© Copyright IBM Corporation 2007 Electronic Health Record / Electronic Medical Record Concept and Challenges November 16, 2007
Jan 15, 2016
© Copyright IBM Corporation 2007
Electronic Health Record / Electronic Medical Record
Concept and Challenges
November 16, 2007
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Most Commonly Used Definition of EHR/EMR
Electronic Health Record (EHR)
“a secure, real-time, point-of-care, patient-centric information resource for clinicians.
The EHR aids the clinicians’ decision-making by providing access to patient health record information when they need it and incorporates evidence-based decision support.
The EHR automates and streamlines the clinicians’ workflow, ensuring all clinical information is communicated and ameliorates delays in response that result in delays or gaps in care.
The EHR also supports the collection of data for uses other than clinical care, such as billing, quality management, outcomes reporting, and public health disease surveillance and reporting.”
Source: http://www.himss.org/content/files/ehrattributes070703.pdf
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Technology Infrastructure
Basic Order Entry and Results Reporting System
Clinical Documentation
Clinical Decision Support Tools
Technology Tools for User Interface
Electronic Medical Record (EMR) is a building block process
and the Clinical System is a major foundation block …. and the Clinical System is a major foundation block ….
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Current State of Systems
Outpatient EMROutpatient EMR
Health SystemHealth System
Inpatient EMRInpatient EMR
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New state level healthcare environment can reallocate services and funding to improve health care outcomes and reduce costs
HHS
FDA
AHRQ
CDC
CMS
VA
MHS
Private Grants
Grants/Bids• CDC Biosurvelliance• NHIN 2• Midcare Modernization
Medicaid/Insurance Companies
Wellness, Disease Management, Claims Analysis, PHR, Exercise Programs
State Employees Insurance Fund
Wellness, Disease Management, Claims Analysis, PHR, Exercise Programs
Hospitals and ClinicsNHIN 2, Relief from uninsured
PatientPortal, PHR, Medical Home, Wellness
PhysiciansHealth Home, Bridges to Excellence, HTS, Portal, Hosted PHR
Network/NHIN
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Forces driving information transformation in provider healthcare
Increasing costs and changing reimbursement
Maturing adoption of IT but still ISV dominated
Market drivers / Demographic shifts
Public reporting cost and quality
information
More informedconsumers
Changing demographics
Stark Law relief for IT
IT System & Standard Adoption
Hospitals must report patient-satisfaction data for Medicare reimbursement
Effective 2007
Growing Pay4 Performance
Bonus paid for each claim meeting specific quality
criteria
Nonpayment for Performance - Medicare’s New Reimbursement Rule
Effective 10/2007
Departmental automation
Hospital-based EMR
Enterprise analytics & integration
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Healthcare Organizations are data rich but Information poor……Challenges• Brittle Applications• Infrastructure complexity• Information Islands• Fragmented knowledge management• Performance and bottlenecks• Application and development silos• Rising cost of meeting business needs• Volume and complexity of data
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Vendor Market
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Product Life Cycles and Vendors
Eclipsys 7000
NewPilot sites completedNew sales acceleratingHigh investment in development
SunsetLittle investmentin supportNo new client sales
DecliningDeclining investment in enhancementsFew new client sales
CompetitiveStrong new client sales. Relatively heavy investment in enhancements
Pre-ReleaseMajor development underway Pilot sites being installed
CernerClassic
SiemensSoarian
SiemensInvision
MeditechC/S &Magic
CernerMillennium
EclipsysSCM
EpicEpicCare
Eclipsys SunriseXA
GE CentricityEnterprise
McKessonHorizon
McKessonParagon
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KLAS 2007 Mid-Year Category Leaders
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Case Studies
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Selection of Electronic Health Record
Governance• Making sure everyone that needs to be involved participates in the
process
Structured and effective process• Structured process• Recognizing when it needs to be tweaked
The Decision• Commitment to make the decision
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Selection process included four key milestones …… Decision Days
Finalization of Key Requirements and Guiding Principles
Finalization of the solution
components for a core clinical
information system
Approval of Vendor Short List
Selection of three vendors with solutions
appropriate and suitable for
CSHS
Approval of Vendor Finalists
Top two vendors whose solutions could
potentially meet the future state needs of
CSHS
Approval of Vendor of Choice
The solution most suitable for CSHS – believed to provide
the best functionality, technical capabilities, and market leadership
Decision Day #1January 2007
Decision Day #2March 2007
Decision Day #3June 2007
Decision Day #4august 2007
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Vendor Comparison Categories
Functionality Functionality
Evaluation based on the key requirements1 from future state sessions
Clinical Documentation Orders Management Medication Management Pharmacy Clinical Decision Support Results Review Usability Health Analytics
1 Key Requirements are in Attachment B
Functionality Functionality
Evaluation based on the key requirements1 from future state sessions
Clinical Documentation Orders Management Medication Management Pharmacy Clinical Decision Support Results Review Usability Health Analytics
1 Key Requirements are in Attachment B
Technology Technology
Evaluation based on the technical requirements identified in the process
Integration with CSHS environment (intra-operability) Scalability Speed and Reliability
Technology Technology
Evaluation based on the technical requirements identified in the process
Integration with CSHS environment (intra-operability) Scalability Speed and Reliability
Company Company
Evaluation based on market intelligence and experiences
Vendor Vision Company Viability Ability to Execute Customer Service Focus Vendor Culture and Goals alignment with CSHS
Company Company
Evaluation based on market intelligence and experiences
Vendor Vision Company Viability Ability to Execute Customer Service Focus Vendor Culture and Goals alignment with CSHS
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Comparative Approach
Overwhelmingly recognized as the leader – second to none.
Generally recognized as a leader - could be tied with one other.
Considered equivalent to others – tied with two or more.
Needs improvement – More than three other vendors considered materially better.
Not generally available – may be building it but doesn’t have it today.
Comparative Scale:
Each vendor was scored according to the following scale:
Note: Vendors are presented in alphabetic order throughout
G
R
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Connectivity Between Inpatient and Outpatient EMR
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Guiding Principles
Physician needs must be met- Maintaining or improving existing functionalities - Implementing process improvements to enhance the quality of care
Patient safety and quality of care will be improved
Regulatory requirements will be satisfied (e.g. JCAHO, etc.)
The revenue structure may only be positively affected
Use the applications as designed, and coordinate business practices to optimize the software
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Thank You