Discovering the New Frontier of Syndromic Surveillance: A Meaningful Use Dialogue on Ambulatory EHR Technology. Corey Spears McKesson Corpora/on
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1 Discovering the New Frontier of Syndromic Surveillance: A Meaningful Use Dialogue on Ambulatory EHR Technology Corey Spears McKesson Corpora/on
2 Definitional Outpa/ent Pa/ent visit from start to end is within the same day Includes many rou/ne visits (unlike Emergency care) Follow- up visits for same issue ~510,000 Providers, from different sized organiza/ons 21% 1-2 providers 50% 3-10 providers 18% providers 9% providers 2% 100+ providers 50/50 Freestanding/Hospital Owned The smaller the provider organiza/on, the less likely they are customer owned Summariza/on based on informa/on from: CapSite 3 rd Annual U.S. Ambulatory EHR & PM Study June 2011
3 Endocrinology Cardiology Internal Medicine Primary Care OB/GYN Dermatology Gastroenterology Diverse group of prac//oners Healthcare Enterprise Healthcare Enterprise Healthcare Enterprise Even more diverse group of Healthcare enterprises Healthcare Enterprise
4 Ambulatory Care Pressures PO Financial Health/ Economics - Marginal financial health/ profitability - Flat reimbursement/ concern over cuts - Prac/ce expenses rising: ~63% of income - PCP salary flat: Up 2%/ yr. in past decade Office- Based Physician Resources - Many physicians work extended hours - Some prac/ces at/ over capacity - An average of hrs spent on non- clinical ac/vi/es Legisla/ve/ Regulatory Reform - HC reform - Affordable Care Act ( ACA ) - 3 linked primary reforms: - Integrated pa+ent care across providers - Value based (bundled) reimbursement payments - Enabled by EHR IT Increasing Insured Popula/on - ACA conver/ng 32M uninsured by Addi/onal insured will enter through Medicaid & health insurance exchanges Source: Nova Group exploratory customer interviews Jan/Feb 2011; Nova Group research
5 Today s Top 10 (Challenges) 1. Preparing to take on more risk 2. Par/cipa/ng in HITECH Incen/ves 3. Dealing with rising opera/ng costs 4. Implemen/ng in an EHR 5. Implemen/ng an ACO 6. Uncertainty of Medicare reimbursement 7. Managing compensa/on based on quality 8. Recrui/ng physicians 9. Nego/a/ng contracts with payers 10. Maintaining physician compensa/on levels Source: MGMA Challenge Rankings, June hkp://
6 2011 Office-based Physician Adoption Rates
7 EHR Incentive Program Active Registrations Source: CMS EHR Incen+ve Program Report, Jan hkps://
8 Ambulatory Care Environment Other Clinical Data Devices, Analy/cs, etc. Ambulatory Healthcare Enterprise EHR Clinical Data Dem/Sch ICD- 9/CPT PMS Financial Data Radiology Laboratory Pharmacy
9 Ambulatory Care Environment Other Clinical Data Devices, Analy/cs, etc. Ambulatory Healthcare Enterprise EHR Clinical Data Dem/Sch ICD- 9/CPT PMS Financial Data Immuniza/on Registry Quality Repor/ng Other repor/ng
10 (extremely) Simple Ambulatory Workflow Front Office Pa/ent Presents Register Pa/ent Update Insurance Schedule Follow- up MA/Nurse Review Medica/ons Capture Vitals Educa/on & Follow- up Physician Assess Pa/ent Perform Tests/ Procedures Order Test/ Medica/on
11 Similarities/Differences to Inpatient EHR Installa/on Variability Single system of mul/ple systems Genera/ng single outbound message with data collected from mul/ple systems (par/cularly discrete data) is a challenge Localized codes or nomenclatures Even with off the shelf configura/ons, there is a challenge due to differences in local repor/ng requirements Organiza/onal and Technological sophis/ca/on Smaller organiza/ons tend have fewer resources and internal technological know- how Smaller ambulatory organiza/ons may have less experience repor/ng to Public Health agencies (electronically) Many more organiza/ons
12 Presenters Michelle Siefert, MT(ASCP) Cerner - Sr. Strategist, Data and Analy/cs Michelle.Siefert@cerner.com Corey Spears McKesson - Enterprise Systems Architect Corey.Spears@McKesson.com
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