unit4 - Learning Objectives Describe Describe the purpose,...

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Unformatted text preview: Learning Objectives Describe Describe the purpose, use, key attributes, and functions of major types of clinical information systems used in health care. Define the key components of an EHR Define system and the current status of these systems. Discuss Discuss the major barriers to EMR and EHR adoption and strategies being employed to overcome them. Current and Emerging Use of Clinical Information Systems Unit 4 Current and Emerging Use of Clinical Information Systems . AHS 435 - Survey of Clinical & Administrative Information Systems Learning Objectives 2 Outline • – – – – – – • • • • . AHS 435 - Survey of Clinical & Administrative Information Systems Clinical Information Systems— Systems— adoption, use, value Give Give examples of how clinical information systems might affect patient safety, quality, efficiency, and outcomes. Define HIE, RHIO, NHIN and identify challenges associated with sharing information across organizational settings. Understand Understand the current ARRA incentive program and the Meaningful Use requirements. 3 Electronic Medical Record/Electronic Health Record Computerized Provider Order Entry (CPOE) Medication Administration Telemedicine Telehealth Personal Health Record Fitting Applications Together Information Exchange Across Boundaries Overcoming Barriers to Adoption ARRA (Stimulus Package) Incentives . AHS 435 - Survey of Clinical & Administrative Information Systems 4 1 Overview of AHS 435 Topics The Medical (Patient) Record Tonight’s Focus IT Operations Management A historical record of patient care historical A communication tool among care communication providers A research and knowledge-gaining tool research knowledgeA teaching tool teaching tool An An operational tool (e.g., order entry) A business tool (e.g. to support billing) business An An administration record (e.g., to manage resources) A legal record with considerable longevity legal . AHS 435 - Survey of Clinical & Administrative Information Systems . 5 AHS 435 - Survey of Clinical & Administrative Information Systems 6 Electronic Medical Record Multiple Names – Same Concept Electronic Electronic Health Record Definitions Definitions Electronic Electronic Medical Record An electronic record of health-related healthinformation on an individual that can be created gathered managed and created, gathered, managed, and consulted consulted by authorized clinicians and staff in one health care organization. one Virtual Patient Record Virtual Patient Record Electronic Electronic Patient Record (Source: National Alliance for Health Information Technology, 2008) Computerized Computerized Medical Record ComputerComputer-based Patient Record . AHS 435 - Survey of Clinical & Administrative Information Systems . 7 AHS 435 - Survey of Clinical & Administrative Information Systems 8 2 Electronic Medical Record MRI Five Levels of Computerization Definitions Definitions An electronic patient record that resides in a system specifically designed to support users by providing designed to support users by providing accessibility accessibility to complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge, and other aids. Institute Institute of Medicine . AHS 435 - Survey of Clinical & Administrative Information Systems . 9 Core Functions AHS AHS 435 - Survey of Clinical & Administrative Information Systems 10 Where are we today? Broad Spectrum . AHS 435 - Survey of Clinical & Administrative Information Systems . 11 11 AHS 435 - Survey of Clinical & Administrative Information Systems 12 3 EMR Adoption in Hospitals EMR Use in Physician Practices . AHS 435 - Survey of Clinical & Administrative Information Systems . 13 13 AHS 435 - Survey of Clinical & Administrative Information Systems 14 14 Where are we today? . AHS 435 - Survey of Clinical & Administrative Information Systems . 15 AHS 435 - Survey of Clinical & Administrative Information Systems 16 4 Value of EMR Improved Improved quality, outcomes and safety Computerized Computerized reminders and alerts Improved Improved compliance with practice guidelines Reduction Reduction in medical errors Improved Improved efficiency, productivity, and cost reduction Improved Improved service and satisfaction . AHS 435 - Survey of Clinical & Administrative Information Systems . 17 AHS 435 - Survey of Clinical & Administrative Information Systems 18 Other major types of CIS EMR Attributes Longitudinal Longitudinal Computerized Computerized provider order entry (CPOE) Medication Medication administration using bar coding Telemedicine Telemedicine Telehealth— Telehealth—for our purposes, we will focus on online communication (e.g. email) between patients and providers Personal Personal Health Record Complete, Complete, accurate, timely Available Available to multiple users Provides Provides decision support capabilities Provides Provides access to knowledge aids Facilitates Facilitates the care process Improves Improves efficiency and effectiveness . AHS 435 - Survey of Clinical & Administrative Information Systems . 19 AHS AHS 435 - Survey of Clinical & Administrative Information Systems 20 5 CPOE Use and Status of CPOE Driven Driven by need to improve patient safety Automates Automates the ordering process Accepts Accepts orders electronically, provides decision support, may aid in diagnosis and treatment Estimates Estimates vary from 3-13%; higher 3estimates usually indicate that physicians are not direct ordering Many organizations are in planning or early implementation stages Looking Looking to advice from others . AHS 435 - Survey of Clinical & Administrative Information Systems . 21 22 Medication Administration Barriers to CPOE use Use Use of barcoding becoming more widespread Aids Aids in correctly identifying patient drug patient, drug, dose, etc. HIMSS HIMSS implementation guide— guide—good resource Complexity Complexity of ordering process Physician Physician entry an issue Takes Takes longer to place order; many systems are ‘cumbersome’, take too many steps Incentives Incentives may not be aligned with use Lack Lack of confidence in system reliability Insufficient Insufficient training Mandating Mandating use – should you? . AHS 435 - Survey of Clinical & Administrative Information Systems AHS 435 - Survey of Clinical & Administrative Information Systems More More widely accepted Has Has been used successfully by many health care organizations organizations Again, Again, has potential to aid in making sure the right meds, get to the right patient, at the right dose… . 23 AHS 435 - Survey of Clinical & Administrative Information Systems 24 6 Telemedicine Telehealth Using Using telecommunications to communicate with patients and deliver services Use Use of telecommunications for the direct provision of care to patients at a distance Email communication Email communication Refilling Refilling prescriptions Registering Registering patient Scheduling Scheduling appointments Over 200 Telemedicine Programs in Over 200 Telemedicine Programs in nation nation Store Store and Forward TwoTwo-Way Interactive TV Funding Funding an Issue Cost Cost Effectiveness Not Fully Known . AHS 435 - Survey of Clinical & Administrative Information Systems . 25 Telehealth AHS 435 - Survey of Clinical & Administrative Information Systems 26 Personal Health Record (PHR) Current Current use of email communication between patients and physicians Value Value to patients and providers Issues Issues An electronic record of health-related healthinformation on an individual that conforms to nationally recognized interoperability standards that can be drawn from multiple sources while being managed, shared, and controlled by the individual. Complexity of infrastructure Degree Degree of integration Message Message structure Cost Cost Security Security Reimbursement Reimbursement (Source: National Alliance for Health Information Technology, 2008) . AHS 435 - Survey of Clinical & Administrative Information Systems . 27 AHS 435 - Survey of Clinical & Administrative Information Systems 28 7 PHR Benefits and Concerns PHR Access Access to Care ConsumerConsumerempowerment Comprehensive Comprehensive Longitudinal Longitudinal Individual controls Companies Companies offering Cost Cost Effective Reduces Reduces Isolation Decreases Decreases Transfers Decrease Decrease Delay in Care Reduces Reduces professional travel Insurers Insurers Microsoft Microsoft Google, Google, others Reduces OverReduces Over-Head Costs Funding Funding an issue . . Cost Cost effectiveness not fully known AHS 435 - Survey of Clinical & Administrative Information Systems 29 Google PHR AHS 435 - Survey of Clinical & Administrative Information Systems 30 Information Exchange Health Health Information Exchange Regional Regional Health Information Organization National Health Information Network . AHS 435 - Survey of Clinical & Administrative Information Systems . 31 AHS 435 - Survey of Clinical & Administrative Information Systems 32 8 Fitting Pieces Together LETS TAKE A BREAK! . AHS 435 - Survey of Clinical & Administrative Information Systems . 33 33 Eight Stage EMR Adoption Model AHS 435 - Survey of Clinical & Administrative Information Systems 34 Barriers to Adoption & Strategies for Overcoming Them Financial(acquisition Financial(acquisition and support) Organizational Organizational or Behavioral (user acceptance) Technical Technical (need for standards, integration) . AHS 435 - Survey of Clinical & Administrative Information Systems . 35 AHS 435 - Survey of Clinical & Administrative Information Systems 36 9 Strategies for Overcoming Barriers Five Barriers to EMR Adoption What What strategies are being employed to help overcome— overcome— Financial Financial barriers? Behavioral Behavioral barriers? Technical Technical barriers? . AHS 435 - Survey of Clinical & Administrative Information Systems . 37 Financial Barrier – It’s No. 1!!! 38 Current Developments CMS CMS estimates that the average cost for an eligible professional to adopt/implement/upgrade a certified EHR technology is $54,000 per physician FTE (full-time equivalent). Plus, CMS (fullestimates that annual maintenance costs average average $10,000 per physician FTE per year. HITECH HITECH is the abbreviation for Health Information Technology for Economic and Clinical Health Act. This Act is a section of the $787 Billion American Recovery and the $787 Billion American Recovery and Reinvestment Reinvestment Act of 2009 (Stimulus Package) which sets aside $19.2 Billion to encourage the adoption of Electronic Health Records by physicians and hospitals. For For eligible hospitals, CMS estimates the range to be between $1 million and $5 million for installation and $1 million annually for maintenance, upgrades, and training. . AHS 435 - Survey of Clinical & Administrative Information Systems AHS 435 - Survey of Clinical & Administrative Information Systems . 39 AHS 435 - Survey of Clinical & Administrative Information Systems 40 10 Features of HITECH Incentive for MD Adoption of EHR Potential of Five-Year Payout of $ 44,000 per Physician $17 $17 Billion of the $19.2 Billion will be paid as incentives to hospitals and physicians who adopt EHR. Since there are varying levels of Since there are varying levels of adoption, adoption, the government will only provide the incentive pay if an organization employs “meaningful use” of the EHR. Payout 2012 2013 2014 $18K ― ― ― $12K $12K $18K ― ― 2013 $8K $8K $12K $15K ― 2014 $4K $4K $8K $12K $15K 2015 $2K $2K $4K $8K $12K 2016 ― ― $2K $4K $8K Total $44K $44K $44K $39K $35K How to read this table: The first row represents the year you adopt an EMR system. The first column represents how much the payout will be each year. For example, if you are a current user, your payout for 2012 will be $12K. If you adopt an EMR system in 2013, your payout will be $15K in 2013, $12k in 2014, and $8K in 2015. . 41 Incentive for Hospital Adoption of EHR AHS 435 - Survey of Clinical & Administrative Information Systems 42 What is “Meaningful Use?” Meaningful Use simply means that a healthcare organization employs its HIT software in a way that provides great value for the patient and other healthcare consumers while ensuring better quality and more efficiency for the provider. Hospitals can receive a base payment of up to $2M initially. Additional incentives are available according to formula based on according to a formula based on discharges, discharges, year of adoption etc., with a cap at $6M. The exact payment schedule is not yet determined. Steve Beller Steve Beller National National Health Data Systems, Inc. Four Keys: 1. Setting the right HER goals. 2. Purchasing the right EHR product. 3. The right Implementation of the EHR. 4. The right Use of the EHR by caregivers. . . AHS AHS 435 - Survey of Clinical & Administrative Information Systems 2011 $18K 2012 . AHS 435 - Survey of Clinical & Administrative Information Systems Current 2011 43 AHS 435 - Survey of Clinical & Administrative Information Systems 44 11 Meaningful Use Meaningful Use Criteria Criteria that Providers must meet: On On December 30, 2009 HHS published two sets of regulations: Improve Improve the quality, safety, and efficiency of healthcare services Reduce Reduce healthcare disparities Engage Engage the patients and their families Improve Improve the coordination of care Improve Improve population and public health Ensure Ensure the privacy and security of PHI The The first set of regulations provides specific details about the requirements of how the EHR must be used in order that its use is valuable and meaningful in improving the care to the and meaningful in improving the care to the patient. patient. The The second set of regulations provides specific details about the requirements of the software in order for the system itself to be used to provide quality care to the patient. Criteria Criteria and Certification requirements for EHR Software to meet: Securely Securely exchange information among providers and between providers and patients Standardized Standardized formats for reporting . Requirements Requirements for internet data exchange . AHS 435 - Survey of Clinical & Administrative Information Systems 45 AHS 435 - Survey of Clinical & Administrative Information Systems Examples of Meaningful Use Essential Capabilities 46 Summary These are examples of the 25 Provider and 23 Hospital criteria CMS has specified to prove Meaningful Use Requirement CPOE Eligible Professionals (EP) Hospitals Notes 80 percent of all orders 10 percent of all orders In Stage 1, electronic communication of orders is only required for e- prescribing; will expand in Stage 2 The capability needs to be enabled and information displayed at the point of care Structured data required; measure is of unique patients not visits or admissions Requires structured data; applies to unique patients, not visits/admissions Drug-drug, drug allergy, drug formulary checking All capabilities enabled All capabilities enabled Maintain up-to-date problem list 80 percent of patients have at least one entry or indication of no problems 80 percent of patients seen have at least one entry or indication of “none” 80 percent of patients seen have gender, race, DOB, ethnicity, preferred language, insurance recorded 80 percent of patients have at least one entry or indication of no problems 80 percent of admitted patients have at least one entry or indication of “none” 80 percent of patients admitted have gender, race, DOB, ethnicity, preferred language, insurance and cause of death recorded 80 percent of patients 2 years and older have BP and BMI; growth chart for ages 2 – 20 80 percent of patients over 13 admitted Maintain active medication and allergy list Record demographics Record vital signs Record smoking status 80 percent of patients 2 years and older have BP and BMI; growth chart for ages 2 – 20 80 percent of patients over 13 seen • • • . AHS AHS 435 - Survey of Clinical & Administrative Information Systems Examined five clinical information systems— systems—their current use, status, and value & their relationship to each other Discussed the value of sharing health information across organizations Discussed the three major barriers to adoption of these systems—financial, systems— behavioral and technical and strategies to overcome them . 47 AHS 435 - Survey of Clinical & Administrative Information Systems 48 12 Chart Notes – Rx module Examples of EHR systems . AHS 435 - Survey of Clinical & Administrative Information Systems . AHS 435 - Survey of Clinical & Administrative Information Systems 50 . 51 AHS 435 - Survey of Clinical & Administrative Information Systems 52 13 Physicians Micro Systems - Practice Partner . AHS 435 - Survey of Clinical & Administrative Information Systems . 53 . AHS 435 - Survey of Clinical & Administrative Information Systems AHS 435 - Survey of Clinical & Administrative Information Systems 54 . 55 AHS 435 - Survey of Clinical & Administrative Information Systems 56 14 . AHS 435 - Survey of Clinical & Administrative Information Systems . 57 AHS 435 - Survey of Clinical & Administrative Information Systems 58 Sample Drug Alert Screen . AHS 435 - Survey of Clinical & Administrative Information Systems . 59 AHS 435 - Survey of Clinical & Administrative Information Systems 60 15 QUESTIONS??? Summary of Patient Chart Adios . AHS 435 - Survey of Clinical & Administrative Information Systems . 61 AHS 435 - Survey of Clinical & Administrative Information Systems 62 16 ...
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This note was uploaded on 08/21/2011 for the course AHS 401 taught by Professor Paustian during the Spring '11 term at University of Alabama at Birmingham.

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