healthcare market drivers
DESCRIPTION
Georgetown University Selection of Electronic Health Record Presented by: Suniti Ponkshe September 22, 2010. Three broad drivers for healthcare transformation: cost containment, greater collaboration and improved quality of care - PowerPoint PPT PresentationTRANSCRIPT
Georgetown University
Selection of Electronic Health Record
Presented by: Suniti Ponkshe
September 22, 2010
Healthcare Market Drivers
Three broad drivers for healthcare transformation: cost containment, greater collaboration and improved quality of care
$ Rising healthcare costs and economic pressures are increasingly constraining access and quality◦ Tax shortfall◦ Rise in unemployment◦ Lack of transparency ◦ Dramatic increase in uninsured population and uncompensated care
Value-driven healthcare will drive optimization and require proactive collaboration among all stakeholders◦ Governments, Payers and Providers shifting focus beyond acute care to Wellness,
Prevention and Chronic Disease management
Increasing demand for improved quality and outcomes measurement
“The stars are aligned for historic transformation in Healthcare”……. And it did ………..
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Healthcare Journey
“The stars were aligned for historic transformation in Healthcare”
……. And we began our journey ………..
American Recovery and Reinvestment Act
The Health Information Technology for Economic and Clinical Health (HITECH) Act
The Patient Protection and Affordable Care Act
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Provisions
American Recovery and Reinvestment Act (ARRA) ARRA 8
The Health Information Technology for Economic and Clinical Health (HITECH) Act Adoption of Interoperable Health IT ONC Authority Medicare and Medicaid Incentives
The Patient Protection and Affordable Care Act (PPACA) Many Implications for Health IT Center for Innovation Service Delivery Models – Accountable Care Organization; Medical Home Payment Models – Shared Savings; Risk Adjusted Payments
4
The HITECH Vision
• State grants for health information exchange• Standards and certification framework
• Privacy and security framework
• Regional extension centers• Workforce training Medicare and Medicaid
Incentives and Penalties
Adoption of EHRs
Meaningful Use of Certified EHRs
Exchange of Health Information
Research to Enhance Health Information Technology
Data
• Improved Individual and Population Health Outcomes
• Increased Transparency and Efficiency• Improved Ability to Study and Improve
Care Delivery
5
6
100
80
60
40
20
0
9%
50%
Size of Practice
> 50 physicians
Perc
enta
ge1 - 3
physicians
DesRoches., N Engl J Med 2008
25
20
15
10
5
0
4%
13%
Level of EHR Function
Fully Functional
Basic System
Perc
enta
geEHR Adoption in Physician Office Practices
Data capture and sharing
Advanced clinical processes
Improved outcomes
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Conceptual Approach to Meaningful Use
Stage 1
Stage 3
Stage 2
2010 Technology Trends
Nine Significant Technology Trends for 2010:
1. Clinical Informatics2. Computerized Provider Order Entry (CPOE)3. Data Infrastructure4. HITECH5. Privacy 6. Reimbursement Reform7. Smart Phones8. Telemedicine
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* Healthcare Informatics February 2010 Issue
Healthcare CIO Trends
Healthcare Information and Management Systems Society(HIMSS) 2010 Leadership Survey Key Priorities: 1. Meeting Meaningful Use Criteria2. Focus on Clinical Systems3. Leveraging Information 4. Optimizing Current Systems5. Focus on Ambulatory Systems6. Patient-Centric Solutions7. Interoperability Between In-house Systems8. Integration with Medical Devices
www.himss.org/2010survey
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Most Commonly Used Definition of EHR
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Electronic Health Record (EHR)“a secure, real-time, point-of-care, patient-centric information
resource for clinicians.
The EHR aids the clinicians’ decision-making by providing access to patient health record information when they need it and incorporates evidence-based decision support.
The EHR automates and streamlines the clinicians’ workflow, ensuring all clinical information is communicated and ameliorates delays in response that result in delays or gaps in care.
The EHR also supports the collection of data for uses other than clinical care, such as billing, quality management, outcomes reporting, and public health disease surveillance and reporting.”
Electronic Health Record (EHR) is a building block process
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and the Clinical System is a major foundation block ….
Clinical Systems Vendor Landscape has Changed …….
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Vendors are becoming full service providers -- through acquisitions and some system building
Payers are getting into product offering
Vendors are migrating to an “open system” platform, i.e., ability to interface with other systems easily
• Health systems are leveraging technology to support and meet their quality strategic plan such as Patient Safety, saving lives and reliable information
Some health systems are adopting “Best of Breed” approaches with appropriate boundaries – supporting quality strategic goal and meeting user needs while adding value
Lines between inpatient and ambulatory vendors are diminishing
Product Life Cycles
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NewPilot sites completedNew sales acceleratingHigh investment in development
SunsetLittle investmentin supportNo new client sales
DecliningDeclining investment in enhancementsFew new client sales
CompetitiveStrong new client sales. Relatively heavy investment in enhancements
Pre-ReleaseMajor development underway Pilot sites being installed
Electronic Health Record
Vendor Market• Hundreds of vendors• Too competitive• Diminishing market sector lines
Selecting EHR • Structured process• Criteria • Impact on the workflow• Right purchasing option
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System Selection Approach
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UnderstandCurrent State
Define Future State Vision
Identify Vendor Short List
Develop RFQ
Conduct Vendor Evaluation
Contract Negotiations
Preliminary Implementation
PlanningPrepare Clinical
Benefits
Identify System Capability Gaps
Conduct Decision
Conduct Decision
Conduct Decision
Three areas pivotal to the Process are ……
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DecisionVision Decision-makingProcess
Vision Requires Review of Key Strategies
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Vision
• Best of Breed, Best of suites, others• Ownership• Analytics• Others
Selection process needs broad support, collaboration and consensus
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Decision-makingProcess
Project Governance Needs to Involve all Constituents ….
19
Clinical SystemSelection (CSS)Executive Steering Team
CCSTechnologyTask Force
CCSCommunicationTask Force
CSSPhysician Advisory Team
CCSCare DeliveryAdvisory Team
An Effective Process is Needed With Milestones
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Establish Goals and Key Requirements
Facilitate Future State Sessions
Develop Comparative Vendor Analysis
Create Short List
Conduct Vendor Demonstrations
Select Finalists
Conduct Additional Evaluation of Vendors
Select Vendor of Choice & Begin Contracting
Decision Day
Decision Day
Decision Day
Decision Day
Vendor Comparison Criteria
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Functionality
Evaluation based on the key requirements from future state sessions
Meaningful Use Criteria Five Priority areasACOsMedication Home Pharmacy Clinical Decision Support Results Review Usability Health Analytics
Technology
Evaluation based on the technical requirements identified in the process
Integration with Current environment (interoperability)
Scalability Privacy & Security Speed and Reliability
Company
Evaluation based on market intelligence and experiences
Vendor Vision Company Viability Ability to Execute Customer Service Focus Vendor Culture and Goals
alignment with the client
Comparative Approach
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Overwhelmingly recognized as the leader – second to none.
Generally recognized as a leader - could be tied with one other.
Considered equivalent to others – tied with two or more.
Needs improvement – More than three other vendors considered materially better.
Not generally available – may be building it but doesn’t have it today.
Comparative Scale:
Each vendor was scored according to the scale
List of
Vendors
Vendor Usability
CATEGORY
Framework Poor Fair Good
Workflows Fair Fair Good
Layout/Screen organization Fair Fair Good
Templates: Documentation Fair Poor Good
Templates: Orders Poor Poor Good
Customization & personalization Poor Fair Good
Visualizations Fair Fair Fair
Future Development Fair Poor Good
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Vendor 1 Vendor 2 Vendor 3
25
Pharmacy/ Medication Safety
Medication Order Entry & Formulary
MgmtSMS
Dosing MgmtSMS
Drug Interactions
SMSCMAR
Med/IV Charting
Drug DatabaseMicromedix
Physician Clinical Practice
Physician Order Entry
Results Review
SMS
Patient Locator/
Patient ListsSMS
Data WarehouseHome Grown
Decision Support TQ/T2
Outcomes Measurement / Comparative Data
Med AI
CredentialingMSO
Report WriterData
Warehouse
Clinical Decision Support
Core Information Management Components
User Interface/ Portal
CareNet
Order EntrySMS
Enterprise Master Person Index
(MPI)SMS EAD
Security Tools
Novell
Clinical Data Repository
CareNet
Rules EngineSMS
PDA Support
Integration Tools
E-Link
ResultSMS
HR/PayrollPeoplesoft
Kronos
Maximum Utilization Moderate Utilization Purchased – Not Implemented In Progress
Common Medical
VocabulariesICD-9/ CPT4
Standard CDM/ Master File
SMS
Admission/ Registration
SMS
Eligibility Verification
HDX
Request for Authorization
Enterprise Schedluling
HBOC
Enterprise Patient Access
Supply Chain
Patient Supply ChargesSMS &
Par Excellence
Patient Assessment
SMS
FlowsheetsSMS
SMSKardex
SMSI &O
Vital Signs
Clinical Documentation
SMSPatient
Assessment/ Tracking
Care PlansSMS
Task ListsSMS
Non-MD ordersSMS
SoftMedChart
Management
Health Information Management
Transcription/ DictationMedquist (Outside Vendor
WincoderCoding
Support
SMSDocument Imaging
SoftMedElectronic Signature
SoftMedMRN
Management and Merge
WincoderAbstracting
InterQual Support for
LOC
Medication Dispensing
Pyxis
Materials Mgmt
Peoplesoft
Departmental/ Support Services
LabSunquest
PathologyCoPath
Blood BankSunquest
RadiologyQuadris
Emergency Department EmSTAT
CardiologyMUSE
SurgerySurgi-ServerOmni-Server
OBGE QS
Cath LabCatalyst
RespiratoryMediserve &
I-Stat
Longitudinal Clinical Data
SMS LCR
Home HealthAllegheny
Home HealthMcKesson/
HBOC
Sr. Living Clinicals
Accu-Med
Sr. Living Financials
Keane
Overview of Major Systems & Implementation StatusDRAFT
Contract Management
VCM
GL/APPeoplesoft
Patient AccountingSMS/Affinity/Keane