EMR - The Time is Now:Physician Alignment through IT

Panel DiscussionRichard Eshbach & Bill Moran

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The President’s Bold Vision for HIT

“Every American will have access to an electronic health record by 2014”

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–What is our Definition of an Electronic Medical Record

–WHS and MSHA Current/Future State of the EMR

In-Patient

Out-Patient

•Stark Safe Harbors

•Regional Out-reach Programs/Opportunities

EMR and our Connected Care Community

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Definition of an EMR

CPR

PHR

EMR

EHR

Are we all speaking the same language…..?

Cardiology/Pulmonary

Pharmacy

Care Giver Notes

Physician Notes

Scanned Images of Documents

History & Physical

Demographic Information

Prior Encounters

Laboratory

Radiology

Discharge Summary

Components of a Patient Record

Boxed Components are Unstructured Information

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EMR Adoption Model Q2 2008

5%

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Hospital involvement in community EMR Deployments

Hospitals will represent 38% of all EMR purchases Hospitals will represent 38% of all EMR purchases up from 11% in 2007 up from 11% in 2007

– – AC Group, Feb 2008AC Group, Feb 2008

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Electronic Medical Record Industry – Only 22% of Hospitals across the country have successfully deployed an EMR

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EMR Scores by Comparison

EMR Scores by Bed Size

2008 Mean Median n

0-100 beds 1.5413 2.0150 2,487

101-200 beds 2.3996 2.2380 996

201-300 beds 2.6460 3.0710 629

301-400 beds 2.7443 3.1240 406

401-500 beds 2.8539 3.1470 209

501-600 beds 3.0859 3.2475 140

600+ beds 3.1114 3.2440 181

EMR Scores by State

State Mean Median n

Alabama 2.0785 2.1980 98

Georgia 2.2465 2.2250 152

Kentucky 2.1391 2.1460 105

North Carolina 2.5061 2.3190 117

South Carolina 2.3467 2.2620 66

Tennessee 2.3367 2.2100 137

Virginia 2.6719 3.1390 83

West Virginia 1.9575 2.0995 50

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Who will take the lead?Who will take the lead?

How will we get there?How will we get there?

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Electronic Medical Record

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MSHA EMR Strategies

Inpatient / Outpatient EMR

•In 2003, strategic EMR initiative launched to build upon a new integrated technology solution powered by a workflow engine

•$40+ million committed by MSHA Board for a multi-year implementation

Physician Office EMR

•Implemented Misys EMR in practices in 2005 and now offering as an MSO hosted service to non-employed physician practices

Regional Integration

•Varying levels of integration with physician practice EMRs depending on their status of EMR adoption

•Exploiting CCHIT compliant inter-operability tools

•Collaboration in regional connectivity initiatives such as CareSpark RHIO

DecisionSupport

PhysicianOrder Entry

Clinical Documentation

Replacement of Order Entry and Ancillary Systems

Technical Infrastructure/Foundation

Increasing ValueOn Journey to

Patient Safety, Quality and Efficiency

Network

Wireless

Monitors

Single Sign On Hardware

Pharmacy

ED

Clinical Access

Cardiology

Rad Upg

Orders

Interdisciplinary Charting

Bar Coding - MAKLiveLive

6 months

>6 monthsPACs

eHIM

2008-09

2009-11

2009-10

2007

Computerized Patient Record JourneyPhases I-III

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MSHA In/Out-Patient ApproachMountain States EMR consist of the following: (We are 75% deployed) An electronic Clinical Data Repository - √ Completed (Soarian Clinical Access)

− Contains 8 years of detailed clinical data An electronic Order Management System - √ Underway (New Soarian Orders) A Picture Archival Communication (PACs) System which allows the capture of medical images –

√ Completed (GE Radiology PACs and Siemens Cardiology PACs (echos, caths, nuclear studies…) An electronic flow sheets of vitals and I/O - √ Completed (Soarian Critical Care and MegaCare) An electronic Pharmacy System - √ Completed (Soarian Pharmacy) An electronic Radiology System - √ Completed (Siemens Radiology) An electronic Transcription System - √ Completed (Dolby with Voice Recognition) An electronic Laboratory System - √ Completed (Cerner Classic, replaced w/ SoftLab) An electronic Nursing/Ancillary documentation System - √ Completed (Soarian Clinical Team) An electronic Paper Medical Record - √ Completed (Soarian HIM)

− eHIM helps you fill gaps in areas throughout your hospitals, where you do not have electronic functionality by scanning, storing and retrieving the paper medical record. Also allows on-line abstraction, coding and completion management and signature by physicians from any location.

electronic workflow engine is “listening” to any care event or condition and can be automatically triggered to pro-actively monitor, notify and escalate steps in the care process across all caregivers.

Hardwired process workflows minimize lag-time between care handoffs and eliminate “dropping the ball!”

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MSHA In/Out Patient Approach

What’s Next………………..

In order to have a “Completed” Electronic Medical Record, these components are scheduled for implementation:

•Nursing Plans of Care•CPOE/ Physician Orders•Physician Progress Notes•Continued/Enhanced Integration to Physician Office EMR’s•Deployment of Home Health Clinical Documentation

On-going enhancement of workflows as more clinical information is available and more clinicians are on-line

Timeframe for Implementation

Foundation Systems

2004-05 2006 2007 2008 2009 2010 2011-12

Replace Ancillaries

Physician Order Entry

Progress Notes

Plans of Care

Orders and Documentation

PharmacyMAKeHIMDictationEDPACs•Rad•EKG•Cardio

Clinical Repository

Monitors

Wireless

Single-sign-on

OrdersAlertsWorkflowsVital SignsAssessmentsDocumentationForms Clinical

Decision Support

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MSHA Ambulatory Approach

Physician Office EMR

•Over a decade of utilizing the Misys office management system in all physician practices and providing as contracted MSO service

•Implemented Misys EMR in practices in 2005 and now offering as a service to private physician practices (under Stark Safe Harbor guidelines)

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MSHA Connectivity Approach

Regional Integration

•Varying levels of integration with physician practice EMRs depending on their status of EMR adoption

•Exploiting CCHIT compliant inter-operability tools

•Collaboration in regional connectivity initiatives such as CareSpark RHIO

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Electronic Medical Record

EMR – Approach

• Understanding how WHS EMR Strategies

− In-Patient EMR (76% completed)

Our In-patient EMR consists of several software applications that make up the chemistry of a EMR. 

−Out Patient EMR

Our Out reach (out-patient) EMR currently consists of a purchased package – AllScripts product 

−Ancillary Strategies around EMR’s

Complexity surrounding multiple EMR strategies – allows us to take advantage of true interoperability through Relay Health.

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WHS EMR StrategiesInpatient / Outpatient EMR•99.2% of Positive adoption through our WHS/Physician Portal – our connectivity tool for our Physicians.

•Over 1,000 Physician Population

•Our Physician voice is critical in shaping our outcomes.

•Physicians ‘decide’ how our electronic medical record is defined – through Physician Technology Committees.

•Board initiative to commit information technology and the exchange of health record exchange for the improvement of patient care within our community.

Physician Office EMR•Today we have over 60+ physician clinics/offices affiliated with Wellmont. We currently Implemented Misys practice management EMR, and currently have installed AllScripts as our out patient clinical EMR solution.

Regional Integration•Continued education and participation in sharing health exchange information to every town/city/and region within our community

•Regional Quarterly IT collaboration initiatives Hosting service, regional/industry benchmarking, best practices

•Establishing a Chime/HIMSS chapter within our Region

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Navigating through the technology

“Nobody said it would be easy”

Phase 1 PACS (AGFA), RIS (STAR), OR (HSM),PACS (AGFA), RIS (STAR), OR (HSM), Transcription/Dictatn.Transcription/Dictatn.

Phase 2 LAB (Cerner), Pharmacy (HMM), CardiologyLAB (Cerner), Pharmacy (HMM), Cardiology

Phase 3 Nursing Doc (HED), AdminRx (barcoding) Nursing Doc (HED), AdminRx (barcoding)

Phase 4 Horizon Lab, Anesthesia, ERHorizon Lab, Anesthesia, ER

Phase 4 Physician Office,Physician Office, CPOECPOE

Phase 5EMREMR

EMR evolution….

In Patient - EMR

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EMR – In Patient Approach…

Wellmont’s EMR consist of the following: (We are 76% deployed) An electronic Order Management System - √ Completed (STAR HOM/Orders)

An Picture Archival Communication (PAC’s) System which allows the capture of medical images – √ Completed (PAC’s)

An electronic Pharmacy System - √ Completed (HMM)

An electronic Radiology System - √ Completed (Star RIS)

An electronic Transcription System - √ Completed (Cquence, Star/HPF, Lanier)

An electronic Laboratory System - √ Completed (Cerner Classic)

An electronic Nursing documentation System - √ Completed (HED)

An electronic Horizon Patient Folder Application - √ Completed (HPF)

− HPF helps you fill gaps in areas throughout your hospitals, where you do not have electronic functionality. This application allow scanned documents and having them back available in ‘REAL-TIME electronically.

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WHS EMR – What’s Next…

In order to have a “Completed” Electronic Medical Record, these components are scheduled for implementation:

−CPOE/Orders

−Physician Notes

− Integration to Physician Office EMR’s and Clinician Care Plans

−Cardiology products have to be fully integrated (90% done)

−Emergency Departments need to be fully integrated

−Anesthesia needs to be fully integrated

Ambulatory Strategy and Solution Update

Ambulatory Strategy

Traditional Methods of Delivering Test Results/Transcriptions

Portal

Fax or Mail

HL7 Interfaces

Manual Process and Costly – Not Actionable

Passive Notification – Requires Provider to Search for Result – Not Actionable

IT Overhead- Costly to Maintain – Not Actionable

Point to Point Interfaces

Interoperability through RelayHealth

RelayHealth provides an intelligent network that enables constituents across healthcare to connect interactively, share information, and collaborate to improve the quality and efficiency of care.

• Improves clinical communication,

• Enhances business performance

• Facilitates the delivery of high-quality care

Connectivity Through the RelayHealth Network

Physician-Physician-to-Physicianto-PhysicianNetworkingNetworking

Physician-Physician-to-Physicianto-PhysicianNetworkingNetworking

Referrals Patient care

collaboration

Hospital-Hospital-PhysicianPhysician

ConnectivityConnectivity

Hospital-Hospital-PhysicianPhysician

ConnectivityConnectivity

Electronic prescriptions

Renewals

Appointment scheduling

Billing questions and online payments

Physician-Physician-Patient AdminPatient Admin

InteractionInteraction

Physician-Physician-Patient AdminPatient Admin

InteractionInteraction

Test results webVisit consultations

Rx renewals Personal health

records

Physician-Physician-Hospital- Hospital-

Pharmacy-Patient Pharmacy-Patient Clinical Clinical

InteractionInteraction

Physician-Physician-Hospital- Hospital-

Pharmacy-Patient Pharmacy-Patient Clinical Clinical

InteractionInteraction

PayorsPayorsRetail RxRetail RxPatientsPatientsPhysiciansPhysicians Financial InstitutionsFinancial InstitutionsHospitalsHospitals

RelayHealth Connectivity RelayHealth Connectivity RelayHealth Connectivity RelayHealth Connectivity

Physician-Physician-Retail RxRetail Rx

ConnectivityConnectivity

Physician-Physician-Retail RxRetail Rx

ConnectivityConnectivity

Emergency Dept connectivity

Care mgmt Results

distribution

Connected and Actionable Network

RH Network

Specialist

Primary Care

Patient

Patient

HL7

Bi-directional Communication

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Physician Practice EMR AdoptionPhysician Practice EMR Adoption

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Congress Passes Medicare Bill with e-Prescribing Incentives (July 15, 2008)

Medicare physicians who use e-prescribing technology will be eligible for incentive payments:

▲ 2% in fiscal year 2009 and 2010

▲ 1% in 2011 and 2012

▲ 0.5% in 2013

Physicians participating in Medicare who do not e-prescribe:

▼ 1% payment cut in 2012

▼ 1.5% payment cut in 2013

▼ 2% in subsequent years

Provision exempts physicians who infrequently use prescriptions

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Stark Safe Harbors – “Rules of Engagement”Stark Safe Harbors – “Rules of Engagement”

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Stark: Long-awaited Regulatory Relief

On August 8, 2006, the U.S. Department of Health and Human Services (HHS) published the final rules regarding provisions in the Medicare Modernization Act.

Facilitate the distribution and adoption of HIT related to electronic prescribing and electronic health records (EHRs)

Rules address ambiguity in current prohibitions to physician self-referral (known as the Stark laws) and anti-kickback statutes

Overview of the Regulations

• Permitted technology

• Minimum technology standards

• Permitted donors

• Permitted recipients

• Payment obligations

• Technology not duplicative

• Documentation

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Regional Out-reach Programs/OpportunitiesRegional Out-reach Programs/Opportunities

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Regional Out-Reach Programs/Opportunities

PayorPayor

PatientPatientHospitalHospital

PhysiciansPhysiciansPhysiciansPhysiciansConnected Community

Financial InstitutionFinancial Institution PharmacyPharmacy

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Hospital involvement in community EMR Deployments

“…“…hospital organizations are trying to figure out how they are going to … hospital organizations are trying to figure out how they are going to … propel EMR solutions to community physicians” propel EMR solutions to community physicians” – – Jared Peterson, VP, ResearchJared Peterson, VP, Research

KLAS, June 2008, when asked about the biggest EMR trends in the next few yearsKLAS, June 2008, when asked about the biggest EMR trends in the next few years

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• Integration with existing physician EMRs at various levels

• Encouraging the adoption by physician practices

• Offering EMR hosting (within SSH guidelines)

• Adoption of CCHIT standards and “exchange” technologies

• Charter involvement in CareSpark (RHIO) initiative

Regional Connectivity Initiatives Gaining Momentum

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QUESTIONS ?