EMRgency Medicine – Are You Ready?

December 10th, 2009

2|

AgendaOpening Remarks

Understanding the HITECH Act

and the EMR Mandate

Lessons Learned: A European

Perspective on EMR’s effect on

savings costs, lives & time

Increasing Your Chances for

Success: What are the Critical

Success Factors for EHR/EMR

Break

Thought Leadership

Discussion

Open Q&A

Networking & Dessert

Dr. Michael Fossel

Dr. Kennedy Ganti

Jean-Michel Van

Paul Roemer

Panelists

3|

OPENING REMARKS

Dr. Michael Fossel | Cerner Corporation

4|

Sometimes,your EMR can be a

―PICNIC‖

5|

Reality:not always a

PICNIC

6|

People will never laugh at

anything that is not based on

truth.- Will Rogers

I feel like I’m working for the

computer, rather than it working

for me. MD, Iowa, 2007

7|

8|

Sound like your EMR?

9|

Extormity and ARRA’s meaningful use

"Our legal team is expending incalculable billable hours to develop a

carefully worded statement that will depict in illustrative terms our

commitment to helping customers and prospects move toward the

eventual demonstration of meaningful use," explained Extormity chief

financial officer Samantha James in a carefully worded statement.

"It is common knowledge that meaningful use criteria are not fully

defined, so Extormity is taking great care not to issue an ironclad, no

exceptions guarantee," added James. "However, we plan to provide

the market with a vague impression of intent designed to inspire a

tinge of confidence and an indication of some degree of willingness to

comply at some future point, all without creating a legal obligation or

definitive pledge to deliver an actionable event."

10|

Who said…

11|

Who and when?Florence Nightingale

1863

―Notes on Hospitals‖

Nothing new under the sun...

Source: London: Longman, et al.

12|

Potential Benefits

Reduce errors

More ―intelligent‖ care

Real-time data

Better communication & documentation

Secure (and HIPAA compliant) data

Reduced labor costs

Reduced litigation

Automated workflows

13|

Costs of doing nothing…

Consider:

>90% of ~30 billion transactions/year by phone, fax, or mail

Physicians spend an estimated:

20-30% searching for information

38% documenting (nurses 50%)

Records misplaced in 30% of visits

Patients average 13 pieces of paper/visit

Offices average $10/visit on paper records

Patient records average 3.3 kg

• 33 cents/dollar spent is non-clinical

14|

Deadlines are nearing, penalties are looming

Why hesitate?

Ill-defined requirements

Unanswered questions

The opportunity to learn from others

Successes in the EU and US

How do we achieve success?

15|

THANK

YOUTHANK

YOU

16|

UNDERSTANDING THE HITECH ACT AND THE

EMR MANDATE

Dr. Kennedy Ganti | NJ Health IT Commission Chair

17|

Understanding the Fundamentals of Electronic

Health Data Use and Exchange:

Stimulus, Software and Sense

18|

The Case for Health IT Adoption

Computerized health data: nothing new

Since the 1970s

At centers like Boston, Indianapolis and Salt Lake City

Electronic medical records such as VA Vista were created

Central data repositories

Enter the Electronic Medical Record

Collection of related pieces of health data on a person's health and

disease

Electronic version of the standard medical charge

Data can be structured

Data can be shared

1

8

19|

The Case for Health IT Adoption

Making better decisions- clinical decision support

Drug-drug interactions

clinical reminders for preventative services

'red flags' on structured lab data

ePrescribing- tracking meds better

Know if patient actually filled a script

Track prescribers tendencies

Connecting the dots

1

9

20|

HITECH: Adding fuel to the fire

Health Information Technology for Economic and Clinical

Health Act

Makes federal funding and planning resources to build an

interconnected, interoperable national health data exchange

network

Provisions:

$18 billion for CMS to promote "meaningful use" of EMR systems

$2 billion for ONC for infrastructural upgrades in HHS, education of health IT professionals,

promotion of interoperable clinical data repositories

$1 billion to Federally Qualified Health Centers (FQHC) for renovation and acquisition of

health IT systems

$550 million for Health IT and other uses for Indian Health Services

$300 million to support regional and sub-national efforts for HIEs

$40 million to be used by Social Security Admin to use EMRs to submit disability claims

2

0

21|

Meaningful Use

Policies, standards and metrics that guide clinical usefulness of

EMRs

Specifies goals by policy, patient setting and time (every two years

starting in 2011)

Guide for CMS for promoting incentive payments and eventually

non-use penalties

Has harmonized goals between ambulatory and inpatient care

Pro- grounded in sound clinical and health policy principle

Con- Not very helpful in other care settings (Long term care,

physical therapy, etc)

2

1

22|

LESSONS LEARNED: A EUROPEAN

PERSPECTIVE ON EMR’S EFFECT ON SAVING

COSTS, LIVES AND TIME

Jean-Michel Van | Cegedim Healthcare Software (CHS)

23|

Group’s Expertise

Cegedim Group2008 : €849 million with 8,200 employees (80 countries)

Cegedim Healthcare Software (CHS)29% of group’s activity

Main market in western Europea) Healthcare provider

b) #1 in France, #2 in the UK, #1 in Italy, #1 in Spain, #2 in Belgium

Definition of EHR:

Data exchange, e-prescribing, CPOE, e-claim

24|

Adoption Rate Across Top Countries

1. Early starters

a) European initiatives earlier than US (Northern Europe): early 1980’ 90’

with e-claims submission, e-referral, e-clinical record

Sources: Castro, D. ITIF, Sept 2009

Fig 1- Use of EHR Systems in Hospitals

CountryPercentage of Hospitals Using

EHR Systems

DENMARK 65

FINLAND 100

SWEDEN 88

France 40

SPAIN 70

US 8

Fig 2 - Use of EHR Systems by Primary Care Physicians

CountryPercent of Primary Care Physicians

Using EHR systems

DENMARK 95

FINLAND 95

GERMANY 42

France 70

NETHERLANDS 98

SWEDEN 100

UK 89

US 28

25|

US and EU: Similar Barriers

1. Privacy issuesa) Danish Web portal Sundhed.dk= privacy functions! Thru Digital Signature, access tracking (40%

healthcare related Internet traffic)

b) Sweden: Good Policy - government-run database (4 to 5 % opt out)

c) Netherlands: stored in healthcare providers. Privacy control (2% opt-out)

2. Data ownershipa) Patients do not manage their data but own them and decide who can view/modify them

3. Cost of IT adoption

Source: Gartner, Ministry of Health Sweden and Sécurité Sociale Report France

Denmark Small subsidies (30%)

Netherlands Tax deductible and incentive payments for every patient (50%)

UK Financial incentives (75%)

France Subsidies (75%)

Spain Financial incentives (90%)

Fig 3 – Cost of IT Adoption and % of total cost

26|

Benefits of e-Health (France, Spain, Holland, UK, Denmark, Czech Republic )

1. ROI ? Yes

2. Benefits for Patient Safety (2005-2008)

15% reduction in prescription errors/year = Electronic Transfer of

Prescription

France: 200,000 reduction of prescription errors

Czech Republic: 75,000 reduction of prescription errors

Netherlands: 26,000 medication errors through CPOE and CDS

Six States: potential reductions of 5 million outpatient prescription

errors across the studied states

Source: Gartner, Ministry of Health Sweden and Sécurité Sociale Report France

27|

Benefits of e-Health (France, Spain, Holland, UK, Denmark, Czech Republic )

3. Benefits for Quality of CareUK: over 250,000 surplus laboratory tests were avoided since 2005

France : 11,000 readmissions to hospital for CHF were avoided

through EMR (an additional 26,000 savings of over €110 million,

if full elec.)

4. Increasing Physician AvailabilityUK: Over 90,000 appointments covered through “Did Not Attends”

option enabled by Electronic Appointment Booking (600,000)

Czech Republic: Almost 560,000 bed-days were become available

every year through Telemedicine, direct saving of €32 million

Sweden: Over 92,500 GP appointments/year were made available

alone through the use of web-portal

Source: Gartner, Ministry of Health Sweden and Sécurité Sociale Report France

28|

Mid + Long-term Costs & Benefits (France, Spain, Holland, UK, Denmark, Czech Republic)

1. Benefits on Annual basis

Average HPOs : annual benefits = annual costs year 3

Source: European Commission « Economic Impact of eHealth Report » 2008

Fig 4 - Annual Costs And Benefits Of E-Health 60 Sites From 1994 To 2008, In € Mill

Present value of annual costs Present value of annual benefits

29|

2. Benefits on Cumulative basis

Average HPOs: annual benefits > annual costs year 5

Cumulative benefit by 2008: € 330 million

Cumulative investment costs (incl. operating expenditure): €155 million

Source: European Commission « Economic Impact of eHealth Report » 2008

Fig 5 - Cumulative Costs And Benefits Of E-Health 60 Sites From 1994 To 2008, In € Mill

Mid + Long-term Costs & Benefits (France, Spain, Holland, UK, Denmark, Czech Republic)

Present value of cumulative costs Present value of cumulative benefits

500

1500

2500

30|

Future of the US e-Health

Each country is different

There is no one best practice!

Same strong signals as in Europe

a) National leadership groups, CCHIT

b) Set of Standards, HL7, SNOMED

c) Incentives

d) Top-down communication

31|

Thank You for Your Attention

« Yes, you can!!! »

32|

INCREASING YOUR CHANCES FOR SUCCESS:

WHAT ARE THE CRITICAL SUCCESS FACTORS

FOR EHR/EMR

Paul Roemer | Managing Principal, Healthcare IT Strategy

33|

EMR—What Should I Know?

What is the elephant in the room?

What does this mean—EMRs must be interoperable

& interconnected?

Know before you buy—what connects to what?

If EMRs aren’t connected, doctors will still need electronic and

paper files

34|

EMR—Where Does that leave you?

Focus on yourself, on what you control

Don’t let Washington drive your decision

ARRA

Certification

Meaningful Use

Decide why EMR is right for you

Figure out what your team should include

Define your requirements

Set a budget

35|

EMR—Fail Safe Points

What are the EMR Fail Safe Points (FSPs)?

EMR is healthcare’s Y2K time bomb.

There a is concurrent national rollout of EMR; standards not

available until 2010.

The costs are very high, so are the penalties

1/3rd to 2/3rd of EMRs implemented have failed

There may not be time to earn the incentives

36|

EMR—Ambulatory Practices

A good argument can be made for waiting. Within 12-18

months they will likely have the opportunity to acquire a

plug-and-play EMR in-house or SaaS, including:

Project management

Selection

Implementation

Adapting workflows

Training

Support

37|

EMR is Wide Open

New England Journal of Medicine (NEJM) received

responses from 63.1% of hospitals surveyed:

Only 1.5% of U.S. hospitals have a comprehensive electronic-

records system present in all clinical units.

7.6% have a basic system present in at least one clinical unit.

Computerized provider-order entry for medications has been

implemented in only 17% of hospitals.

Respondents cited capital and maintenance

costs as the primary barriers to implementation

38|

EMRif it doesn’t connect…

Just because EMR’s have been implemented,

doesn’t mean they’re of much value.

“I've witnessed more serious errors with the EMR than in my

previous 25 years as a physician.”

Christine A. Sinsky, MD

"...our system for delivering medical care is clearly in crisis...At

the heart of the problem is the fragmented nature of the way

health information is created and collected,"

Bill Gates

Most EMRs don’t operate beyond the walls of the

building in which they were implemented

39|

EMRAre you ready?

Enterprise Readiness

Assessment

Implementation Playbook

Risk Assessment

Cost Benefit/Funding

Analysis

Implementation Management

Federal funding

Incentives, grants

And penalties

EMR

Readiness

Methodology

has a 6 phase

scorecard.

40|

Enterprise Readiness Assessment

The Enterprise Readiness Assessment identifies gaps in:

Change Management Readiness

Technology Readiness

Risk Management

Standards Readiness

41|

EMR Implementation Playbook

The Implementation Playbook defines a program or set

of projects the enterprise needs to execute in order to

implement EMR. Potential projects may include:

Requirements

SW selection

Change Management

Integration

Policy, Procedure or Process

Training

42|

Enterprise Risk Assessment

The Enterprise Risk Assessment should help you

identify potentially fatal EMR implementation risks:

Staffing

Program management

Readiness

43|

EMR Cost Benefit/Funding Analysis

The Cost Benefit Analysis identifies:

The cost of implementation and the level of funding

necessary to successfully implement EMR

Funding sources such as grants or federal government

loans

The short term costs and the long term benefits

ROI development and monitoring

44|

EMR Implementation Management

Implementation Management oversees projects to

successfully implement each EMR project managing:

Project task management

Budget, Schedule, & ROI

Issues tracking and resolution

Staffing and skill requirements

Project accountability and visibility

45|

In Summary

46|

THOUGHT LEADERSHIP PANEL DISCUSSION

47|

Overview

Panel:

What is an EMR? Dr. Naomi Grobstein

Meaningful use Dr. Kennedy Ganti

Implementation Dr. Ganti/Dr. Fossel

Interoperability Paul Roemer

Which vendor? Dr. Spencer Kroll

Are EMR’s good? Jean-Michel Van

Getting reimbursed Dr. Kennedy Ganti

Who owns the data? Dr. David Memel

Q&A

48|

QUESTIONS & ANSWERS

49|

NETWORKING & DESSERT