across 50 connected locations
• 15 Specialties
• 165,000 patients in the system & growing
• 1,700 ‐
2,300+ visits per day
• Interfaces: Labs, Imaging Results, Hospital Notes, Transcription, Phone
Appointment Reminders, Eligibility Checking, ePrescribing, ECG, Spiro,
Advanced Holter & Stress Treadmill
• Enterprise Chart Community4
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Introduction: Nautilus Healthcare Mgmt Group
Introduction: Nautilus Healthcare Mgmt Group
Physician Services Division• Technology Implementation & Support• Billing & Revenue Cycle Management• Group Practice Management• Accounting/Financial Management• Management Consulting
IPA Management Division
Greater Newport Physicians IPA
Cedars Sinai Foundation IPA
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
• EHR deployed since 2001
• 184 physicians and growing
• 65 practices
• 18 specialties
• Hosts full suite of NextGen applications
• Provides full implementation and on‐going
technology support for medical group clients
Basic EMR, Fully Functional EHR
May 2010 6
Data from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.158.4942&rep=rep1&type=pdf
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Fully Functional EHR
77
ElectronicHealth Record
HL7
HL7
HOSPITAL or SURGERY CENTER
LABS
IMAGERESULTS
SCANNING
PAYERS
HL7
USB USB
Net‐worked
CONNECTED DEVICES & RESULTS
PHR /PORTAL
PHARMACY
PRINTING
Net‐worked
FAX
EHR
eCommunity
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Achieving Meaningful Use
8
http://healthit.hhs.gov
The MMG eVision
9
HospitalsHospitals
State Information HighwayState Information Highway National Health Information Network (NHIN)National Health Information Network (NHIN)
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Nautilus HIE Connectivity VisionNautilus HIE Connectivity Vision
Hospitals
Community Clinical Portal(ER access, non- EMR physicians)
ReferenceLabs
Nautilus/NextGen
Primary Care Specialist
IPA
Hospitalist
Non-NextGenEHR’s
Common Processes
• Physician Governance / Priority Setting
• Dedicated Clinical personnel (not IT)
• Dedicated IT personnel
• Dedicated Support personnel &
processes
• Ticket / Issue Leads & tracking capability
• Sales Implementation Support
• Various Specialties & Practice Sizes
• “We are very different/more complex”
• Stark / Hospital /IPA Funding 11
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Differences
• Southern California vs. Northern California
• HIE vs. Enterprise Chart for data sharing
• Physician Engagement / Cost Infrastructure
• Service Offerings
– Remote IT Support
– MSO Services
• Accounting• Billing • Practice Management
• Other wrap around services
12
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Implementation Approach
13
Sales EPM EHRSupport/
IT & Clinical
• Sales Contracting Process
• EPM Implementation
• EHR Deployment
• Support: IT and Clinical
• Data Sharing/Interoperability
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Data
Sharing
Lessons Learned –
Sales/Adoption
• Physician decision‐making process is lengthy
• Physicians believe that they operate differently
for core business processes
• Physicians are very concerned about cost, even
with subsidized product offerings
• Practices need to contribute and commit for their
success – “skin in the game”
• Contract is critical: set expectations for timelines,
commitment, change mgmt and leadership
– Include financial penalties for delays14
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Sales EPM EHRSupport/
IT & ClinicalData
Sharing
Lessons Learned ‐
EPM
EPM – Practice Management and Billing/Collections• Office Inefficiencies become very visible
• Need defined Practice Business Operations
• Demographic conversion –
decision point
• “Certified Billers”
and “Certified Coders”
become more critical
• We don’t teach billing; we teach billers how to use the system
• Patient Statements not distributed as regularly as some
practices believe
• Timely filing is critical
• First check after go live between 7‐11 days
• Effectively articulate the benefits of shared master files (i.e.
payers, contracts, referring physicians)
15
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Sales EPM EHRSupport/
IT & ClinicalData
Sharing
MMG ‐
Lessons Learned ‐
EHR
Phased Based Approach to EHR Implementation– Charting, eRx, Scanning & Tasking– Labs & Provider Approvals– Imaging Results & Hospital Notes– Inboxes– Consulting Notes– Reporting– Patient Recalls– Billing Decisions to discontinue paper fee ticket– Practice Optimization & hands on support during go‐live
• It is a journey; not an over‐night destination
• Competition is valued and encouraged
• Inefficiencies become high‐lighted ‐
“chart in trunk”
• Gained efficiencies “can’t be given up”
• Providers are doing more with eCharts
(more thorough tracking and contra‐indications)
16
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Sales EPM EHRSupport/
IT & ClinicalData
Sharing
Nautilus ‐
Lessons Learned ‐
EHR
• Preparation, planning and training are key
• Workflow assessment and redesign make or break success
• Physicians must practice adequately in advance of go live
• Need effective scanning and abstracting protocols
• Big Bang Go Live Approach : all providers in a practice
location go live with most EHR functionality on a given date– Charting, eRx – Labs orders & result signoff– Imaging Results– Messaging– Coding in EHR (no paper fee ticket)
• Hands on support during go live
• Robust follow‐up; refresher training; monitoring
• Small practices are just as challenging as large ones
17
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Sales EPM EHRSupport/
IT & ClinicalData
Sharing
Lessons
Learned ‐
Support
Support – IT & Clinical
• Physicians expect near perfection with EHR support
• Create clear parameters for support issue turnaround time
• Interfaces are expensive
• Regulations encourage community development and less
island mentality
• Outsource if possible: you will eventually need to be part
of an eCommunity
• Manage upgrades, patches & template changes
• Plan for server environment changes
• Expect to build custom reports 18
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Sales EPM EHRSupport/
IT & ClinicalData
Sharing
19
MMG ‐
Lessons Learned – Data Sharing
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Sales EPM EHRSupport/
IT & ClinicalData
Sharing
Data Sharing and Interoperability
• At MMG, we started with separate practices within our
NextGen enterprise – no visibility of data
• In 2009, converted to Enterprise Chart wherein all clinical
data is available to all physicians in the MMG enterprise
• Extensive education and overcoming physician fears was
required
• Now, physicians very happy with enhanced access and
improved continuity of care
• Looming privacy regulations in California are a concern
20
Nautilus ‐
Lessons Learned – Data Sharing
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A
Sales EPM EHRSupport/
IT & ClinicalData
Sharing
Data Sharing and Interoperability
• In Nautilus NextGen enterprise, each practice is separate –
shared MPI but no visibility of clinical or financial data
• Utilize NextGen’s HIE application to facilitate data sharing
between practices, hospitalists and external entities
– Meds, allergies, chronic dx, histories
– Hospital radiology reports, labs, transcribed documents
– Closed loop referrals: can attach data electronically and send
to specialist; get consult note back
• Must be easy for physicians to access data or they won’t
• Patient connectivity – via integrated web portal
Patient Portal Features
•
Document distribution
‐Test results, orders, patient educ.
•
Secure email messaging
•
Broadcast messaging
•
Appointment reminders/requests
•
Patient online forms
•
Medication list and refills
•
Statement view and online bill pay
21
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A BTW - Patients LOVE this!
Q & A
22
AGENDAo Introduction
o Fully Functional
EHR
o Meaningful Use
o Connectivity
and HIE
o Common
Processes
o Differences
o Lessons Learned
o Q & A