1 EMR Proposal

White Plains Community Hospital

Group 2 Consulting LLC

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Group 2 Consulting LLC

•  George Asante

•  Peggy Barnaba

•  Judith Binderman

•  Linda Bund

•  Steven Edwards

•  Peter Gilbert

•  Kristina Rogers

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Overview - EMR

White Plains Hospital EMR Proposal

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Why an EMR?

•  The Health Care System fails patients too frequently

•  IOM calls for “an infrastructure that permits fully interconnected, universal, secure network of systems that can deliver information for patient care anytime, anywhere.”

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What is an EHR? The EHR is: •  Safe •  Real time •  Point of care •  Patient centric information resource

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Crossing the Quality Chasm

•  Safe •  Effective •  Patient Centered •  Timely •  Efficient •  Equitable

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An EMR System will •  Share patient information between clinicians •  Improve Processes via efficient workflow •  Improve Quality through common order sets •  Facilitate Clinical Decision Support •  Support more accurate and timely Revenue

Management •  Reduce costs by reducing redundant tests

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Clinical Benefits - EMR

White Plains Hospital EMR Proposal

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Clinical Benefits of EMR - General EMR allows organizations to: •  Reduce time waiting for follow-up, authorizations

and eligibility •  Standardize documentation and coding •  Facilitate disease management •  Ensure continuity of care •  Improve tracking of patients who need care •  Expand outreach to the community

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Clinical Benefits of EMR - Clinicians Clinicians will be able to: •  Obtain patient information from any location in

the hospital •  Receive decision support for treatment

recommendations •  Access patient data •  Integrate measurement into everyday routines

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EMR and Healthy People 2010 An EMR can help White Plains meet these goals by: •  Providing a tool to help track the quality of service

provided •  Identifying needed improvements in data quality,

processes or healthcare provided •  Creating reports to evaluate how the health status

of the community is changing

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Overall Clinical Benefits of EMR

EMRs will: •  Eliminate repetitive tasks •  Increase patient privacy •  Improve quality of care •  Improve patient and employee satisfaction •  Provide tools to increase services and improve

care, while saving money

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Infrastructure / Technology Cost Components

White Plains Hospital EMR Proposal

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Infrastructure / Technology Direct, one-time costs

•  Hardware & peripherals •  Packaged and

customized software •  Network, peripherals,

supplies, equipment •  Facilities upgrades •  Initial user training •  Project Management

costs

Direct, ongoing costs •  Salaries for IT and

assigned end user staff •  Software maintenance,

subscriptions, upgrades •  Facilities rental and utilities •  Professional services •  Ongoing training

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Infrastructure / Technology

Indirect, ongoing costs • Data integrity •  Security •  Privacy •  IT policy management • Help Desk

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Total Cost of Ownership (Major vendors) Cerner IDX EPIC QuadraMed Average Minus 25% Plus 25%

Total One-Time Software Cost $2,120,194 $3,264,444 $3,201,754 $1,806,573 $2,598,241 $1,948,681 $3,247,802

Total One-Time Implementation Cost $7,623,151 $7,907,089 $7,908,089 $5,657,449 $7,273,945 $5,455,458 $9,092,431

Total One-Time Vendor Support $800,048 $1,571,884 $1,458,879 $464,355 $1,073,792 $805,344 $1,342,239

Total On-going Clent Support $3,040,000 $3,040,000 $3,040,000 $3,040,000 $3,040,000 $2,280,000 $3,800,000

Total $13,583,393 $15,783,417 $15,608,722 $10,968,377 $13,985,977 $10,489,483 $17,482,472

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Cost / Benefit

White Plains Hospital EMR Proposal

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Cost Benefit Areas Expenses Decrease •  Transcription

  Staff time and number of staff needed •  Coding

  Staff time and number of staff needed •  Physical Materials/Storage

  Material Cost, staff time, and space cost

•  Eligibility, Authorization and Referral Management   Staff time and wasted services

•  Data mining and Analysis   Staff time and number of staff needed

•  Services and Health maintenance reminders   Staff time and number of staff needed

•  Physician Productivity   Staff time and number of staff needed

Positive Revenue Impacts •  Coding

  Accurate Claims=faster reimbursement, lower accounts receivable days and faster cash flow

•  Physical Materials/Storage   Reallocated Space=better value use of space

resulting in additional revenue potential •  Eligibility, Authorization and Referral Management

  Accurate service decisions= decrease in incorrect service choices and increased profits

•  Data mining and Analysis   Faster identification of research and clinical

trial candidates=more successful grant completions, publications, new grant application success probability, notoriety, and talent= increased revenue, quality, and service

•  Services and Health maintenance reminders   Increases in service volume=increased

revenue •  Physician Productivity

  Increases in service volume=increased revenues

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Cost Benefit Areas Research (Rand Corporation on EMR Net Potential Savings)

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Cost Benefit Areas Research-”Cost Benefit of Electronic Medical Records in Primary Care”

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CPOE Computerized Physician Order Entry

White Plains Hospital EMR Proposal

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Advantages of CPOE •  Transparency of orders •  Reduction of transcription & medication

errors •  Evidence based decision making •  Security •  Remote access •  Aggregate Data (QM & Mgmt reporting) •  Billing

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Evidence of ROI

Data Source: Return on Investment for a Computerized Physician Order Entry System R. KAUSHAL, MD, MPH, A. K. JHA, MD, C. FRANZ, PHD, J, GLASER, PHD, K. SHETTY, MD, T.JAGGI, BA, B. MIDDLETON, MD, MBA, MSC, G. J. KUPERMAN, MD, PHD, R. KHORASANI, MD, MPH, M. TANASIJEVIC, MD, MBA, D. W. BATES, MD, MSC, CPOE Working Group JAIMA Vol 13 No. 3 May / Jun 2006 Pg 261

•  Dosing guidance, •  Nursing time, •  Prevention of adverse drug events. •  Improved workflow, •  Cancellation of Inappropriate Orders •  Reduced test utilization and/or duplication

Net savings in published studies ranges from $8-$16 million

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Key Areas of focus for WPH Improvements In: Imaging Testing

Laboratory Testing

Prescribing Patterns Medication Errors

Leads to: " Reduced Testing

" Reduced Testing

" Appropriate Orders

" Reduced Error Rate

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Potential Cost Savings WPH

Category Ref Variable(s) / CPOE

Functionality

Data WPH data assuming

conservative estimates

WPH Cost Savings

(potential) Radiology (ref 13) Test reduction Guidelines

Repeats 8% reduction in

tests 3% (150,000) * $500 per exam

$2, 250, 000

Laboratory (ref 13, 14)

Test reduction Guidelines Repeats

6% reduction in tests

3% of (2.2 million tests) *$60

$3, 960, 000

Prescribing Patterns

(ref 15,16)

Inappropriate dosage and use

Guidelines

17% reduction in medication costs

17% * (annual Pharmacy budget)

$1, 525, 000

Medication Errors

(ref. 17,18, 19)

Hospital Tort costs, malpractice

Legibility, BCMA, dosage checks

32% reduction 14,138 in-pts $361/pt (6% reduction)

$765, 572

Totals $8, 500, 572

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Deployment Timeline

White Plains Hospital EMR Proposal

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Suggested Deployment Timeline

Year 2 Year 6 Year 7 Year 3 Year 4 Year 5 Year 1

Year 1 • Governance Structure, Executive and

Physician Champions

• Vision & Scope

• Assessment of Out-patient workflows

• Evaluations of Ancillary connectivity & interface

• Functional Design & Specification of Core CPOE Computerized Physician Order Entry

• End-User Interface Design, measurements and reporting requirements

• Pilot Implementation and Assessment.

• Technical Support, hardware, and architecture

Subsequent Years 2 – 7

• CDR – Clinical Data Repository • CDSS – Clinical Data Support System

• CMV – Clinical Medical Vocabulary •  PACS – Picture Archive and Communication System (internal to radiology and then expand)

• eMAR – Electronic Medication Records and definitive patient identification method

•  CCD – Fully integrated Continuity of Care with all entities all partners within the Health Care Entity

• Fully Implemented Electronic Medical Records (Stage 6)

• Bonus Features - Physician Portals, Patient Wellness Data

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Summary

White Plains Hospital EMR Proposal

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Given our mission to provide: …high quality, acute health care and preventive medical care in

a caring and compassionate manner to all people who live in, work in, or visit Westchester County and its surrounding areas…

And our approach of:

•  Developing and implementing new services to respond to the changing and varied health care needs of the communities we serve;

•  Creating resources to maintain financial viability to fund high quality programs and services;

•  Maintaining a state-of-the-art facility and equipment to support the Hospital's programs and services; and

•  Providing a working environment which attracts and retains the most talented, dedicated and committed people

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The Case for an EMR*

•  Meets critical clinical goals

•  Meets organizational goals

•  Meets community goals •  Meets revenue goals

•  *Must include CPOE

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It’s Simple A fully integrated EMR, with CPOE: •  Is the right thing to do •  Saves us money •  Improves patient safety and quality of care •  Enables us to keep up with change • Helps our staff do their job more easily

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Questions?

White Plains Hospital EMR Proposal