IV HEALTH INFORMATION TECHNOLOGY EXECUTIVE SUMMIT 2013 HIT & HIE Challenges and Opportunities for Healthcare Transformation IV HEALTH INFORMATION TECHNOLOGY

IV HEALTH INFORMATION TECHNOLOGY

EXECUTIVE SUMMIT 2013 HIT & HIE Challenges and Opportunities for Healthcare

Transformation

Health Information Exchange and Quality

What does this mean for the health care sector?

As with any revolution, there will be winners and losers: those who adapt successfully and those who do not. Daniel Masys, one of the early thinkers and conceptual architects of the medical informatics movement, reviews the stakes and the prospects for the future of the workforce in regard to the changes under way. His description of the coming tectonic changes is compelling, as are his suggestions about the evolving roles of physicians and other health professionals.

Among health professionals there will certainly be winners and losers, however, and the emergence of new categories of jobs.

Failure to communicate effectively will be likely to place a health care provider at an economic disadvantage.

The health professional who refuses to use a computer is a justifiably endangered species in this emerging environment.

IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013

HIT & HIE Challenges and Opportunities for Healthcare Transformation

The Center for Medicare and Medicaid Services (CMS) calls EHRs, “the right step in continued progress of healthcare”.EHR can help hospital monitor, improve and report data on healthcare quality and safety.

HIE REALITY:• HIE environment is under continuous

development;• Cooperation must take precedence

over competition;• Statewide HIE’s should cooperate

with private HIE’s to provide synergistic services



THE COMMONWEALTH FUNDUsing Electronic Health Records To Improve

Quality And Efficiency:The Experiences Of Leading Hospitals

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Jul/1608_SilowCarroll_using_EHRs_improve_quality.pdf

USEFUL LESSONS AND INSIGHTS FROM 9 HOSPITALS THAT ARE (WERE) CONSIDERING EHR ADOPTION,

RAMPING UP THEIR EHRs TO MEET MEANINGFUL USE CRITERIA,

OR TAILORING THEIR HER TO PROMOTE HEALTH CARE QUALITY AND SAFETY







KEY DRIVERS OF EHR ADOPTION:

IMPROVING QUALITY AND CONTINUITY OF CARE

- AT MOST HOSPITALS, ADOPTING A COMPREHENSIVE HER WAS PART OF A STRATEGIC PLAN TO INTEGRATE INPATIENT AND OUTPATIENT CARE AND PROVIDE A CONTINUUM OF COORDINATED SERVICES

ACROSS THEIR SYSTEM.- THE HER WAS EXPECTED TO IMPROVE COMMUNICATION AMONG

PROVIDERS ACROSS CARE SITES- SOME HOSPITALS (INTERVIEWEES) NOTED THAT THESE LEVEL OF COORDINATION WOULD BE NECESSARY FOR FURTHER DELIVERY

SYSTEM REFORM (SUCH AS ACOs)



A BUSINESS CASE FOR HEALTH INFORMATION EXCHANGE IS NOW

EMERGING

New delivery system and payment models that promote higher quality, cost effective care are

proliferating in the market placeThrough CMS Innovation, the federal government is investing hundreds of millions of dollars in new

models of care, including demonstration of Accountable Care Organizations, Advance Primary Care, Patient Centered Medical Home, Home based

care and Bundle Payments.




EMERGING

A recent study identified 30 ACOs arrangements within 22 health plans and this numbers is

expected to grow

According to a Recent survey of hospitals And health systems conducted by the Advisory Board,

nearly half of respondents expect to have an accountable care organization in place by 2013,

and 78 percent plan to do so by 2015.



A BUSINESS CASE FOR HEALTH INFORMATION EXCHANGE IS NOW EMERGING

More robust requirements for EHRs and information exchange contained in MU Stage 2 are scheduled to go into

effect in October 2013 for hospitals and January 2014 for EP. These new requirements, combined with delivery

system and payment models, are increasingly creating the ‘business case’ for clinicians, hospitals, and other providers

to begin exchanging data electronically across organizational boundaries.

According to a Clinical Survey, a Majority of clinicians believe that electronic exchange of health information will

have a positive impact on health care.




EMERGING

A clear majority of clinicians surveyed believe that the electronic exchange of health information across

care settings will have a positive impact on: the quality of patient care (80 percent)

Ability to meet the demands of new care models (78 percent)

Ability to participate in third party reporting (72 percent)Positive impact on improving efficiencies in their practice

settings (69 percent)Reducing health care cost (57 percent)



KEY STRATEGIES TO SUCCESSFULLY IMPLEMENT AND OPTIMIZE EHR

Strong Leaders who are both forceful and realistic

Achieving buy-in from physicians and other staff was cited as a critical challenge by hospitals. While only a

minority of staff members was resistant to EHRs per se, many physicians and others had significant concerns

about anticipated upheaval and changes in their day to day activities. Their anxiety was compounded by

ambiguity about their potential benefits of the new system, as well as wariness about clinical rules being

imposed on them.



KEY STRATEGIES TO SUCCESSFULLY IMPLEMENT AND OPTIMIZE EHR AND HIE

Involve Clinical Staff in her Design and Implementation

All interviewees emphasized that the most important factors in building support for the HER were having

clinician staff drive the process and involving as many staff as possible in its design and development.In addition to forming high level implementation

teams, key staff members through the hospital were assigned to design teams and committees to help

tailor her system to the hospital environment

Examples of Hospitals’ Use of Clinical Teams for EHR DevelopmentGundersen Lutheran Medical Center, La Crosse, Winsconsin

The hospital gradually put together a 50-person clinical team primarily comprising nurses a few physicians focused on information services. The team focused on ensuring that the EHR was built with patient care as its top priority.

Metro Health HospitalWyoming, Michigan

A ‘core’ team about 100 FTEs was establish and met regularly for 18 months; it included nurses, physicians, and staff from throughout the hospital systems who focused on workflow.

Carilion Memorial HospitalVirginia

The parent health system use a three-level implementation system:• Executive team with direct oversight of the project; included hospital COOs,

CMOs, CNOs, CEO of ambulatory care, and others;• Steering committee that develop policies and procedures; and;• Operating team comprising frontline staff who incorporated the new system

into daily processes in the hospitals and other sites.

Sentara General HospitalVirginia

The parent health system brought 185 people (many of them floor nurses) from across integrated system, trained them on the new EHR, and then sent them back to teach others. These “super users” are embedded throughout the organization and called on whenever there is a need to tweak or modify the system.

New York – Presbyterian New York – New York

Used clinical specialists to break up the EHRs note template into structured fields so that information can be extracted for MU data reporting. It also has a House Staff Quality Council with an IT sub committee that meets monthly and discusses issues as improving hand off communication using a custom EHR feature, developing and electronic checklist to track safety and regulatory requirements.

Geisinger Wyoming Valley HospitalPennsylvania

The parent health system selected the ‘best and brightest’ in the organization to implement the EHR. Involved a physician optimization team, a nursing ‘super user’ team, and a inpatient EHR project IT team for analysis, system development and issue tracking and management.

Yale – New HeavenConnecticut

The system buys physician time away from practice so as not to penalize them for being involved in customizing the EHR; prior to roll out of the new EHR, scores of physicians worked in customization every Tuesday morning.




Invest Heavily in and Require TrainingThe hospitals faced tremendous logistical

challenges in training virtually all hospital staff and clinicians in how to use EHRs. They need to expand their IT staff to work with HER Vendor to customize the system, including adding IT Focused clinicians who could bridge the conversation (effectiveness) between technology and practice. Training needs

continued as new staff members are hired and changes/updates are made to the system.



KEY STRATEGIES TO SUCCESSFULLY IMPLEMENT AND OPTIMIZE EHR AND

HIE

Use EHRs to Aggregate Performance Data

Some Hospitals were frustrated by the limitations of EHRs to facilitate reporting, particularly their inability to generate reports for CMS Hospital

Compare or Meaningful Use Certification.




Involve Quality Improvement Leaders in Developing and Updating EHRs

Hospitals must include quality improvements and accreditation personnel in the selection, design,

and tailoring of their HER systems. Several Hospitals noted that their quality staff worked

with IT staff to customized dropdown menu choices in the HER to be consistent with many

other external (regulations) reporting requirements



IMPACT OF EHR AND HIE ON QUALITY OF CARE

TARGETING ON QUALITY IMPROVEMENT EFFORTSThe Hospitals report that a major benefit of their EHRs

has been the ability to look at patterns in performance data to identify problems areas, thereby

facilitating quality improvement efforts and identifying opportunities for process redesign.

Carilion developed 15 automated reports on the use of patient restraints, each identifying different aspects

of restraint use such as patient demographics, diagnosis, and time of day used.




PERFORMANCE REPORTING AND ACCOUNTABILITY

The Hospitals used their comprehensive EHRs often in conjunction with additional quality

reporting programs, to generate performance reports with trends and benchmarks.




IMPROVED COMMUNICATION

The Leading Hospitals report the EHR contribute to faster, more accurate communication between

providers within the hospital and between ambulatory and hospital settings. Patients’ care plans, medical history, allergy lists, medication

records and progress notes are easily accessible, enabling authorized users to see the complete

medical story.




CONSISTENT, EVIDENCE-BASED CARE

The Leading Hospitals embedded clinical guidelines in their EHR systems

At Yale-New Heaven Hospital, about 80% of ordering is guided, with prompts and questions

to help clinicians select the best drug or treatment protocol.



EFFICIENCIES AND RETURN ON INVESTMENTS

More Time for Patient Care and Quality Improvement

Sentara nurses found the EHR-based discharge tool reduced the time spent searching paper records for relevant information; clinicians do not have to

return to the unit to access patient recordsQuality improvements staff found that EHRs made performance reporting faster and more efficient




IMPROVING THROUGHPUT AND REDUCING REDUNDANCYThe Hospitals report that the EHR improved patient flow,

or throughput, because care processes can be streamlined and discharges are more predictable and can happen earlier, leading the shorter lengths of stay

and faster bed turnover and reassignment.

At Sentara, the time to assign a bed for a newly admitted patient has decreased by 90 minutes, with a 80%

reduction in time to admit an emergency department patient.




CAPTURING CHARGESOn aspect of efficiency is being able to bill for all

services delivered while minimizing administrative and documentation costs.

Gundersen reduced its write-off for care associated with inadequate documentation of

services or required Medicare waivers.

Health data sharing networks are crucial to quality improvements, cost containment, and health care

accessibility. By enabling the flow of patient data across organizations, data sharing improves almost every aspect

of healthcare in America, from insurance markets to better research. With costs rising rapidly and many

Americans continuing to lack health care insurance, the development of technology infrastructure and data

sharing are vital to modernizing the health care system and integrating data compiled by a number of different

organizations.

RE: TITLE III—IMPROVING THE QUALITYAND EFFICIENCY OF HEALTH CAREPART I—LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE MEDICARE PROGRAMPART II—NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY

Q & A

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IV HEALTH INFORMATION TECHNOLOGY EXECUTIVE SUMMIT 2013 HIT & HIE Challenges and Opportunities for Healthcare Transformation IV HEALTH INFORMATION TECHNOLOGY