Mark Anderson is the CEO of AC Group, a national healthcare IT consulting firm. He has over 36 years of experience in healthcare IT, including serving as CIO for multiple regional healthcare systems. He regularly speaks on electronic health records (EHRs) and healthcare IT. The document discusses EHR trends, challenges with adoption and use, and the need for a strategic, enterprise-wide approach to business intelligence to improve outcomes and efficiencies across the healthcare organization. It also addresses issues around data integration, clinician buy-in, and the importance of an accountable culture for dashboard and scorecard applications.
2. Mark Anderson, FHIMSS, CPHIMSS
Healthcare IT Futurist
CEO of AC Group
National Speaker on EHR > 800 sessions since
2001
Semi annual report on Vendor product functionality and
company viability
36+ Years In Healthcare IT
CIO Position at Three Multi Facility Regional IDN’s
Installed over $1B in technologies since 1972
Provided EHR information to over 25,000 Physicians
Over 400 EHR Search and Selection Projects and 12
community HIE projects.
Former CIO of a 2,300+ physician (500+ Practices) IPA
3. BI Tools in Healthcare
Healthcare organizations are overwhelmed with data. But without a
program in place to target, gather, deliver and analyze the most
relevant data, these organizations will continue to be data rich but
information poor.
Forward-thinking healthcare organizations realize that data—
and, thus, business intelligence (BI)—is at the center of informed and
precise decision-making that will improve patient and service
outcomes in addition to ensuring their organizations’ future.
To achieve the full benefits of BI, organizations must take an
enterprise-wide, strategic approach vs. tackling small tactical
projects, and realize that the greatest efficiencies come from
integrating data historically stored in silos of databases in
financial, operational and clinical systems.
4. BI Tools in Healthcare
A strategic focus is the difference between simply recognizing the
value of managing key information for analytical purposes and
transforming the culture to evidence-based decision-making at all
levels at the point of care.
Cost savings are the main driver for implementing BI in healthcare
organizations, followed by the need to improve medical outcomes.
But who actually receives the cost benefits?
A strategic approach to BI, which cuts across the
organization, requires buy-in from not only top executives but also
physicians and clinical staff. Without buy-in and acceptance of the
data, clinicians will not act of the BI intelligence.
5.
6.
7.
8. So where are we today?
8 Http://www.acgroup.org Page No: 8
10. Total Patient Encounters
Home Other Encounters Inpatient
Health 3% Setting
Nursing 2% 12%
Home
2%
Physician
Office
81%
11. Where is the data today?
2012
Home Health
1% Patient's University
home Hospitals
SNF/Nursing 18% 15%
Homes
Other 2% Community
Ambulatory Hospitals
5% Physician Offices 21%
38%
12. Where is the source of the data?
100.0%
80.0%
60.0%
40.0%
20.0%
0.0%
2000
2005
2010
2015
Electronic Discreet Data Paper Based Data
15. Stage Functionality 2008 2011 Meets MU
Complete EHR; CCD transactions to share
Stage 7 data; Data warehousing; Data continuity with 0.3% 1.00% 100.0%
ED, ambulatory, OP, BI Tools
Physician documentation (structured
Stage 6 templates), full CDSS (variance & compliance), 0.5% 2.80% 75.0%
full R-PACS
Stage 5 Closed loop medication administration 2.5% 3.70% 50.0%
CPOE, Clinical Decision Support (clinical
Stage 4 2.5% 10.30% 10.0%
protocols)
Nursing/clinical documentation (flow sheets),
Stage 3 CDSS (error checking), PACS available outside 35.7% 49.70% 5.0%
Radiology
CDR, Controlled Medical Vocabulary, CDS, may
Stage 2 31.4% 15.40% 0.0%
have Document Imaging; HIE capable
Stage 1 Ancillaries - Lab, Rad, Pharmacy - All Installed 11.5% 6.70% 0.0%
Stage 0 Lab, Radiology and Pharmacy not Installed 15.6% 10.50% 0.0%
16. Hospital functionality
Pharmacy/Medication Safety Physician Clinical Practice Clinical Decision Support
Physician Results Rules and Data Severity
Medication Outpatient Order Sets Report Writer
MAR Order Entry Review Alerts Warehouse Adjustment
Order Entry Prescriptions
Comparative
Substitution/ Task Lists/ Outcomes Resource
Dosing Formulary Provider Database
Cost Workflow Pathways Protocols Measurement Utilization
Management Management Documentation Access
Management Tools
Access to Ambulatory Provider
Positive Rounding Patient History/ Patient Locator/ Credentialing
Drug Drug Practice Profiling
Patient Tools Problem Lists Patient Lists
Interactions Databases Management
Identification
Enterprise Patient Access
Robot
Interface Core Information Management Components Admission/ Enterprise Eligibility
User Interface/Portal Registration Scheduling Verification
Data Aggregation and Reporting Tools Technical
Request for Consumer
Departmental/Support Services Denial
Authorization Portal
Management
Common
Radiology/ Master Person Clinical Research
Lab Cardiology Data Medical
PACS Index (MPI) Repository Clinical Documentation
Repository Vocabularies
Patient I&O
Emergency Surgery Decision Flowsheets
Pathology Order Rules Standard Assessment Vital Signs
Department Support
Entry Engine CDM
Repository
Other Kardex Task Lists Care Plans
Blood Bank Departmental Security Integration Consumer PDA
Systems Tools Tools Content Support
Transition Non-MD Specialty
Planning Orders Documentation
Health Information Management Care Management
Initial & Clinical Critical Care Patient Interfaces
Chart Precertification Discharge Documentation Education to Monitors
Transcription/ Coding Concurrent Denial
Management Authorization Planning
Dictation Support Review Management
(Deficiencies)
Payor InterQual Supply Chain
Document Workflow Electronic Communication Support for Work Lists Pathways Patient Support for
Imaging Tools Signature and Notes LOC Tracking &
Supply Product
Reconciliation
Charges Standards
Social
MRN Post Acute Readmit Disease
Release of Services
Management CDMP (?) Placement Alerts Management Interface to
Information Support
and Merge ERP System
Solution Sets Solution Components
17. Connecting Physicians
Delivers the Connected Community
Hospitals Ancillary
Departments
Employers Physicians
Hospitals are best positioned and
In-patient Clinicals &
best served to lead the way to a
Physician Portal
connected care community
Homecare Physician Office Retail
Providers Solutions Pharmacy
Broad Community
Patients
Connectivity
Payors & PBMs
Page No:
Http://www.acgroup.org 17
18. It shouldn't take a
brain surgeon to
design one patient
centric community
EHR with BI tools
Page No:
Http://www.acgroup.org 18
24. The Problem Today
Referral tracking is paper based
Patient’s must register each time they see a new Physician
Patients must provide each provider duplicate information:
Social History, Medical History, Family History
What Medications are you on?
Physicians do not have adequate and timely information
about the patient
Business Intelligent Tools (BI) only works when you have data.
What the community needs is a new way of connecting and
sharing timely patient information.
26. DRT is Discrete Reportable Transcription
Allows the provider to use the EHR for viewing of patient clinical
information.
After the physical exam, the provider dictates their note like they
have the past 20+ years.
The dictated report is sent to a transcription service for transcription
or via Dragon
The Software takes the dictation, creates a clearly defined patient
note and then automatically populates the EHR with practice specific
discrete recordable and reportable data directly into the practice’s
EHR.
27. Data Entry Time
New Patients Established Patients
350
300
Seconds
250
200
150
100
50
0
Dicate Handwrite EHR DRT EHR
Number of seconds for data entry of discrete clinical data
Source: 573 Patient charts
28.
29. ARRA/HITECH ACT
Feb 17, 2009 –ARRA/HITECH Acts signed into law
$19.5 billion for health IT adoption, EHR and HIE
Goal (forecast) is adoption and meaningful use of EHR
by 90% of physicians and 70% of hospitals by 2015
Bulk of funds appropriated go towards incentive
payments to eligible providers (EPs) and eligible
hospitals (EHS)
30. HITECT Requirements
In order to qualify for the incentive
payments, both physicians and hospitals have to
prove three things:
1. Use of a certified EHR product with ePrescribing capability that
meets current HHS standards.
2. Connectivity to other providers to improve access to the full view
of a patient’s health history.
3. Ability to report on their use of the technology to HHS.
The second area is “meaningful use”
31.
32.
33. Cost? What Cost?
Acquisition
Implementation and Training
Maintenance and Upgrade
Lost Productivity
Personal Cost
(The Pain & Suffering)
Inappropriate Physician Tasks
Page No: 33
34. EHRs cost to much?
5 – Year Total Cost per Provider
$90,000
$80,000
$70,000
$60,000
$50,000
$40,000
$30,000
$20,000
$10,000
$-
Level 1 Level 2 MU 2008 2011 2013 2015
Costs
38. National Survey’s and Certification
ONC 2011 Certified Products – 499 Vendors
CCHIT 2011 Products – 89 Vendors
Regional Extension Centers (REC) – 35 Vendors
KLAS top 10 EHR vendors – 10 Vendors
Black Book – 15 Vendors
AC Group – 35 Vendors
Top selling vendors – 10 Vendors
38
39. EHR Failure rate
Through 2012, the EHR failure rate continues to
increase.
When asked, ―1 year of EHR installation, are you seeing
80% of your patients using the EHR for
charting, ROS, HPI, Evaluation, coding, orders and
results reporting‖.
73% of the physicians (3,245) indicated that no, they were
NOT using the EHR for 80% of their patients.
18% replaced or were not using EHR
Why, are 73% of the physicians NOT fully utilizing the EHR
after 1 year?
So why are there so many failures?
Page No: 39
40. Take Home Message
Create a culture of accountability as part of the deployment of dashboards and
balanced scorecards.
Prepare stakeholders that a long period of data preparation and cleansing may
be necessary before applications can roll out.
Improve capabilities to track patients, costs, and assets.
Incorporate information from business systems and clinical systems.
Involve physicians and other key stakeholders in the planning process.
Obtain a highly motivated stakeholder to create an immediate win that will
generate enthusiasm throughout the organization for evidence-based decision-
making
41. For More Information
Mark R. Anderson, FHIMSS, CPHIMS
CEO and Healthcare Futurist
AC Group, Inc.
118 Lyndsey Drive
Montgomery, TX 77316
(281) 413-5572
eMail: mra@acgroup.org
Web Site: www.acgroup.org
However, the use of EHR is still in question. The 2010 CDC/NCHS national Ambulatory Care Survey projects that almost 50% of physicians have already purchased some type of EHR product, but only around 10% are using the product as a fully functional EHR product.Around 25% are using EHR as a basic systems. This means that 15% of all providers have purchased an EHR and are NOT using the product at all. Part of the reason is usability, identified slowdown in patient care, and many of these systems have crashed over time and data was lost. When this occurs, physicians lose trust in the EHR solution.
We need to allow choice but move everyone in one direction
First lets start by looking at the time it takes to collect the information.
