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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

EMR and our 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



Are we all speaking the same language…..?



components of a patient record
Components of a Patient Record

Scanned Images of Documents

History & Physical

Physician Notes

Demographic Information

Care Giver Notes

Prior Encounters



Discharge Summary


Boxed Components are Unstructured Information


hospital involvement in community emr deployments
Hospital involvement in community EMR Deployments

Hospitals will represent 38% of all EMR purchases

up from 11% in 2007

– AC Group, Feb 2008

Electronic Medical Record Industry – Only 22% of Hospitals across the country have successfully deployed an EMR
emr scores by comparison
EMR Scores by Comparison

EMR Scores by Bed Size

EMR Scores by State

How will we get there?

Who will take the lead?

msha emr strategies
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



Computerized Patient Record JourneyPhases I-III

Increasing Value

On Journey to

Patient Safety, Quality and Efficiency



Bar Coding - MAK



Interdisciplinary Charting

6 months


Rad Upg


>6 months









Single Sign On



msha in out patient approach
MSHA In/Out-Patient Approach

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!”



msha in out patient approach1
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
Progress NotesTimeframe for Implementation

Foundation Systems

Clinical Repository




Replace Ancillaries

  • Pharmacy
  • MAK
  • eHIM
  • Dictation
  • ED
  • PACs
  • Rad
  • EKG
  • Cardio

Orders and Documentation




Vital Signs




Plans of Care

Physician Order Entry

Clinical Decision Support

msha ambulatory approach
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)
msha connectivity approach
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
emr approach
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.
whs emr strategies
WHS EMR Strategies

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



navigating through the technology
Navigating through the technology

“Nobody said it would be easy”

EMR evolution….

Phase 5


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…

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…

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


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



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

Fax or Mail

Manual Process and Costly – Not Actionable


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 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




Retail Rx


Financial Institutions

Connectivity Through the RelayHealth Network

Physician-Hospital- Pharmacy-Patient Clinical Interaction

Physician-Patient AdminInteraction

Physician-Retail RxConnectivity



  • 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



Bi-directional Communication


RH Network

Primary Care


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 long awaited regulatory relief
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
Overview of the Regulations
  • Permitted technology
  • Minimum technology standards
  • Permitted donors
  • Permitted recipients
  • Payment obligations
  • Technology not duplicative
  • Documentation
regional out reach programs opportunities
Regional Out-Reach Programs/Opportunities



Connected Community



Financial Institution


hospital involvement in community emr deployments1
Hospital involvement in community EMR Deployments

“…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
  • 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