Lessons Learned from Expanding the Boundaries of the EMR

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1 Lessons Learned from Expanding the Boundaries of the EMR Phyllis Teater and Thomas Bentley DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Disclosure Phyllis Teater, MBA Thomas Bentley, RN, MS Has no real or apparent conflicts of interest to report HIMSS

3 Learning Objectives Describe 3 important lessons learned when extending the EMR to smart phones for clinicians Describe 3 considerations for patients being able to access their PHR via a smart phone Describe 2 types of clinical information that patients can enter into a kiosk for incorporation into the EMR

4 A Single, Integrated Health Record

5 The Evolving Electronic Medical Record Electronic Health Record HIMSS Definition Model 1.0 Published June, 2003 Electronic medical records (EMRs)* are a digital version of the paper charts in the clinician s office. An EMR contains the medical and treatment history of the patients in one practice. EMRs have advantages over paper records. Electronic health records (EHRs)* do all those things and more. EHRs focus on the total health of the patient going beyond standard clinical data collected in the provider s office and inclusive of a broader view on a patient s care. EHRs are designed to reach out beyond the health organization that originally collects and compiles the information. * U.S. Department of Health & Human Services

6 OSUWMC EMR 10 Years Ago Information Warehouse Results Specialty Location/ Function Centric CPOE Lacked Continuity Ancillary Billing Scheduling Large Electronic Gaps

7 Pushing Our Boundaries and Definition EMRAM Benchmark Episode and Longitudinal Continuity 100% Electronic Scope of an EMR was Broadening Source for EMR Adoption Model

8 Technology Outpacing the EMR Mobile Devices Access Methods Efficiency Focus Patient Empowerment Personal Health Record Workflow Considerations Home Monitoring Increasing Expectations Internet Adoption* 36% % 2011 Kiosks for Clinical Info * Pew Internet & American Life Project Surveys, March 2000 August 2011.

9 Paradigm Shift IT Pushing Technology Users Demanding Technology

10 The Empowered Consumer 5-7 Years Ago Patients began to access information on the internet Patients would bring printouts from reference materials Clinicians concerned about a lot of misinformation

11 Smart Phones / Tablets Early attempts run the full application on a mobile device. Few found this useful. Security and Standardization Concerns Focused Applications engineered specifically to leverage the strengths of the device Devices being tested iphone ipad Android Windows 8 / Surface RT Can these devices replace PCs/WOWs?

12 Current Future Phone Based Tools Similar to Phone for more robust Document notes with real time speech to text Patient photo update Review and act of staff/result messages Read and respond to patient message Photographing patients, wounds, etc. with integrated camera Medication bar coding, simple documentation eprescribing Ordering Documenting telephone encounters integrated with phone capabilities Patient calendar/appointment integration Video visits Usage: For providers this is supported on their personal devices, they are not supplied by OSUWMC. Primarily used in a limited fashion when away from the clinical setting. This may change in the future.

13 Tablet Based Tools (ipad & Android) Current Future View chart (medications, allergies, problems, notes and results) View schedule Document notes / partial dictation Review and act of staff/result messages Read and respond to patient message Photographing patients, wounds, etc. with integrated camera Medication bar coding, simple documentation eprescribing Ordering Documenting telephone encounters integrated with phone capabilities Simple telemedicine

14 Smartphone / Tablet - Device Differences

15 Bring Your Own Device Policy

16 Smartphones & Tablets for Clinicians Lessons Learned Can t standardize on a single device / platform Will not replace a full PC (yet) Lines between personal and work become blurred Focus on specific workflows to improve Starting to offer new capabilities Big impact to clinician satisfaction Application must be designed to leverage the platform PC, Smartphone, and Tablet each play a role Windows 8?

17 Patient Portals and Personal Health Records Gender 25% 20% 15% Portal User EMR Age 37% 63% Female Male 10% 5% 0%

18 Secure Patient / Physician Communications Messages Initiated by Patients Messages Initiated by Physicians Mar 08 Sep 08 Mar 09 Sep 09 Mar 10 Sep 10 Mar 11 Sep 11 Mar 12 Sep 12 Mar 08 Jun 08 Sep 08 Dec 08 Mar 09 Jun 09 Sep 09 Dec 09 Mar 10 Jun 10 Sep 10 Dec 10 Mar 11 Jun 11 Sep 11 Dec 11 Mar 12 Jun 12 Sep 12 Dec 12

19 PHR Satisfaction on Clinic/Office Patients RECOMMEND THIS PROVIDERS OFFICE Visits to offices with 30 or more Respondents in Mychart* Visits to offices with less than 30 Respondents in MyChart^ Active MyChart Users (969 surveys) Non Active and Non MyChart User (3969 surveys) MyChart Difference 89.9% 89.0% 0.9% % Definitely Recommend Office Patients Have Active MyChart Account No Yes* 88.8% (n=1320) 92.1% (593) 89.2% (2649) 86.3% (376) *Difference Significant at 95% level, ^ Difference Significant at 90% level 19

20 Patient Portals on Smart Phones 6% 3% 91% High Patient Expectations PC Only iphone & PC Android & PC Available for 20 months Available for 14 months

21 Current Future Lessons Learned Patient Portals Reviewing Results / Record Requesting Appointments Medical Advice Proxy Access Direct Scheduling View/pay co pay and bill evisits Diagnosis based resources and tools Completing information before visits Inpatient capabilities A patient tool, not a physician tool. Culture change! Physician adoption is a critical cultural shift. Myths and concerns must be addressed Key to Meaningful Use. 93% of OSUWMC providers about the 10% stage 1 requirement. Broader functionality will increase user participation and satisfaction. Becoming a patient expectation

22 Smartphones for Patients Support mobility, not the full PHR Designed for the platform, not just a web app Leverage other phone capabilities

23 Office Visit Patient is identified and enrolled Patient receives a MetrikLink Home Monitoring Workflow At Home Patient uploads data through MetrikLink Standard Phone Line At Home and in the Office Patient and Physician view uploaded data results MyChart EpicCare Patient Doctor

24 PLA Workflow - Ordering

25 How Results Are Reviewed

26 How Patients Review Their Results

27 Home Monitoring Summary Current Future Lessons Learned Blood Pressure, limited primary care offices Dependent on analogue phone lines Multiple device types Strategy to reduce readmission Connection methods and dependencies are limiting Support for patients is challenging Fixing incorrect results is challenging Clinic workflow and feedback to patients is challenging Very difficult to do well

28 Kiosks to Collect Clinical History Registration and Check In Clinical History Targeted Surveys Functions External to the EMR

29 Collecting Clinical History Medical History Surgical History Social History Family History Patient Enters Clinical Information Stored in Patient History Clinician can File to History to EMR

30 Questionnaires Purpose Replace paper questionnaires typically completed before the visit. Cumbersome to find, not available for analysis Only a portion of patients are portal users Scanning Patient Portal EMR Kiosk Tablet / PC Patient Portal Patient Data Collection

31 Medical and Surgical History

32 Medical and Surgical History

33 Family History

34 Social History

35 Patient Feedback

36 Integrating with Biomedical Devices How far we have come! Remember paper charting? Illegible No ability to search, query or aggregate data Trending on chart not feasible Unavailable without chart Missed data Lost records

37 Current Interface Devices Patient Monitors Fetal Monitors Hemodynamics Ventilators ECG V02/Stress ECG Glucose Monitors Coming in 2013 Anesthesia ABG Coming in 2013 Spirometry PFT Future Dialysis IV Pump TBD depending on industry availability

38 Lessons Learned Difficult to test integration Test environment Availability of clinicians Determine satisfactory scenarios to test extreme values Ability to correct data errors

39 Thank You! Phyllis Teater Thomas Bentley

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