THE PAIN AND GAIN OF ELECTRONIC MEDICAL RECORDS AND IMAGE CAPTURE IN OPHTHALMOLOGY

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1 THE PAIN AND GAIN OF ELECTRONIC MEDICAL RECORDS AND IMAGE CAPTURE IN OPHTHALMOLOGY Ann Koval Baylor College of Medicine THE ADMINISTRATORS ROLE

2 CHANGE

3 DENIAL

4 FEAR

5 WE WERE THE SMARTEST IN OUR CLASS WECAN DO THIS

6 HOW SOON CAN THEY BE GONE?

7 HOW SOON CAN I SEE THIS WHEN I OPEN THE PATIENT RECORD?

8 WHERE DO YOU FIT IN? What role will you play?

9 WHERE ARE YOU NOW? EMR AND IMAGE CAPTURE IN PLACE EMR ONLY NO EMR AND NO IMAGE CAPTURE

10 KNOW YOUR ORGANIZATION WHAT IS YOUR ROLE IN THE ORGANIZATION KNOW YOUR FACULTY AND CLINIC PLAN NETWORK WITHIN YOUR ORGANIZATION

11 YOUR ORGANIZATION HOSPITAL BASED PRACTICE? MULTI SPECIALTY GROUP PRACTICE? SINGLE SPECIALTY GROUP PRACTICE?

12 YOUR ROLE ACADEMIC ADMINISTRATOR ACADEMIC ADMINISTRATOR with clinical responsibilities

13 FACULTY AND CLINIC HOW MANY FACULTY? WHAT SUBSPECIALTIES DO YOU HAVE? WHAT IMAGES DO YOU NEED TO CAPTURE? WHERE DO YOU WANT TO VIEW THE IMAGES? HOW CAN WE IMPROVE WHAT WE HAVE?

14 PLAN WHERE ARE YOU STARTING? WHAT IS THE GOAL DEFINE WHO NEEDS TO BE INVOLVED Faculty Staff Hospital personnel College or Hospital IT WHAT IS YOUR TIMELINE?

15 NETWORK Regardless of where you are in the process IT Be sure to network with: HOSPITAL ADMINISTRATION FINANCIAL ADMINISTRATION INSTITUTIONAL EMR TEAM

16 THE BAYLOR COLLEGE OF MEDICINE EXPERIENCE 2009 EPIC Cadence (scheduling) 2009 EPIC Prelude (registration) EPIC Optime (ASC) 2012 EPIC EpicCare (ambulatory record) 2012 iviews Imaging System

17 WE LEARNED: 1. It takes time 2. Coordination with IT is essential 3. Time invested in faculty buy in is valuable 4. Collections do improve with EMR 5. On demand record and image availability helps with patient satisfaction

18 PAIN FACULTY FRUSTATION INSTITUTIONAL INTERACTIONS SOFTWARE SUPPORT UNREALISTIC EXPECTATIONS THE TIME INVESTMENT REQUIRED RESOURCE ALLOCATION

19 Sigrid Button Casey Eye Institute Oregon Health and Science University History OHSU leadership early adapters 2006 Go-live on Epic Workarounds and poor user interface results in: Decreased volume Increased workload Frustrated Faculty

20 2012 Kaleidoscope not an institutional priority Casey must compete for institutional resources Presentation is made to hospital administration

21 OUR CASE: distinct subspecialties from plastics to neuro to contact lenses. 2. Diverse workflow. 3. Unique diagnostics. 4. High volume up to 70 patients per day per provider of the 10 busiest physicians at OHSU. 6. Casey provides over 14% of Ophthalmology s outpatient visits.

22 WHY KALEIDOSCOPE 1. Specialty specific documentation tailored for improved efficiency and quality. 2. Capture discrete information from examination (critical for meaningful use). 3. Better workflow for imaging and numerical device integration

23 WHAT WE LEARNED FROM OTHERS 1. An institution already using EPIC reports that Kaleidoscope improved efficiency FTE faculty see 38,000 visits; FTE faculty see 53,000 visits using Kaleidoscope. 2. What we extrapolated for Casey in 2011 we saw 79,404 patients with 26 FTE faculty. We have the potential of seeing 110,748 patients in 2013 with 28 FTE faculty. IS THIS REALISTIC? POSSIBLY

24 ANOTHER WAY OF LOOKING AT IT Could efficiencies with Kaleidoscope help us see one additional patient per half day session? We believe it could on average based on thoughtful faculty analysis of Kaleidoscope features. We have 6,336 half day sessions. Using average pro fee and facility fee, our collection rate, we could increase revenue to faculty and institution by $1.9 million per year.

25 IS THIS REALISTIC? WE THINK SO IF: 1. Institutional resources are allocated for good implementation. 2. Patients are available we think so because average third next available is 35 days and, 3. Demographic changes in the future should create more demand.

26 BEYOND DOLLARS WE ANTICIPATE: 1. IMPROVED DOCUMENTATION 2. BETTER PROVIDER SATISFACTION 3. RICHER DOCUMENTATION LEADING TO BETTER RETROSPECTIVE STUDIES 4. BETTER PATIENT CARE 5. IMPROVED QUALITY MONITORING AND REPORTING (Meaningful use and Research) 6. IMPROVED EFFICIENCY

27 Cameron Blount University of California, Davis RELATIONSHIP WITH INSTITUTIONAL IT

28 THE UC DAVIS EXPERIENCE: RELATIONSHIP IS VITAL! DON T GO IT ALONE INSTITUTIONAL IT INVESTMENT AT UC DAVIS EMR IMPLEMENTATION SPEAK UP! PERSISTENCE IS KEY MEDICAL DIRECTOR S ROLE SET UP REGULAR MEETINGS IT S ALWAYS MORE WORK THAN YOU THINK IT IS INDUSTRY DOESN T HELP (DICOM, etc) UC DAVIS HIRING SOLUTION INVESTMENT ON BOTH SIDES

29 Jeff Good Northwestern University School of Medicine CHARGE CAPTURE AND COLLECTION IMPROVEMENTS

30 THE GAIN

31 ROUNDTABLE

32 Image Capture Vendors some vendors There are other vendors and your current institutional PACS may also be willing and able to provide the service. Merge Health (OIS) Topcon Synergy Topcon Imagenet R4 Sonomed Escalon Axis Anka EyeRoute iviews Imaging System PACsPlus ophthalmology INFINITT ophthalmology Visbion IPACS MedVision IMPAX for ophthalmology

UCSF Medical Center. CTG Dec. 7, 2013

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