Carolyn P. Hartley Edward D. Jones, III

HIT Summit WestMarch 6, 2005

EHR Selection and Implementation

A Step by Step Guide

Healthcare Industry Convergence and TrendsEd Jones

SVP, FisaCure

Chair, WEDI Foundation

Convergence and Trends

Federal government shift from administrative to clinical standards

CHI Initiative Executive Order 13335 to create

ONCHIT Secretarial Summit to launch Decade of

Health Information Technology Framework for Strategic Action (4 goals)

Framework for Strategic Action Goal 1: Inform Clinical Practice. This

goal centers largely around effort to bring EHRs directly into clinical practice.Strategy 1. Provide Incentives for EHR

Adoption. Strategy 2. Reduce Risk of EHR

Investment. Strategy 3. Promote EHR Diffusion in

Rural and Underserved Areas.

Goal 2: Interconnect Clinicians Interconnecting clinicians will allow

information to be portable and to move with consumers from one point of care to another. This will require an interoperable infrastructure to help clinicians get access to critical health care information when their clinical and/or treatment decisions are being made. Strategy 1. Regional Collaborations. Strategy 2. Develop a National Health

Information Network. Strategy 3. Coordinate federal health

information systems.

Goal 3: Personalize Care

Consumer-centric information helps individuals manage their own wellness and assists with their personal health care decisions.Strategy 1. Encourage Use of

Personal Health Records. Strategy 2. Enhance Informed

Consumer Choice. Strategy 3. Promote Use of Telehealth

Systems.

Goal 4: Improve Population Health

Population health improvement envisions improved capacity for public health monitoring, quality of care measurement and bringing research advance more quickly into medical practice. Strategy 1. Unify Public Health Surveillance

Architectures. Strategy 2. Streamline Quality and Health

Status Monitoring. Strategy 3. Accelerate Research and

Dissemination of Evidence.

Convergence & Trends (cont’d) Accreditation and Certification of vendors Regional Health Information

Organizations Secretary of Health and Human Services

Michael Leavitt from Utah Health Savings Accounts (emerging

industry – medical banking) EHR standards development

Health Level Seven (HL7)

2-year draft standards for trial use (DTSU) pilot project.

• Announcement of pilot coincided with HHS Secretary Tommy Thompson’s launch of the “Decade of Health Information Technology.”

• What the pilot is not…• A messaging specification.

• An implementation specification.

• A conformance specification.

• An EHR specification.

• A conformance testing metric.

• An exercise in creating a definition for an EHR or EHR System

HL7 Pilot

What the pilot is…

An opportunity to test EHR

components, called functional descriptors, and to make comments to HL7 concerning specifics and relevancy to the conduct of business.

Convergence & Trends (cont’d)

Staff shortages Cultural attitudes about healthcare Upcoming generation of boomers’

demands for healthcare Personalized medicine

Electronic Health Records

MMAHIPAAHL7ONCHITStaff shortagesEHRsYou

YOU

ARE

HERE

Selection and Implementation

Carolyn P. Hartley

President, CEO

Physicians EHR, LLC

Moving into the EMR/EHR

Key Definitions Electronic Medical Records Practice Management Systems Electronic Health Records Personal Health Records Electronic Health Record Systems

Why EMRs Are Challenged With Integration

Push/Pull

Pull data Push data

NO!

Why RHIOs Might Be the Answer

Regional Health Information Organization

Central database Trusted resource Patient confidence Interoperability

EMR CategoriesLicensed software Hosted onsite

Own the software

IT Staff onsite

Investment over 5 years

ASP (Internet hosted) Hosted offsite

Subscription fee

Less initial investment

No IT staff

Blend Part Licensed software

Part ASP

What to Expect From an ASP

Possible hardware upgrades Secure and fully searchable data

448 bit encryption Automatic daily backup Own the data (format a concern) 24-hour support and free upgrades Training and implementation Ideal for “non-” or “semi-techies” $100/month to $thousands/month

What to Expect From Licensed Software Larger investment up front, less over

long haul Fixed costs, can be depreciated Onsite IT staff Hardware upgrades Investment in server Implementation, training, support $15,000 to $millions

What to Expect from a Blend

Move slower into EMRs through ASP, pay hosting fee

Own the software license 24 hour technical support Outpatient, ambulatory service center Training, implementation Bigger discounts Ideal for health community networks

201 Vendors queried

97

29

75

Licensed SoftwareASPBlend

January 2005 2010 Predictions

Your Wants and Needs(Your Primary Focus)

Prescriptions and referrals Analyze and share images Manage chronic diseases? Practice long distance medicine? Integrally linked to health care

community?

931 Flavors of EMR(How do you manage documentation?)

Type Dictation Voice recognition Handwriting recognition Scan documents Templates

What hardware do you like?

PDA Tablet PC Laptop Wireless Desktop computers Combination

Evaluation and Selection of EMRs

Narrow the field Determine delivery platform Determine number of users Integration and interoperability of

players Role of partners/stakeholders in

evaluation

The Role of Patients in Your EHR Selection

Many shapes of Personal Health Records (PHR)Thumb driveCell phonePDAsCredit/debit card

• Magnetic stripe• Mini processor

The Role of Colleagues in your EHR Selection

No EMR functions in isolation Evaluate your sphere of influence Increased buying power from

collaboration Case Study: Winona Health Role of IPAs, MSOs, RHIOs, Medical

Societies

Evaluation and Selection

Review online demonstrationswww.physiciansehr.com Demo Depot

Request in-person demonstration (often the point of sale)

Ask to solve a problem not in the salesperson’s repertoire

Companies that help you select an EMR

EMR Consultantwww.emrconsultant.com

EMR Institute, Incwww.emrinstitute.comEMR Finder™

Medical Records Institutewww. medrecinst.com

Purchasing and Negotiating

Ed Jones

Purchasing and Negotiation

Every contract has sections that are worth negotiating.

Purchasing and Negotiation

Due Diligence on the vendor/company Relationship with HL7? Participate in EHR Certification? How many practices of my size, type? How well do you work with IT

consultants? Ask about the strength of strategic

partners

Purchasing and Negotiation

Evaluate your current practice management system for integration

Submit an RFPSmall practices: 6 pagesCommunity networks: 6-25 pagesSet a deadline and stick to it

Purchasing and Negotiating

Leverage your existing IT investment Who manages system upgrades and

how often? Evaluate who is considered a user:

physicians only? Or all users? Costs of ASP, Licensed Software, or a

blend

Budgeting and Planning

Functions and features to look for:ASP, License, BlendAdd onsDocumentation costsStaffing costsCoding reimbursementReporting mechanisms (how are we

doing?)

Budgeting and Planning

What are the revenue enhancers? Clinical trialsCoding reimbursementMedical bankingIncreased patient interactionReduced insurance premiums

Implementation and Training

Ed Jones

Carolyn Hartley

Not At All Like Buying a Car

Like buying a car for your teenager. No point in purchasing an EMR

without training and implementation. Implementation plan begins with

understanding how your staff moves information.

Implementation

Workflow in a physicians practice

Before After

Implementation

Workflow in a hospital setting

Before After

Implementation: Integrated Healthcare Community

Hospital

PatientAssisted Living

Skilled nursingPrimary Care Physician

Specialist

Laboratories

Radiology

Hospice

payer

Pharmacy

Home care

Find the patient record.

Training

Understanding of how people learn There will be push-back – upsetting

the politics of “who has access” Need for internal coaches Role-based Understand level of training intensity Time span Ongoing support

www.physiciansehr.com

www.amapress.org

Available:

www.amazon.com

Product Demonstration

LabCorp

Product Demonstration

Allscripts

Product Demonstration

EMR company