Electronic Medical Records:
Retrieval and Underwriting
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Texas Medical Dictionary
Artery.............................. The study of paintings
Bacteria.......................... Back door to the cafeteria
Barium............................. What doctors do when patients die
Benign............................ What you be, after you be eight
Caesarean Section......... A neighborhood in Rome
Cat scan......................... Searching for Kitty
Cauterize........................ Made eye contact with her
Colic................................. A sheep dog
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Texas Medical Dictionary
Coma.............................. A punctuation mark
Dilate............................... To live long
Enema............................. Not a friend
Fester.............................. Quicker than someone else
Fibula............................... A small lie
Impotent..........................Distinguished, well know
Labor Pain....................... Getting hurt at work
Medical Staff.................... A Doctor's cane
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Texas Medical Dictionary
Morbid..............................A higher offer
Nitrates.............................Cheaper than day rates
Node................................ I knew it
Outpatient....................... A person who has fainted
Pelvis.............................. Second cousin to Elvis
Post Operative............... A letter carrier
Recovery Room............. Place to do upholstery
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Texas Medical Dictionary
Rectum...........................Dern near killed him
Secretion........................Hiding something
Seizure.......................... Roman emperor
Tablet............................ A small table
Terminal Illness............. Getting sick at the airport
Tumor........................... One plus one more
Urine............................. Opposite of you're out
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Sources
ACORD
MIB
PilotFish
Copy Services
Buyers Guide White Paper
Masters candidates in hospital administration Baylor University
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Today’s Presentation
Introduction to EMR / EHR - glossary of terms
Who’s driving HER adoption? What’s Law Got To Do With It? Healthcare Business - $$$ (who makes / saves money?) Government’s role Vendors
How will it affect me? Life insurance underwriting?
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Glossary
ARRA – American Recovery and Reinvestment Act. Among many other initiatives, the law provides incentive payments for healthcare providers that use EMRs. Incentive payments begin in 2011 and will gradually decrease until 2014 – after which, providers not using EMRs will be penalized.
EMR – Electronic Medical Records. Computerized system that stores notes, prescriptions, and other medical information for a patient in an electronic format rather than on paper. EMRs make searching for, retrieving, and sharing patient data more user-friendly and efficient. A federal mandate, called the Health Information Technology for Economic and Clinical Health Act (HITECH) and introduced in 2009, requires all medical practices and hospitals to adopt the EMR system by 2014.
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Glossary
EHR – Electronic Health Record. Electronic Health Record attempts to promote a more holistic view of patient records where continuum of care is the key aspect, allowing access to medical information by multiple stakeholders. Many healthcare systems possess pieces of the Electronic Health Record such as computerized physician order entry or electronic medical records within one point of care. However, only 1.5% of hospitals in the United States actually utilize a fully integrated Electronic Health Record
CCR – Continuity of Care Record. A new document standard being developed for EMR software vendors to allow patient data to be easily moved from on eMR vendor in the same format.
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Glossary
CCDIT – Certification Commission for Healthcare Information Technology. The organization that certifies healthcare IT products, including the certification to qualify EMR software for government incentive payments.
CDR – Clinical Data Repository. A database that consolidates data from a variety of healthcare providers to present a single health record for a patient.
REC – Regional Extension Center. Government funded system that offers technical assistance, guidance, and information on best practices to support and accelerate health care providers’ efforts to become meaningful users of EMR.
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The Drivers
Healthcare providers - improved healthcare - thorough, fast access to patient records Studies
» John Hopkins University study published in 2009 reviewed 41 hospitals. Those using EMR
15% lower death rate 16% fewer complications Lower operating costs
» Arizona State University study in 2010 found that hospitals using latest EMR technology reduced emergency room wait by 22% compared to old or no EMR
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The Drivers
Minimize dangerous errors / drug interactions – handwriting» Automatically alerts doctors of patient allergies or
dangerous drug interactions» National Academy of Sciences’ Institute of Medicine
determined sloppy handwriting led to 7,000 deaths every year in the United States.
More focus on patients, less on paperwork Automatic wellness reminders supports scheduling
important tests, exams – treatments screenings and immunizations
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The Drivers
Data mining – patient notification of drug recall, warnings, etc .
Software assisted diagnosis and treatment suggestions Improved customer service when patients call with
questions. Records are immediately available. Case study in a large practice in the Midwest reduced their patient responses from fifteen to five minutes.
Differential diagnosis Association of disease and treatment
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The Drivers
Sharing of data» Communicating with other organizations doctors,
hospitals, labs, physical therapists, pharmacists, etc. » Referrals – efficiently generate referral
letterandattach patient records» Prescriptions – electronic or autofax prescriptions to
pharmacist» Printing of EMR for chart requests (paving the
cowpath)» EDI – sharing of actual electronic data
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The Drivers
Summary» Better care» Safer environment for patients» More efficiency
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The Drivers
Reduce cost Increased efficiency Less wasted time searching for missing charts Lower operation costs Better quality of care Data mining Predictive diagnosis Scoring
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The Drivers
Government regulations American Recovery and Reinvestment Act (ARRA) of
2009» $45 billion to fund EMR adoption» Initial payments begin in 2011
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The Drivers
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The Drivers
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The Drivers
» Penalties beginning 2015 - doctors and hospitals alike without meaningful use by 2015 will receive decreased Medicaid and Medicare reimbursements
1% in 2015 2% in 2016 3% in 2017 3% - 5% thereafter
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The Drivers
Vendors 210 different providers of EMR solutions
» McKesson» General Electric» Cerner» Epic» Allscripts/Eclipsys
Large vendors Certification – integration and connectivity standards Security
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Obstacles
The New England Journal of Medicine has identified five major perceived barriers to adoption of Electronic Health Records: inadequate capital for purchase, unclear return on equity, maintenance costs, physicians’ resistance, and inadequate IT staff.
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Obstacles
Cost Only 20% of doctors and 10% of hospitals are currently
using EMR. Short term increased cost
» Systems» Software
Lost efficiencies due to training and learning curve Training – doctors, nurses, technicians and aids have not been trained in these systems. Costs associated with training cannot be overlooked.
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Obstacles
Inadequate technical staff – many times contractors must be hired to support installations.
Conversion of existing paper documents Long term yet to be determined CCHIT – Certification Commission for Healthcare
Information Technology
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Obstacles
Physician resistance With the advent of the Electronic Health Record,
physicians are being asked to completely change the way that they practice medicine.
New EHR systems are forcing physicians to use a computer throughout the entire continuum of care forcing the alteration of many habitual processes.
Data must be input into the system rather than through verbal documentation.
Each particular EHR vendor has its own unique terminology for navigation, making the learning curve even steeper.
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Obstacles
Security Privacy leaks and data breaches Access to large quantities of patient history information Data could be mined Strict access policies must be written and strictly
enforced including password protection, copying of records to external media or portable storage device
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Effects on Record Retrieval and Underwriting
Sharing of EMR data Current model requires printing to paper or other
electronic image format (pdf, tif, jpg) and sending via mail, fax or other electronic means
Data format standards » Health Level 7 (HL7) is an international community of
healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information.
Headquartered in Ann Arbor, MI Archaic standards
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Effects on Record Retrieval and Underwriting
» Clinical Data Repository – new document standard being developed for EMR software vendors to allow patient data to be easily moved from one EMR vendor to another in the same format
New XML standard CCR – needs work, cooperation Build once compliant with HL7 or CCR standard,
integrate with many across vendor systems and healthcare providers
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Conclusion
Great but how can we benefit without all the downside?
Some of these benefits include: immediate computerized decision support, improved patient continuum of care, and elimination of paper charts. However, these benefits may pale in comparison to the overall cost of implementing and maintaining the system. Installation costs of the actual system, training costs, and opportunity costs such as lost productivity from staff and clinicians make up significant costs of implementation.
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