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EMR - The Time is Now: Physician Alignment through IT. Richard Eshbach & Bill Moran. Panel Discussion. “Every American will have access to an electronic health record by 2014”. The President’s Bold Vision for HIT. EMR and our Connected Care Community.

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Emr the time is now physician alignment through it

EMR - The Time is Now:Physician Alignment through IT

Richard Eshbach & Bill Moran

Panel Discussion


The president s bold vision for hit

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

The President’s Bold Vision for HIT


EMR and our record by 2014”Connected Care Community

  • 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


  • Definition of an emr
    Definition of an EMR record by 2014”

    CPR

    EMR

    Are we all speaking the same language…..?

    EHR

    PHR


    Components of a patient record
    Components of a Patient Record record by 2014”

    Scanned Images of Documents

    History & Physical

    Physician Notes

    Demographic Information

    Care Giver Notes

    Prior Encounters

    Pharmacy

    Cardiology/Pulmonary

    Discharge Summary

    Laboratory

    Boxed Components are Unstructured Information

    Radiology


    Emr adoption model q2 2008
    EMR Adoption Model Q2 2008 record by 2014”

    5%


    Hospital involvement in community emr deployments
    Hospital involvement in community EMR Deployments record by 2014”

    Hospitals will represent 38% of all EMR purchases

    up from 11% in 2007

    – AC Group, Feb 2008


    Electronic Medical Record record by 2014”Industry – Only 22% of Hospitals across the country have successfully deployed an EMR


    Emr scores by comparison
    EMR Scores by Comparison record by 2014”

    EMR Scores by Bed Size

    EMR Scores by State


    How will we get there? record by 2014”

    Who will take the lead?


    Electronic Medical Record record by 2014”


    Msha emr strategies
    MSHA EMR Strategies record by 2014”

    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

    11/17/2014

    12


    Computerized Patient Record Journey record by 2014”Phases I-III

    Increasing Value

    On Journey to

    Patient Safety, Quality and Efficiency

    2009-11

    2009-10

    Bar Coding - MAK

    Live

    2008-09

    Interdisciplinary Charting

    6 months

    ED

    Rad Upg

    PACs

    >6 months

    2007

    Cardiology

    eHIM

    Orders

    Pharmacy

    Network

    ClinicalAccess

    Monitors

    Single Sign On

    Hardware

    Wireless


    Msha in out patient approach
    MSHA In/Out-Patient Approach record by 2014”

    Mountain 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 electronicflow 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!”

    11/17/2014

    14


    Msha in out patient approach1
    MSHA In/Out Patient Approach record by 2014”

    • 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

    11/17/2014

    15


    Timeframe for implementation

    Progress Notes record by 2014”

    Timeframe for Implementation

    Foundation Systems

    Clinical Repository

    Monitors

    Wireless

    Single-sign-on

    Replace Ancillaries

    • Pharmacy

    • MAK

    • eHIM

    • Dictation

    • ED

    • PACs

    • Rad

    • EKG

    • Cardio

    Orders and Documentation

    Orders

    Alerts

    Workflows

    Vital Signs

    Assessments

    Documentation

    Forms

    Plans of Care

    Physician Order Entry

    Clinical Decision Support


    Msha ambulatory approach
    MSHA Ambulatory Approach record by 2014”

    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)


    Msha connectivity approach
    MSHA Connectivity Approach record by 2014”

    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


    Electronic Medical Record record by 2014”


    Emr approach
    EMR – Approach record by 2014”

    • 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.


    Whs emr strategies
    WHS EMR Strategies record by 2014”

    Inpatient / 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

    11/17/2014

    21


    Navigating through the technology
    Navigating through the technology record by 2014”

    “Nobody said it would be easy”


    EMR evolution…. record by 2014”

    Phase 5

    EMR

    In Patient - EMR

    Phase 4

    Physician Office,CPOE

    Phase 4

    Horizon Lab, Anesthesia, ER

    Phase 3

    Nursing Doc (HED), AdminRx (barcoding)

    Phase 2

    LAB (Cerner), Pharmacy (HMM), Cardiology

    Phase 1

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


    Emr in patient approach
    EMR – In Patient Approach… record by 2014”

    Wellmont’s EMR consist of the following: (We are 76% deployed)

    • An electronicOrder Management System - √ Completed(STAR HOM/Orders)

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

    • An electronicPharmacy System - √ Completed(HMM)

    • An electronicRadiology System - √ Completed(Star RIS)

    • An electronicTranscription System - √ Completed(Cquence, Star/HPF, Lanier)

    • An electronicLaboratory System - √ Completed(Cerner Classic)

    • An electronicNursing documentation System - √ Completed (HED)

    • An electronicHorizon Patient Folder Application - √ Completed(HPF)

      • HPFhelps 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.


    Whs emr what s next
    WHS EMR – What’s Next… record by 2014”

    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

    11/17/2014

    25


    Ambulatory strategy and solution update

    Ambulatory Strategy record by 2014”

    Ambulatory Strategy and Solution Update


    Traditional methods of delivering test results transcriptions
    Traditional Methods of Delivering Test Results/Transcriptions

    Fax or Mail

    Manual Process and Costly – Not Actionable

    Portal

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

    Point to Point Interfaces

    HL7 Interfaces

    IT Overhead- Costly to Maintain – Not Actionable


    Interoperability through relayhealth
    Interoperability through Results/Transcriptions 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

    RelayHealth Connectivity Results/Transcriptions

    Hospitals

    Physicians

    Patients

    Retail Rx

    Payors

    Financial Institutions

    Connectivity Through the RelayHealth Network

    Physician-Hospital- Pharmacy-Patient Clinical Interaction

    Physician-Patient AdminInteraction

    Physician-Retail RxConnectivity

    Hospital-PhysicianConnectivity

    Physician-to-PhysicianNetworking

    • Emergency Dept connectivity

    • Care mgmt

    • Results distribution

    • Electronic prescriptions

    • Renewals

    • Appointment scheduling

    • Billing questions and online payments

    • Test results

    • webVisit consultations

    • Rx renewals

    • Personal health records

    • Referrals

    • Patient care collaboration


    Connected and actionable network
    Connected and Actionable Network Results/Transcriptions

    Patient

    Specialist

    Bi-directional Communication

    HL7

    RH Network

    Primary Care

    Patient


    Physician Practice EMR Adoption Results/Transcriptions

    11/17/2014

    31


    Congress passes medicare bill with e prescribing incentives july 15 2008
    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


    Stark Safe Harbors – “ (July 15, 2008)Rules of Engagement”

    11/17/2014

    33


    Stark long awaited regulatory relief
    Stark: Long-awaited Regulatory Relief (July 15, 2008)

    • 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
    Overview of the Regulations (July 15, 2008)

    • Permitted technology

    • Minimum technology standards

    • Permitted donors

    • Permitted recipients

    • Payment obligations

    • Technology not duplicative

    • Documentation


    Regional Out-reach Programs/Opportunities (July 15, 2008)

    11/17/2014

    36


    Regional out reach programs opportunities
    Regional Out-Reach Programs/Opportunities (July 15, 2008)

    Hospital

    Patient

    Connected Community

    Physicians

    Payor

    Financial Institution

    Pharmacy


    Hospital involvement in community emr deployments1
    Hospital involvement in community EMR Deployments (July 15, 2008)

    “…hospital organizations are trying to figure out how they are going to … propel EMR solutions to community physicians” – Jared Peterson, VP, ResearchKLAS, June 2008, when asked about the biggest EMR trends in the next few years


    Regional Connectivity Initiatives Gaining Momentum (July 15, 2008)

    • 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

    11/17/2014

    39


    QUESTIONS ? (July 15, 2008)


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