UAE Progress on the Acute Care EMRAM. Prepared by HIMSS Analytics Presented by Jeremy Bonfini

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1 UAE Progress on the Acute Care EMRAM Prepared by HIMSS Analytics Presented by Jeremy Bonfini

2 2013 Q Q4 Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 2.2% 2.9% Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS 11.1% 12.5% Closed loop medication administration 20.9% 22.0% CPOE, Clinical Decision Support (clinical protocols) 15.1% 15.5% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries - Lab, Rad, Pharmacy - All Installed 31.9% 8.4% 3.5% 30.3% 7.6% 3.3% All Three Ancillaries Not Installed 6.9% 5.8% Data from HIMSS Analytics Database 2012 HIMSS Analytics N = 5437 N = 5458

3 Outside of North America, Closed Loop Medication Administration is in Stage 6 and Radiology PACS is in Stage 5 We switched them to more reflect the market

4 Middle East EMR Adoption Model SM Stage Stage 7 Stage 6 Stage 5 Stage 4 Stage 3 Stage 2 Stage 1 Stage 0 Short Description Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP Physician documentation (structured templates), full CDSS (variance & compliance), closed loop medication administration Full complement of R-PACS displaces all film-based images CPOE, Clinical Decision Support (clinical protocols) Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology Clinical Data Repository (CDR), Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries Lab, Radiology, Pharmacy All Installed All Three Ancillaries (LIS, RIS, PHIS) Not Installed Data from HIMSS Analytics Database 2013 HIMSS Analytics

5 Middle East EMR Adoption Model SM, Abu Dhabi Hospitals Stage Short Description 20 AUH Hospitals Stage 7 Stage 6 Stage 5 Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 0% Physician documentation (structured templates), full CDSS (variance & compliance), closed loop medication administration 55% Full complement of R-PACS displaces all film-based images 15% Stage 4 CPOE, Clinical Decision Support (clinical protocols) 0% Stage 3 Stage 2 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 10% Clinical Data Repository (CDR), Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable 10% Stage 1 Ancillaries Lab, Radiology, Pharmacy All Installed 10% Stage 0 All Three Ancillaries (LIS, RIS, PHIS) Not Installed 0% Data from HIMSS Analytics Database 2013 HIMSS Analytics

6 Middle East EMR Adoption Model SM - Dubai Hospitals Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 0.0% 0.0% Physician documentation (structured templates), full CDSS (variance & compliance), Closed Loop Med Admin Full Complement of Radiology PACS 0.0% 0.0% 0.0% 7.4% CPOE, Clinical Decision Support (clinical protocols) 4.3% 7.4% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries Lab, Rad, Pharmacy All Installed 4.3% 30.4% 39.1% 3.7% 37.0% 33.3% All Three Ancillaries Not Installed 21.7% 11.1% Data from HIMSS Analytics Database 2012 HIMSS Analytics N = 23 N=27 6

7 The Payoff on Investment Occurs at the Upper Stages Investments in Stages 2 through 5 are like a construction project Messy Complicated Setbacks, errors Frazzled Stage 6 begins to have payoffs Stage 7 truly stands out as having ROI

8 We Are Making Progress 30.00% % DHA Hospitals at Stage % 25.0% 20.00% 15.00% 14.8% 10.00% 5.00% 4.3% 0.00%

9 All hospitals within each EMRAM Stage Representation of TJC Top Performing Hospitals BY Number of Quality Metrics Excelling In, within each EMRAM Stage 50.0% 45.0% 39.8% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 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

10 All hospitals within each EMRAM Stage Representation of Hospitals with an "A" Leapfrog Hospital Safety Grade by EMRAM Stage 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 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

11 *Program from U.S. Medicare to earn additional reimbursement Value-Based Purchasing (VBP) Program* Clinical Performance Score Patient Experience Performance Score + = Total Performance Score 70% 30% TPS 100 = High Value Performance TPS 0 = Low Value Performance

12 AVG Clinical Score Value-based purchasing (vbp) projected Clinical score Tipping Point Tipping Point Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 EMR Adoption Model Stage

13 So, What is This Saying? Government incentives seems to be helping grow healthcare IT investment Without incentives, progress will be much slower Not just money, but incentives and disincentives Quality Safety Efficiency 13

14 Some Real Benefits from Stage 7 Health Care Systems Prepared by HIMSS Presented by Jeremy Bonfini

15 SOME CLINICAL & PROCESS IMPROVEMENTS OF STAGE 7 HOSPITALS

16 Legacy Health Reduction in Transcription Costs

17 Legacy Health 62% Reduction in Hospital Acquired Infections

18 Rules & Alerts Drive Best Practices

19 Improvements in Immunizations: 77% to 97%

20 Frequent Fliers in the Emergency Department (more than 7 visits in 6 months) Through proactive case management reduced visits in target population by 50%

21 Obtaining HA1C Testing in Office

22 Mammogram Protocol Conformance 55% to 71% in 1 year

23 Overall, Where are the Benefits Coming From? Benefit N of Organizations Decreased transcription costs 23 Improved documentation quality 22 Decreased cost of paper forms and storage 16 Reduced medication errors or adverse drug events 16 Clinical cost reduction 13 Reduced staffing 10 Improved reimbursement inpatient or outpatient 9 Increased use of preventive care 8 Reduction in drug use and/or cost 7

24 HOW ABOUT OPERATING MARGIN BY EMRAM STAGE?

25 Average Operating Margin Source: HIMSS Analytics TM Database Trends: EMR Adoption Profitability By Stage for 2008 and 2011, % 6.00% 6.19% 5.00% 4.00% 3.53% 4.06% 3.91% 4.91% 3.00% 2.00% 1.00% 0.00% -1.00% -2.00% 1.62% -1.52% 0 (2008 N = 392; 2011 N=225) 2.84% 2.25% -0.43% -0.34% -0.58% 1 (2008 N = 354; 2011 N=171) 2.35% 1.53% 0.77% 2 (2008 N = 850; 2011 N=400) 2.56% 2.32% 1.79% 1.47% 3 (2008 N = 1060; 2011 N=1303) 4 (2008 N = 88; 2011 N=369) In 2008 In % 1.66% 5 (2008 N = 55; 2011 N=202) 2.52% 2.20% 6 (2008 N = 48; 2011 N=144) 7 (2008 N = 0; 2011 N=13)

26 HOW ABOUT HOSPITAL EFFICIENCY BY EMRAM STAGE?

27 Oh, You Wanted to Know About the Ambulatory EMRAM?

28 Ambulatory EMR Adoption Model SM US HIE capable, sharing of data between the EMR and community based EHR, C&BI Advanced CDS, proactive care management, population health management Patient portal and patient engagement CPOE, physician documentation with CDS, external data exchange Nursing documentation with CDS, E-prescribing 1.23% 3.62% 6.73% 0.97% 8.72% CDR, access to results from outside facilities Access to clinical information, unstructured data, multiple data sources Paper chart based 24.55% 5.27% 48.91% N = 20,529

29 Noteworthy on A-EMRAM 16 organizations have earned Stage 7 Representing over 1,100 locations Some stellar examples of patient engagement (Stage 5) Reducing CHF readmission rates by 40% Improving asthma protocol adherence from 17% to 78% Competing cohorts on weight loss Two examples of multi vendor PHRs

30 30 Employee Satisfaction

31 Proof that good planning works

32 P4P Outcomes BP Interventions

33 PROBLEM: The total economic burden of diabetes in the United States is estimated at $245 billion, a 41% increase from Reliant s Diabetes HbA1c Screening Rate and Control Rate did not change significantly with EHR implementation 1. American Diabetes Association. Economic Costs of Diabetes in the U.S. in Diabetes Care. 2013;36(4):

34 Yes, Stage 7 sites are driving significant benefits. HIMSS Analytics requires candidates to present at least three case studies of quality and efficiency improvements both inpatient and outpatient services

35 Yes, Stage 7 sites are driving significant benefits. HIMSS Analytics requires candidates to present at least three case studies of quality and efficiency improvements both inpatient and outpatient services

36 Jeremy Bonfini Executive Vice President, HIMSS International

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