Welcome to PINNACLE Network Webinars! “Selecting and Electronic Health Record for Your Cardiology...

Welcome to PINNACLE Network Webinars!

“Selecting and Electronic Health Record for Your Cardiology Practice”

October 13, 20114:00-5:00pm EST

Thank you for joining us today!

Choosing “Your” best EMRChoosing “Your” best EMR

Jay Alexander, MD, FACCJay Alexander, MD, FACC

NorthShore University Health Systems NorthShore University Health Systems

OrOrLife after a poor EMR choiceLife after a poor EMR choice

A case study in how to choose a wrong A case study in how to choose a wrong system and survive.system and survive.

North Shore CardiologistsNorth Shore Cardiologists

• 12 physicians, 3 mid-level providers12 physicians, 3 mid-level providers• 4 North Chicago locations4 North Chicago locations• On staff at 6 area hospitalsOn staff at 6 area hospitals• Specialists in invasive and non-invasive Specialists in invasive and non-invasive

cardiology and critical carecardiology and critical care• In 1/2011 Integrated into a healthcare system In 1/2011 Integrated into a healthcare system

with a system wide EMRwith a system wide EMR• 3 EMR in less than a decade3 EMR in less than a decade

Ahead of the curve (2004)Ahead of the curve (2004)

• The best intentionsThe best intentions– Improve efficiency and productivityImprove efficiency and productivity– Position practice for pay-for-performance Position practice for pay-for-performance

programs, other changes in healthcareprograms, other changes in healthcare– Improve practice negotiating position with payor Improve practice negotiating position with payor

organizationsorganizations– Realize the value of rich clinical informationRealize the value of rich clinical information

• The wrong choiceThe wrong choice

Our first mistakeOur first mistake

Reasonably good PM

system

Reasonably good EMR

system

=

Our 1Our 1stst EMR EMR

• InflexibleInflexible

• ExpensiveExpensive

• UnresponsiveUnresponsive

Inflexible EMRInflexible EMR

• Not easily adaptable for our practiceNot easily adaptable for our practice• Forced conformity to a single workflowForced conformity to a single workflow• Workflow was not conducive to the practice of Workflow was not conducive to the practice of

cardiologycardiology• Only one way to enter notesOnly one way to enter notes• Custom templates/multiple templates proved Custom templates/multiple templates proved

impossibleimpossible

Expensive EMRExpensive EMR

• After two years…After two years…– An investment of over $400,000An investment of over $400,000– Only three physicians using the systemOnly three physicians using the system

» The three most tech-savvy physiciansThe three most tech-savvy physicians» Struggling mightily every dayStruggling mightily every day

Unresponsive EMR companyUnresponsive EMR company

• Slow to respondSlow to respond– Next upgradeNext upgrade– Next releaseNext release– Next yearNext year

• Our workflow is better than your workflow…Our workflow is better than your workflow…

The last straw…The last straw…

• Spend another $80,000 and your EMR will do Spend another $80,000 and your EMR will do what you want it towhat you want it to

The decision to switchThe decision to switch

• Our practice was not a democracyOur practice was not a democracy• Benevolent dictatorship structure enabled us Benevolent dictatorship structure enabled us

to weather the transitionto weather the transition• Old EMR performance was so bad, the Old EMR performance was so bad, the

change was actually welcomechange was actually welcome• Never a question of abandoning EMRNever a question of abandoning EMR

Now what?Now what?

• New EMR must be:New EMR must be:– Affordable – we could not/would not double our Affordable – we could not/would not double our

investmentinvestment– Flexible – we wanted control of our workflowFlexible – we wanted control of our workflow

• New EMR company must be:New EMR company must be:– ResponsiveResponsive– AgileAgile

We talked to other cardiologistsWe talked to other cardiologists

Look at this system…

Affordable EMRAffordable EMR

• Lower initial investmentLower initial investment– Web-based, ASP systemWeb-based, ASP system

» Avoided initial cost for servers and database licensesAvoided initial cost for servers and database licenses» Avoided long-term costs for hardware upgrades, IT Avoided long-term costs for hardware upgrades, IT

support, and other expenses now borne by EMR vendorsupport, and other expenses now borne by EMR vendor

Accessible EMRAccessible EMR

• Anytime, anywhere access over the internetAnytime, anywhere access over the internet• Any location, any computer, with no need to Any location, any computer, with no need to

download softwaredownload software• It’s 3:00 am, do you know where your patient It’s 3:00 am, do you know where your patient

records are?records are?– On a secure Website, which I can access in my On a secure Website, which I can access in my

pajamas from my home computerpajamas from my home computer

Flexible EMRFlexible EMR

• Smaller up-front investment focused on Smaller up-front investment focused on tailoring EMR:tailoring EMR:– For our practiceFor our practice– For our workflowFor our workflow– For our physician preferencesFor our physician preferences

• Workflow changesWorkflow changes– Best practices consultingBest practices consulting– As opposed to “we know what’s best”As opposed to “we know what’s best”

Our 2nd systemOur 2nd system

© copyright 2008 Jay Alexander

Responsive EMR companyResponsive EMR company

• Changes are made on our calendar, as Changes are made on our calendar, as opposed to their master release scheduleopposed to their master release schedule

• Web-based application is imminently more Web-based application is imminently more flexible and modifiableflexible and modifiable

• Our EMR partner actually wants our input, Our EMR partner actually wants our input, and they act on it!and they act on it!

TemplateTemplate


PQRI modulePQRI module


From apathy to enthusiasmFrom apathy to enthusiasm

• Able to get 12 Cardiologists and 60 Able to get 12 Cardiologists and 60 employees on system in less than 3 monthsemployees on system in less than 3 months

Warnings and alertsWarnings and alerts


Flexible encounter Flexible encounter documentationdocumentation

• By practice or by physician:By practice or by physician:– Point and clickPoint and click– DictationDictation– Document managementDocument management

Point & clickPoint & click


DictateDictate


Document managementDocument management


Modular functionalityModular functionality

• Comfortable increments vs. “all in”Comfortable increments vs. “all in”• Web-based architecture includes PACS Web-based architecture includes PACS

functionality to integrate imagingfunctionality to integrate imaging• New modules such as PQRI, e-prescribing New modules such as PQRI, e-prescribing

and Pinnacle (IC3) reporting added with and Pinnacle (IC3) reporting added with regularityregularity

• Modules can be enabled when we are ready Modules can be enabled when we are ready for themfor them

PACS functionalityPACS functionality


What to avoidWhat to avoid

• Do not assume your EMR and PM should come from Do not assume your EMR and PM should come from the same companythe same company

• Bigger does not necessarily mean betterBigger does not necessarily mean better• Be wary of systems that require dramatic workflow Be wary of systems that require dramatic workflow

changechange• Do not select an EMR that degrades service to patientsDo not select an EMR that degrades service to patients• Do not be dazzled by flashy graphics – look under the Do not be dazzled by flashy graphics – look under the

hoodhood• Be skeptical of big reductions in patient volumes and Be skeptical of big reductions in patient volumes and

resulting revenuesresulting revenues• If hefty up-front investments are required, keep looking!If hefty up-front investments are required, keep looking!

What to look forWhat to look for

• Take a test drive and put the EMR through its Take a test drive and put the EMR through its pacespaces

• Talk to other cardiology practices, and ask Talk to other cardiology practices, and ask about the good, bad and uglyabout the good, bad and ugly

• Choose a system that is CCHIT CertifiedChoose a system that is CCHIT Certified• Find an EMR partner that is nimble and Find an EMR partner that is nimble and

responsiveresponsive

Where to lookWhere to look

• Make sure your selection is certified- Make sure your selection is certified- www.cchit.orgwww.cchit.org

• If looking for an EMR check out CCHIT If looking for an EMR check out CCHIT website products tabwebsite products tab

• Also check out HealthIT.govAlso check out HealthIT.gov• ACC- Cardiosource- Health IT (Informatics)ACC- Cardiosource- Health IT (Informatics)

What to look forWhat to look for

• One size does not fit all – find an EMR that can be One size does not fit all – find an EMR that can be tailored to your practice and your clinicianstailored to your practice and your clinicians

• Find a natively Web-based system that is accessible Find a natively Web-based system that is accessible any time, anywhereany time, anywhere

• Flexible encounter documentation is key – can you Flexible encounter documentation is key – can you point and click, dictate and manage paper? Dragon?point and click, dictate and manage paper? Dragon?

• A system where a patient can exchange information A system where a patient can exchange information electronically with the EHR systemelectronically with the EHR system

One more thing to look forOne more thing to look for

• Vendor that supports the practice of Vendor that supports the practice of cardiology and cardiology best practicescardiology and cardiology best practices

• Find a Vendor that can:Find a Vendor that can:– Has integrated and automated ACC Pinnacle data Has integrated and automated ACC Pinnacle data

collection and reportingcollection and reporting– Is committed to supporting ACC initiatives around Is committed to supporting ACC initiatives around

evidence based medicine and appropriate use evidence based medicine and appropriate use criteriacriteria

Stimulus feeding frenzyStimulus feeding frenzy

Stimulus fundingStimulus funding

• Effectively doubles the size of the healthcare Effectively doubles the size of the healthcare IT marketIT market

• It starts with $44,000 in EMR adoption and It starts with $44,000 in EMR adoption and usage incentives beginning in 2011usage incentives beginning in 2011

• It ends with penalties for practices that don’t It ends with penalties for practices that don’t adoptadopt

• Can help mitigate the cost barrierCan help mitigate the cost barrier• Does little to address the problems of practice Does little to address the problems of practice

upheavalupheaval

Invest your incentives wiselyInvest your incentives wisely

• $44,000 will barely cover the up-front cost for $44,000 will barely cover the up-front cost for most EHR systems (like our original EMR)most EHR systems (like our original EMR)

• $44,000 on the wrong EMR will cost you $44,000 on the wrong EMR will cost you dearly (I should know)dearly (I should know)

• Will you fulfill Meaningful use criteria to Will you fulfill Meaningful use criteria to collect $44,000?????collect $44,000?????

• Start now, adopt in comfortable increments, Start now, adopt in comfortable increments, and be ready to demonstrate meaningful use.and be ready to demonstrate meaningful use.

Before you buyBefore you buy

• Where is your practice headed-stay private, Where is your practice headed-stay private, merge, integrate???merge, integrate???

• Our practice worked to develop a EMR that Our practice worked to develop a EMR that did what we needed just in time to change for did what we needed just in time to change for the 3the 3rdrd time thanks to a practice change. time thanks to a practice change.

• If considering merging or integrating wait to If considering merging or integrating wait to purchase. purchase.

©

33rdrd System- EPIC System- EPIC

• Comprehensive HERComprehensive HER• Decision supportDecision support• Patient interaction-”NorthShore Connect”Patient interaction-”NorthShore Connect”• System wide systemSystem wide system• Robust e-prescribingRobust e-prescribing• Can modify to fit practice to some extent but Can modify to fit practice to some extent but

does effect workflow and practice pattern.does effect workflow and practice pattern.

Thank you!Thank you!

• Questions and commentsQuestions and comments

Welcome to PINNACLE Network Webinars! “Selecting and Electronic Health Record for Your Cardiology...

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