EMRAM is the Standard What are the Benefits? John P Hoyt EVP HIMSS Analytics

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1 EMRAM is the Standard What are the Benefits? John P Hoyt EVP HIMSS Analytics

2 SO, WHAT ARE STAGE 7 ORGANIZATIONS? A Little background Required

3 Who Is HIMSS Analytics? A subsidiary of HIMSS We collect data on what information systems are deployed in healthcare systems in the U.S., Canada on a census basis On a sample basis in Europe, the Middle East and AsiaPac From this data, we populate the EMR Adoption Models (EMRAM) EMRAM = the acute care model that reflects increased sophistication in deployment and use of healthcare IT

4 History of the Acute Care EMRAM The acute care EMRAM was developed in 2005 Thought leadership for the industry to compliment the HIMSS Analytics data base Based on data from 5,400 hospitals in the U.S. and 700 in Canada Why the structure? It is the typical manner by which hospitals rollout enterprise clinical systems Are there any usual variations? Academic Medical Centers often have CPOE live to enable education for the medical students and residents The first Stage 7 validation occurred in Q4 2008

5 2011 Q Q1 Complete EMR, CCDA transactions; Data Analytics to Improve Care 1.1% 3.1% Physician documentation (structured templates), full CDSS, full R-PACS Closed Loop Medication Administration 4.0% 6.1% 13.3% 24.2% CPOE, Clinical Decision Support (clinical protocols) 12.3% 15.7% Clinical documentation, CDSS (error checking) 46.3% 27.7% CDR, Controlled Medical Vocabulary, CDS, HIE capable Ancillaries - Lab, Rad, Pharmacy - All Installed 13.7% 6.6% 7.2% 3.2% All Three Ancillaries Not Installed 10.0% 5.6% Data from HIMSS Analytics Database 2014 HIMSS Analytics N = 5439 N = 5449

6 Canada EMR Adoption Model SM Complete EMR, CCDA transactions; Data Analytics to Improve Care Physician documentation (structured templates), full DCSS, full R-PACS Closed loop medication administration 2011 Q2 0.0% 0.0% 0.5% 0.2% 2014 Q1 0.6% 0.5% CPOE, Clinical Decision Support (clinical protocols) Clinical documentation, CDSS (error checking) CDR, Controlled Medical Vocabulary, CDS, HIE capable Ancillaries Lab, Rad, Pharmacy All Installed All Three Ancillaries Not Installed 1.7% 33.2% 23.9% 12.2% 28.3% 3.6% 32.5% 28.9% 14.5% 19.4% Data from HIMSS Analytics Database 2014 HIMSS Analytics N = 639 N = 640

7 Q2 Q1 Complete EMR, CCDA transactions; Data Analytics to Improve Care 1.1% 3.1% +182% Physician documentation (structured templates), full CDSS, full R-PACS 4.0% 13.3% +233% Closed loop medication administration 6.1% 24.2% +297% CPOE, Clinical Decision Support (clinical protocols) 12.3% 15.7% Clinical documentation, CDSS (error checking) 46.3% 27.7% CDR, Controlled Medical Vocabulary, CDS, HIE capable 13.7% 7.2% -47% Ancillaries - Lab, Rad, Pharmacy - All Installed 6.6% 3.2% -52% All Three Ancillaries Not Installed 10.0% 5.6% -44% Data from HIMSS Analytics Database 2014 HIMSS Analytics N = 5439 N = 5449

8 Why Do We Do It? Thought leadership Quality, Safety, Efficiency improvements To inform government policy Numerous countries and regions use HIMSS Analytics to gather data for their policy formulation To reflect the market Where is the market heading To drive the market

9 STAGE 7 STUDIES ON A MACRO SCALE Correlations With Stage 7 Status

10 Representation of TJC Top Performing Hospitals BY Number of Quality Metrics Excelling In, within each EMRAM Stage All hospitals within each EMRAM Stage 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 39.8% 20.7% 18.1% 30.1% 16.3% 12.9% 10.6% 12.8% 6.5% 6.2% 10.0% 2.3% 6.4% 6.4% 1.7% 10.1% 8.1% 4.8% 4.2% 6.5% 7.9% 9.7% 0.4% 1.9% EMRAM Stage 3 or less 4 or more Source: HIMSS Analytics

11 Representation of Hospitals with an "A" Leapfrog Hospital Safety Grade by EMRAM Stage 100.0% 90.0% All hospitals within each EMRAM Stage 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Tipping Point 62.6% 30.8% 20.1% 21.8% 12.8% 14.3% 5.9% 0.0% Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7

12 Value Based Purchasing (VBP) Clinical Scores Tipping Point 64.3 AVG Clinical Score Tipping Point Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 EMR Adoption Model Stage

13 What About Cost Efficiency? Some Ground Breaking Research on the Financial Effect of EMR Deployment

14 What We Found in Researching Hospitals that implemented EMR between 1996 and 2009 did NOT generally see a reduction in operating expense, EXCEPT: Cost rise immediately during and following implementation and then fall back to previous levels However: Hospitals in locations with IT intensive industry found cost reductions after three years Hospitals in other locations found costs increased The initial cost increases was smaller for those in IT intensive locations Used by permission Avi Goldfarb The Trillion Dollar Conundrum: Complementarities and Health Information Technology (NBER Working Paper No )

15 Used by permission Avi Goldfarb

16 Efficiencies Adjusted for Case Mix Index Quality scores Readmission rate Labor input etc..

17 Hospital Cost Efficiencies BY EMRAM Stage Early DRAFT Not for Distribution Used by permission Eric Ford

18 Some Are. But Why?? ARE YOU STILL QUESTIONING BAR CODE ENABLEMENT?

19 4. Knowledge is shared and information flows freely 6. Safety is a system property.

20 A LITERATURE REVIEW FOR MEDICATION BAR CODING ALSO: BLOOD PRODUCTS AND HUMAN MILK

21 Where Do Medication Errors Occur? 58% of errors occur in administration 36% of errors occur in transcribing from handwriting 6% of errors in ordering, transportation, and documenting 1 1 JHCQ, Vol 26, #6, pgs 5-11

22 Medication Safety Comparison with & without BCMA Timing errors without & with bar codes 2 6,723 without bar codes : 11.5% timing errors 3.1% were judged serious ADE 7,318 with bar codes: 6.8% timing errors (-40.9%) 1.6% were judged serious ADE ( -50.8%) Wrong Medications 57.4% Wrong dose 41.9% Improper documentation 80.3% Transcription errors: - 100% 2 N Engl J Med 2005; 353: July 28, 2005

23 Medication Safety Sentara Health System Stage 7 & Davies Award 12,459 Medication errors avoided per month SSM Health System Stage 7 Journal of Health Care Quality sites 59% reduction in medication errors 2 University of Houston showed BCMA led to decreased time on medication administration and increased time on direct patient care in ICU 3 Medication errors reduced 58%, but timing errors did not change significantly 4 St. Joseph s Candler reported 66% reduction of errors, excluding timing errors 5 2 JHCQ, Vol 26, #6, pgs Am J Health Syst Pharm Jun 1;68(11): American Journal of Health-System Pharmacy July 1, 2009 vol. 66 no Am J Health-Syst Pharm Vol 71 Feb 1, 2014, pg 214

24 Medication Safety From 1,465 medications administrations observed, errors reduced 56% - mostly timing errors 5 Cardiac surgery Increased the quantity of drugs administered 21.7% Increased drug charges by 18.8% Decreased documentation time by 8 minutes per case 6 St. Jude s Research Hospital - pediatric dosing & medication administration Reduced ADE by 47% 7 5American Journal of Health-System Pharmacy Vol 65, pgs American Journal of Health-System Pharmacy Vol 66, pgs The Journal of Pediatrics Volume 154, Issue 3, Pages e1

25 USING I.T. TOOLS TO IMPROVE PATIENT ENGAGEMENT

26 Target Your Problems and Cohorts Rural north central health system attacked CHF readmission rate Weight gain due to medication insufficiency or behavior factors, is a strong predictor of readmission Gave away blue-tooth enabled weight scales to targeted CHF patients Reduced readmissions by 42% over 12 months

27 Target Your Problems and Cohorts Asthma protocol adherence was an issue with children & teenagers Use PHR to engage patients Improved asthma protocol adherence from 6% to 78% in 18 months Teenage obesity & Fit Bits.. Create competitive cohorts with PHR

28 Thank You! John P Hoyt Executive Vice President HIMSS Analytics

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