The EHR Crash Course WHAT MARKETERS REALLY NEED TO KNOW JOE MEADOWS

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1 The EHR Crash Course WHAT MARKETERS REALLY NEED TO KNOW JOE MEADOWS 1

2 Think Patients Engagement Strategy Program Design Project Management at Intersections of Healthcare & Technology Do well by doing good 2

3 Which is more common: Using a smart phone health app, or ing with your doctor? 17% 31% Office of the National Coordinator for Health Information Technology. 'Trends in Individuals Use of Health IT: ,' Health IT Quick-Stat #46. dashboard.healthit.gov/quickstats/pages/fig-individuals-health-it-use.php. June

4 Let s get the buzzwords out of the way " Four major components of Health IT erx (e-prescribing capability): Arguably the most basic electronic health function, e-prescribing allows a HCP to electronically generate a prescription and send it electronically to a pharmacy. It s also the way formulary information is most often communicated. EMR (electronic medical record): Think of this as a digital/ electronic version of a HCP s chart for a patient. Over 80% of all e-prescribing systems exist within an EMR. Digital information is much easier to use in terms of billing, categorizing, and searching so this is an improvement over paper. Terms often used interchangeably EHR (electronic health record): More than just a digital version of the chart, an EHR includes the functions of an EMR plus functions that allow information to be shared between HCP, health systems, and even with the patient. A fully functioning EHR allows ALL parties involved in a patient s care (including the patient and caregivers) to see the same information. PHR (personal health record): This is the patient s own record of their health, that they and their caregivers update. These can be either stand-alone OR connected to an EHR. Information can be similar to that found in the EHR, but may also include information about supplements, exercise, diet and other health-related information. 4

5 This is no longer news." But there s a lot we can learn from it Physicians and other providers achieving standards for health IT incentives Most recent national data through % of providers using an EHR by early 2014 (modest increases likely since then) Over 90% of hospitals using EHRs $30 billion generates buy-in Doctors and Hospitals Use of Health IT More Than Doubles Since Accessed July 1,

6 A state-by-state look at EHR adoption Office of the National Coordinator for Health Information Technology. 'Office-based Physician Health IT Adoption,' Health IT Dashboard. dashboards/physician-health-it-adoption.php. October

7 But WHY? What s the REAL problem that" government / payers / health systems" hope to address via EHRs? 916% 165% $15, x Increase in the US Consumer Price Index since 1980 Amount US healthcare costs have increased since 1980 Average annual cost of employer sponsored health insurance (family) Multiple US spends on perperson healthcare vs. avg OECD country Source (US Cost Data): U.S. Health Care Costs: Issue Modules, Background Brief. (n.d.). Retrieved May 21, 2013, from Source (CPI Data): US Inflation Calculator (online CPI Tol). (2008). Coinnews Media Group LLC. Retrieved from Source (Premium Data): Family Health Premiums Rise 4 Percent to Average of $15,745 in 2012, National Benchmark Employer Survey Finds. (n.d.). Retrieved May 21, 2013, from Source (OECD Data): OECD Health Data 2012: How Does The US Compare (Data Summary). (n.d.). Retrieved from 7

8 Meaningful Use: stage-by-stage goals Stage 1 Electronically capturing health information in a standardized format Using that information to track key clinical conditions Communicating that information for care coordination processes Initiating the reporting of clinical quality measures and public health information Using information to engage patients and their families in their care Stage 2 More rigorous health information exchange (HIE) Increased requirements for e-prescribing and incorporating lab results Electronic transmission of patient care summaries across multiple settings More patient-controlled data Stage 3 Improving quality, safety, and efficiency, leading to improved health outcomes Decision support for national high-priority conditions Patient access to selfmanagement tools Access to comprehensive patient data through patientcentered HIE Improving population health Source: Meaningful Use. Accessed June 26, P. 1. 8

9 Importance of Meaningful Use is moderating," as accountable care becomes more important Meaningful Use s6ll important, but less so Stage 1: Data Capture & Sharing Stage 2: Advanced Clinical Processes Stage 3: Improved Outcomes Value over Volume (Accountable Care) becoming more important 2013 View 2015 View Source: September Products Used for MU.xlsx. Office of the National Coordinator for Health Information Technology; Accessed at: on November 8,

10 EMR Market Share Ambulatory Market Epic Systems Corpora6on Allscripts Other, 27.4% 20.8% eclinicalworks LLC NextGen Healthcare GE Healthcare Greenway Health LLC 1.0% 1.2% 11.7% Cerner Corpora6on Prac6ce Fusion 1.2% 1.4% 2.5% 2.8% 4.2% 5.7% 6.7% 7.4% athenahealth Inc McKesson Eyefinity/OfficeMate 2.9% 3.2% Community Computer Service Inc e- MDs Source: September Products Used for MU.xlsx. Office of the National Coordinator for Health Information Technology; Accessed at: on November 8,

11 Market share for specialist EHRs " often more concentrated" (Dermatology shown here) 1.2% 1.3% 2.4% 2.8% 2.8% 3.2% 3.4% 5.2% 13.9% 7.1% 8.3% 19.4% 11.8% 17.1% Epic Systems Corpora6on Modernizing Medicine Inc NexTech Systems Inc Allscripts eclinicalworks LLC NextGen Healthcare Encite Inc GE Healthcare Cerner Corpora6on Prac6ce Fusion Greenway Health LLC SRSsoc McKesson Other (each < 1%) Source: September Products Used for MU.xlsx. Office of the National Coordinator for Health Information Technology; Accessed at: on November 8,

12 You don t need to be an expert." You do need to understand the rules. EHRs can be used for engagement, but they have a unique set of rules compared to what you re accustomed to seeing. 12

13 EHRs are used for 5 primary functions." Concentrate on Two Record Measure Calculate Enforce Communicate 13

14 How your drug gets included in an EHR." Or not. Manufacturer FDA Drug Compendia First Data Bank Medi- Span Multum Elsevier EMR cloud or or Health System Prac6ce HCP practice triggered 14

15 What to do BEFORE you launch The importance of Drug Compendia for EHRs Example based on multiple drugs in multiple therapeutic classes (all very bad days for the brand managers involved) Drugerooneo 5mg/1ml extended release suspension for subcutaneous injection, Single Dose Tray Drugerooneo 5mg/1ml extended release suspension for subcutaneous injection, Pen Injector What happens if the drop-down drug selection name box in the EHR is shorter than your drug name? How s that going to work out for launch of your new Drugerooneo pen? Much better: Drugerooneo 5mg/1ml Pen Injector, extended release suspension for subcutaneous injection Drug File Integration issues can be addressed BEFORE you launch It s much cheaper and easier than trying to fix the problem later 15

16 From formulary win to EHR. Or not. Manufacturer Payer / PBM Intermediary (e.g., Surescripts) EMR Supplier Physician EMR Intermediary Switch Pharmacy Patient 16

17 Common Areas of Pharma Involvement (See agency partners and the DCOE for in-depth discussions) Provider Messaging Banner Ads Contextual (in work flow) Alerts Reference (links) Tools Pa7ent Messaging Adherence / Awareness In- office print Portals Limited Text, In- home (e.g., mail) Lijle pharma integra6on Pa7ent Savings erx delivery relies on Notes sec6on Pa6ent may not know you saved $ Evidence of posi6ve prescriber influence Low redemp6on rates Distribu6on vs. Redemp6on Model 17

18 Aggregators are a lot like mutual funds A reasonable way to quickly invest in a diverse of offers Electronic Health Record Vendors Healthcare Prac6ces Aggregators Pa6ent Engagement & Technology Capabili6es Challenges Fragmented, Desire Capabili6es Busy Compe6ng Priori6es Time & Skill 18

19 Half of All Physicians Can" Securely Message Patients Office of the National Coordinator for Health Information Technology. 'Office-based Physician Health IT Adoption,' Health IT Dashboard. dashboards/physician-health-it-adoption.php. October

20 Patient Portals:" A growing opportunity for engagement Portals are often used to: Review information from recent visits with providers Review hospital discharge summaries Review medication lists Keep track of immunizations Record medication and other allergies Record lab results View educational materials Source: What is a patient portal? (n.d.). Retrieved May 21, 2013, from and help patients: Exchange secure with their providers Request prescription refills Schedule non-urgent appointments Check benefits and coverage Update contact information Make payments Download and complete forms 20

21 Population Health Management This Population Health Not to be confused with Public Health Caring for the Health Outcomes of Defined Groups of People 1 (i.e., Populations) What we as a society do collectively to assure the conditions in which people can be healthy 1. Examples Clean drinking water Proper Sanitation Don t Smoke Campaigns But remember, they re not your patients 21

22 Where You Will Likely Be Most Active (Today) Clinical Decision Support Provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care Computerized alerts/ reminders Clinical guidelines Condition-specific order sets Focused patient data reports and summaries Documentation templates Diagnostic support Contextually relevant reference information Clinical Decision Support, from HealthIT.gov. Accessed at on March 24,

23 Population Health/CDS & Pharma: This Is Not About Your Brand Our advice: Demonstrate partnership and leadership via these types of programs. Measure impact. Use other tactics and tools to differentiate your brand. 23

24 Data, Data Everywhere Most pharma facing EHR suppliers are making data sales an important part of their offerings Understand what you are buying, and consider: Data rights (what % of their universe is covered?) Whether you need to buy from multiple sources (is one primary care EHR s client base all that different from another?) How you plan to use the data, and whether a particular EHR is your best option based on your core customer audience Specialist mix Traditional data suppliers may be able to add in EHR data evaluate as part of your decision 21 24

25 Trends shaping the future of Health IT Replacement EHRs and Industry Consolida6on Improved Interoperability Data Security Increased Pa6ent Engagement Early adopters will switch to improve Market has 400+ suppliers Larger players likely to absorb smaller co. s Fragmenta6on of market has impeded info sharing MU requirements, other factors will drive this Pa6ents benefit Digital format makes data easier to share, but poten6ally easier to steal unless security is top of mind Providers s6ll struggling with how to protect and secure data Increased use of pa6ent portals expected to help drive this Meaningful Use Stage 2 criteria were relaxed in 2015, but proposed MU3 requirements much more stringent 25

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