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Successfully Choosing Your EMR
Founder Medical Strategic Planning, Inc
Art Gasch
Health Summit West
Slide 2
Self - Disclosure
No conflicts with EMR developers or EMR distributorsNo conflicts with EMR developers or EMR distributors
Author:Author: Successfully Choosing Your EMR: 15 Crucial Decisions
Architect:Architect: MSP EHR Selector website (www.ehrselector.com)
The book & website are mentioned in this presentation
It’s a law, not a suggestion – but what’s the right approach to adopt?
82% of practices and 92% of hospitals lack comprehensive EMR/EHR
Slide 4
20% MDs Unhappy With EMR Deployed
Satisfied
“Not easy-to-use” & “workflow disruptions” are two major causes of EMR deployment failures
Slide 5
Crucial Decision(s) Physicians Now Face
1. When to sail into action?
2. How to navigate EMR adoption?
3. Continue to wait in port for the reform storm to weaken and pass by?
Once the storm passes, the waters will become more calm & saferOnce the storm passes, the waters will become more calm & safer!!
Slide 6
Steps & Considerations in Choosing Your EMR
3. Practice & Staff Readiness Assessment3. Practice & Staff Readiness Assessment
Widespread, successful EHR adoption is foundational for all healthcare reform
1. Form EMR Committee – Engage All Affected1. Form EMR Committee – Engage All Affected
2. Determine Current & Future Needs2. Determine Current & Future Needs
4. Carefully Evaluate EMR Alternatives4. Carefully Evaluate EMR Alternatives
5. A Web-based EMR Information Resource5. A Web-based EMR Information Resource
0. Understand Paradigm Change Faced0. Understand Paradigm Change Faced
Understand the Paradigm Change
Slide 8
For 1For 1--10 primary care practices, it will be a 10 primary care practices, it will be a major paradigm change that requires computermajor paradigm change that requires computer
technology staff may not be familiar with!technology staff may not be familiar with!
Slide 9
A more structured way to describe the encounter
“On my trip to TEPR I spent $1,079.48, mostly on the hotel and travel expenses.”
--- versus ---
What was the total for mileage and parking? – can’t be answered from the freeform description. How much detail is enough? How much longer does charting take?
Slide 10
EMR – A New Paradigm, Not an Electronic Version of the Paper Record
If the clinical data is structured, it’s stored in a DBMS and screens
displayed are database reports, not images of physical pages. How
EMRs store & manage data is critical to their ability to document
various PQRI & HEDIS quality measures.
EMR Planning, Adoption, Deployment is a Process
PGPs required to submit more specific patient data to an increasing number of intermediaries
With little incentive to offset the costs and risks of capturing the data
Slide 12
‘Tug-of-Wars’ Due to Misaligned Priorities
Primary Care MDThe CIOLegacy IT Vendor
CIO – ‘Create as few new EHR interfaces to legacy hospital systems as possible’
MDs - ’Saying “No” to EHRs that cripple office workflow & productivity’
Form the EMR Committee
Be Inclusive, not exclusive
Determine Current & Future
Needs & Risks
Keys to Avoiding RAC Audits
CMS and its RAC Bounty Hunters
Courtesy – Foley & Lardner
Don’t Rush (Plan & Deployment)
Process
Slide 17
Commonly Overlooked Issues
Individualized EMR process based upon your practice readiness assessment
Security Mgmt
EMR
Satisfaction
Ratings
Workflow
Anal.
Backup Power &
Contingency
Planning
Staff EMR
Orientation
Readiness
Assessment
Office
Renovations
Form EHR
Committee
Slide 18
Key Activities May be overlooked or abbreviated in accelerated deployment approaches
Copyright 2009 ‐
All Rights Reserved by MSP
Slide 19
Typical EMR Planning Timeline (with Selected EMR Milestones)
The EMR or EMR/PMS or EMR/PMS/Portal Planning Process Has MORE steps (takes longer) if an in‐office EMR deployment is the objective!
All Detailed Tasks by Role are NOT shown above
Slide 20
EMR Adoption Must Be Quick for RECs to Succeed
Medical Strategic Planning I Professional Information Transforming North American Healthcare Markets
Slide 21
Three REC Payment Milestones
SubscriptionSubscription DeploymentDeployment MU CertificationMU Certification
1/3rd
Second payment when
EMR is deployed and
provides CPOE and e‐RX
and received e‐Lab results
1/3rd
REC gets paid for signing
you up. Focused on
marketing first
1/3rd
Final payment when EP is
certified as a Meaningful
User of EMR technology
Math is simple ‐
anything that delays a payment milestone, puts REC at financial
risk. Expediting DEPLOYMENT is key to timely receipt of 2nd
payment.
Slide 22
License Grant: Vendor Example
Subject to the terms and conditions of this Agreement, Vendor grants Licensee a non-transferable, non-exclusive license to use the Software for its internal purposes.
Vs.
Subject to the terms and conditions of this Agreement, Vendor grants to Licensee a perpetual, non-exclusive license to use the Software for its business activities. Such business activities include, but are not limited to, the right of Licensee’s parents and their respective affiliates, subsidiaries, and joint venturers to access and use the Software. In addition, Licensee may serve as a service bureau for the foregoing entities.
If you were buying a house, would you use the seller’s attorney?
Courtesy Foley & Lardner
Slide 23
Specifications
Most vendors warrant to the “documentation”
– EMR Vendor controls the documentation
– Can change at any time. Functionality “creep”Is specific functionality/interoperability required?
RFQ and response included or not?
Courtesy Foley & Lardner
Slide 24
Legal Agreement Scope
How thoroughly are each of these points covered? Law firms with national heatlhcare practices, like Foley & Lardner or LeClairRyan can help. Figure $5-9K for EMR related legal work on RFQ and final contracting/licensing.
Courtesy Foley & Lardner
Practice & Staff Readiness
Assessment
Slide 26
Practice & Staff Readiness Assessment
Carefully Evaluate EMR Alternatives
Picking an EMR is like buying a house or purchasing a car
Slide 28
A Crucial Decision to Make
Did you let someone else do that for you, or did you want to do it yourself?
Whoever makes the choice, YOU will live with it everyday!
Slide 29
www.ehrselector.com shows ‘functionally qualified’ EHR developers (that RECs didn’t present to you)
TEXT EXTTEXT
• Little consistency in EMR features from state to state, apart from MU
• Vendors qualified inconsistent from one state to another.
• Some EMR vendor products that meet MU criteria are overlooked in many states.
A A ‘‘functionallyfunctionally--qualifiedqualified’’ EMR product EMR product is one that has the same is one that has the same functionality as the common functionality as the common denominator of RECdenominator of REC--selected EHR selected EHR products.products.
…
575 more EMRs
in between (of both types)
Over 600 EHR Products Listed on
www.EHRSelector.com
Website!
Slide 30
A One-stop Portal for Diverse EHR Needs
www.ehrselector.comOffering Independent, Impartial:
• Lists of EMR Planning, Deployment &
Security Consultants, Accountants,
Lawyers, Chart Conversion/Scanning
Services
• EMR Educational Resources
• Hardware Suppliers
• Post‐Deployment System Support
• EMR Product satisfaction scores (KLAS)
• EMR Selection Tracking, Tools & Reports
for EMR Consultants/RECs
•
Ability to compare 687 features of key
EMR products to your needs.
Slide 31
Scroll down to see add’l. criteria
Compare Vendors 3 at a Time
Slide 32
Keep Scrolling Through All 680 Criteria
See which vendors offer which features
Slide 33User Interface – A Crucial Issue
Slide 34
Logically Organized Categories and CriteriaLogically organized criteria global, REC & user defined profiles simplify selection
Slide 35
How Do I Get Patients Involved with my EMR?
Slide 36
Both require careful planningIn-Office vs. Web-based EMR Deployment
Less External I-Net & Theft Exposure
I-Net essential for operation, redundant connectivity required
Browser-based operation & rapid deployment make this the REC
favorite for EP clients
Greater In-office skill set. Required & some hardware maintenance.
In-Office Appoach
Web-Based ASP Approach
Which is ‘right’ for your practice?
Slide 37
Areas of Concern What you need to consider
Loss of Internet Connection Can be a power failure, or I-Net provider failure, so your contingency plan must cover all of these.
EMR Responsiveness Internet can be slow, and add 1 (or more) seconds to menu responses.
Non-control of EMR upgrades In the ASP model, every client migrates to new versions at same time at the will of the EMR developer. Can create a training issue.
Workflow Customization Issues ASP apps may not be as user-customizable as in-office EMRs.
PMS Integration Challenges Can be more challenging to integrate Web-EMR with in-office PMS, or even impossible.
Browser IssuesWith 4 major brands, and several versions/brand, and numerous options, and different renderings of sites, browser management is not trivial to get and keep right.
Increased Security RisksEvery ASP user is ‘facing’ the I-net, and any user breach can compromise entire network. ASP EMR are also better targets for hackers than any individual office is.
Lack of Control of Backup Strategy and on-site access to patient files
How long does it take an ASP to restore backup if patient files are lost or breached, or ASP and EMR are two different organizations
Special Licensing considerations to be addressed
Some issues don’t exist with in-office deployments, but require special terms for web-based deployments.
User Interface Constraints Speech recognition is more challenging in I-net based EMRs. Many practices are used to transcription, and like speech recognition EMRs.
Issues With I-Net Based SaaS ASP EMRs
Slide 38
Slide 39
2010 EHR Book Library
Learning Resource Category
Resource Supplier & Website Resource Name/Title Contact or Author &
WebsiteContact Email & Phone
Books
Wiley-Blackwell Customer Care 10475 Crosspoint Blvd Indianapolis, IN 46256
Successfully Choosing the Right EMR – 15 Crucial Decisions Released April 2010ISBN 978-1-4443-3214-8
Arthur Gasch & Betty Gasch, RN, BSN
877-762-2974 Voice 800-605-2665 FaxOr Amazon
Books MGMA Press or Amazon
Electronic Health Records, 2nd Edition, Transforming Your Medical PracticeReleased 2010ISBN 978-1-56829-343-1
Margret Amatayakul2313 W. Weathersfield Schaumburg, IL 60193
877-ASK MGMA
Books
AHIMA 233 N. Michigan Ave., Suite 2150 Chicago, IL 60601
How to Evaluate Electronic Health Record (EHR) Systems ~$129 - Released 2008
Patricia Trites and Dr. Reed Gelzer
312-233-1100 Rita Scichilone
Books Prentice Hall PTR EMR Complete: A Worktext, January, 2010 Daniel Limmer Amazon or Borders
Online
Books Elsevier Health Sciences
The Electronic Health Record for the Physician's OfficeReleased 2010ISBN 978-1-43770-0-282
Any DeVore Amazon or Borders Online
Just released (2010) books provide excellent introduction to EMR issues that transcend MU. They can prepare staff for college courses or may be all that is needed, depending on baseline EMR knowledge in clinical staff. Your Practice Readiness Assessment will show you.
Slide 40
Upgrade Time…
is not Your Time
Slide 41
Do any of the ASP EMRs offered to you include a user-customizable workflow engines?
(These offer users the ability to make their workflow specific for each user, and for specific types of patient encounters, without requiring EMR vendor assistance or charges).
If user workflow modification isn’t built-in, it can’t be added on. An example of an EMR with workflow management is EncounterProOpen Source EMR.
Workflow and Application Customization
The number of keystrokes required to accomplish any task and the entire patient encounter is critical. This is something that no REC can evaluate for you because they don’t know your workflow!
Slide 42
User-Accessible Workflow Customization
A few of the 13 criteria for user-customizable workflow functions
Slide 43
Getting EMR Integration Right
HIE Integration
RHIOsWeb Portal
Basic EMR
Patient Kiosk
IntegratedPMS
If EMR is on web, and PMS is in your office, their integration can be more challenging
Slide 44
Getting EMR Integration Right
The EHR Selector A Consultant’s Management Tool
Slide 47
MSP’s EHR Selector is Easy
TEXT EXTTEXT
Simple to find www.ehrselector.com
Convenient cascading selection categories
Slide 48
EMR Selection is About Getting Details Right!
48Feb. 2, 2010 48
9 of 35 Rx Criteria For ‘MU’ requires only 3
2 not req’d by MU can result in patient death
Slide 49
Assert 144 Criteria in ONE Global (AGA) Profile
Criteria picked by AGA physicians who have already adopted EHR and found them to be important.
Slide 50
Built-In ‘Help’ Systems Clarifies Questions or Raises Important Considerations
Help may be brief Help may be brief or extensive, but or extensive, but is generally concise is generally concise and relevant.and relevant.
Help is a Help is a click away!click away!
A Glossary of Terms A Glossary of Terms is also availableis also available
Slide 51
Glossary Provides Basic Info w/Hot-Link to More Info
From Help Screen
Hot Link to background info on the Internet
Slide 52
After Assertion, Simply Submit
TEXT EXTTEXT
Attach functional criteria listed to your RFQ to document needs
Slide 53
Searching by Keyword Quickly Locates Features
Which can then be quickly asserted with a single click!
Slide 54
Developers’ KLAS Ratings
MSP EMR Selector includes embedded
KLAS ratings
MSP EMR Selector includes embedded
KLAS ratings
Slide 55
Web-based EHR Selector Comparison Matrix
MSP Competitor A Competitor B Competitor C Competitor D
Uses 3rd-Party Vetted Information Yes No No No No
Partners w/Major MD Organizations 6 No No Some Yes
KLAS Research EMR Ratings Yes No No No No
2010 Meaningful Use Flags Yes ?? ?? ?? No
Sells EHR Products No Yes No No No
Exhibitor Fees Fund EHR Selector Company No No No Yes Yes
Provides EHR Consulting No No No Yes ???
Solicits EHR Commissions or Finder’s Fees ? No Yes ??? ??? ???
Direct Match & Vendor Feature Magnifier Yes No No No No
REC/Consultants Mode Yes No No No No
Look For - No conflicts of interest – truly impartial, partially-vetted, developer-neutral data!
Slide 56
Thanks for your interest.
Leave me a business card if you would like a copy of the presentation.
Questions & Answers
Slide 57
Medical Strategic Planning, Inc. Arthur Gasch – Founder, Board of Directors 5 Shelbern Dr. - Lincroft, NJ 07738 [email protected] Ph: 732-219-5090 Fax: 732-219-5066 Wm. F. Andrew – VP EHR Business Unit Online: http://www.medsp.com and [email protected] http://www.ehrselector.com
Selected MSP EHR Partners/Associates:Carolyn Samuels, M.D. – Creator of EHR Selector, Managing Member CSMed, LLCRobt. Bruegel, Ph.D. – Associate for Andrew & Associates EHR BenchmarkDavid Ginsberg – Founder, Privaplan, Inc.
Selected EHR Cooperating Organizations:ACC – College of Cardiology AGA – Gastroenterological AssociationAHQA – Health Quality Association HIMSS – Hlth Info Mgmt & Sys. Society
MSP Contact Information