Electronic Health Records

Cash Cow or Money Maker

Kate HorkingsHealth Information Services Operations Director

Our Locations

Southern Health Vital Signs

• Acute, Sub-acute, Mental Health, Aged & Community

• Service area of 2,800 square kms and 750,000 people

• 12,000 staff

• Annual turnover of $700 million

Southern Health Vital Signs

• 134,000 inpatient attendances

• 700,000 outpatient attendances

• 1.8 million Patient Master Index entries

• 2.6 million MR location moves annually

Why are we doing this?

Our Vision

• A paperless Medical Record always at hand

Advancedhealth recordmanagement

Improveerror rates

RemovePaper handling

VastlyImprove efficiency

EnhancedInformation

accessand distribution

Improveclinical

productivityImprove

accessibility

First placeto find

results and reports

Betterdecision support

Full history always at hand

Multi-site access for clinical discussions

Clinical focuson the patient

not theprocess

Results acknowledgement

HealthSMART clinical

integration

No clinician need to manage

record

Betterpatient outcomes

Improved care

Better service co-ordination

Increased privacy of Health

information

Preparing for an EHR System

How does a Health Service start?

An EHR is a journey,

not a destination

Think BIG, Start Small

Target Objectives

• Reduce clinical access times for current medical records by 100%

• Reduce clerical costs by 50% (per record movement)

• Reduce medical record movement to other sites by 100%

• Improve time to provide test results viewing in medical records by 95%

• Return floor space• Reduce incidence of lost records to 0%

Scanned MR – The Bridge to an EHR

Paper Based Record Includes:

Requesting the MR

Awaiting MR arrival

Receiving MR

Updating tracking screen

Sending MR to requestor

Systems / Databases Used:

Homer – PMI & Tracking

PRT – Mental Health Tracking

Lab Vision – Pathology

Merlin – Pharmacy

Electronic Health Record Includes:

Logging into EHR system

Typing in appropriate UR Number

Systems / Databases Used:

Homer – PMI

EHR System – including Interfaces with Pathology, Pharmacy etc.

The Southern Health ProjectDELIVERABLES

• Expand Casey model across SH to replace paper

records- Execute two year project (Infrastructure and business change)- Change Medical records processes and lower costs by 52%- Achieve 3 year return on investment

• Implement new functionality to gain additional benefits- Results acknowledgement- Electronic discharge summaries- Electronic alerts

The Southern Health Project

BENEFITS• Gain patient, staff and financial benefits proven at Casey• Greater efficiency at clinics @ Casey

• Enable clinicians to make informed decisions based on

timely access to accurate record and results information • Use clinical buy in to support HealthSMART clinical

system project and ultimately EHR• Safer working environment – less physical handling of

records

Outpatients Clinic Retrieval Process

Eliminated Processes

Get Outpatient List for Clinics

Search Local Records

Request additional Records from storage

Collate in booking order

Deliver to Clinic

Appointments Open Record

Treat Patients

Record Treatment observations

AppointmentsSearch SMR for Patient

Open Record

Treat Patients

Record treatment observations

2 hours 15 minutes

Scanned Record

Paper Record

• A significant number of processes are eliminated through the use of a scanned medial record.

Lessons Learnt

• Know your current processes

• Monitoring systems of a paper based department are still paramount

• Turn around time is critical

• Clinical buy-in is essential

• Forms management is critical

• Implementation plan – big bang or site based

Testimonials

“I think the CPF system is desirable in that it allows me quick and easy access to obtaining patient information at times when the patient record is off site or needed by others (eg the ward, coding) etc. It allows for rapid review of the patient’s presentation, management and staff involved which is often necessary in a short space of time.”

Medico Legal OfficerSouthern Health

Testimonials

“I loved the scanned record as it was;1. User friendly – very easy to use and teach somebody

else to use.2. Convenient to be able to look up patient information

quickly.3. Really great if a patient arrives for an appointment on

the wrong date as history is available electronically and patient can thus be easily seen.

All in all, makes for greater efficiency in clinic.”Manager, Outpatient Services

South East Sector

Financial - Operating Cost Control

2006 2007 2008 2009 201020052004

$3m

$4m

$5m

$2m

Year

Operational cost

As is

SMR roll out

Note: $ values approximated

Increased record numbers and record management cost drives up total costs

Costs are much less sensitive to increased records numbers and IT automation contains record management cost

Financial Return on Investment

Net Cumulative Cashflow - CPF Deployment

-3,000,000

-2,000,000

-1,000,000

-

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

Y1 Y2 Y3 Y4 Y5

Elapsed Time

Net Cumulative Cashflow Net Cumulative Cashflow Including Intangibles

(000) As Is    SMR deploy    

As Is v SMR

Cumulative Cash Flow

  Op Ex Cap Exp Total Op Ex Cap Ex Total

Year 1 $4,168 $0 $4,168 $3,738 $1,978 $5,716 -$1,547 -$1,547

Year 2 $4,424 $37 $4,461 $3,354 $1,377 $4,731 -$270 -$1,817

Year 3 $4,763 $487 $5,250 $2,880 $0 $2,880 $2,371 $553

Year 4 $4,948   $4,948 $2,932 $0 $2,932 $2,016 $2,570

Year 5 $5,109 $225 $5,333 $2,681 $0 $2,681 $2,652 $5,223

      $24,163     $18,940 $5,223  

FINANCIALS – 3 year payback

Adding Value to Southern Health

Add

ed V

alue

Financial Accountability

Has a 3 year payback period

Contributes to a financially sustainable organisation with marginal growth

costs

Reduces the unit cost from $11.97 to $5.92

Project Savings

• Major operating cost savings will come from:• Labour• Storage• Consumables• Transportation

Paper Vs Scanning - some costs

Paper Department $23.04 per separation

Scanned Department $11.40 per separation

51% reduction

Tracking in a paper dept $1.17 per move

Tracking in a scanned dept $0.58 per move

51% reduction

Paper Record Construction $1.62 per record

Scanned Record Construction $0.00 per record

100% reduction

Remember….

Be brave, be determined, be resolute!

What may seem impossible today, may be

the norm tomorrow!

It’s not going away!

Moving to an EHR is not an alternative.

It is not an IF, it is a WHEN!

Don’t get left behind, the planning starts NOW!