How to Protect Revenue & Physician Productivity

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Marybeth Hardy
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1 How to Protect Revenue & Physician Productivity Before, During & After EHR Adoption Presented By Kirk L. Miller, FACHE, VP of Physician Services, Mark Suzuki, MD & Howard Brumberg, MD G. William Brown, CEO

2 Excela Health 3 rd largest healthcare system in Pittsburgh Metropolitan area Employs over 150 physicians in multiple clinical specialties Began adopting the Allscripts Enterprise EHR in 2009 Adopted Entrada s clinical documentation technology in 2011

clinical specialties Began adopting the Allscripts Enterprise

3 Entrada Protects physician productivity and revenue before, during, and after EHR adoption Enables physicians to continue dictating the relevant portions of the clinical encounter Available on all Apple ios and Windows Mobile devices and any desktop computer Integrates the return of narrative text into a patient encounter within an EHR

clinical encounter Available on all Apple ios and Windows Mobile devices and any

4 Hospital Employment Trends

5 Physician Staffing at Hospitals Physicians hope to... Protect income from rising costs and stagnant reimbursement rates Achieve a more favorable work-life balance Hospitals hope to... Shore up their referral base Capture admissions Improve quality and efficiency through better clinical integration across care settings -Center for Studying Health System Change

favorable work-life balance Hospitals hope to.

6 Hospital Hiring Trends Hospitals are aggressively hiring a more balanced mix between primary care physicians and specialists.

7 EHR Adoption State of the Union

8 1 in 4 office-based physicians have adopted a basic EHR, while 15% of acute care hospitals have adopted an EHR. EHR Growth -National Center for Health Statistics

9 41% of office-based physicians currently plan to apply for EHR incentive payments. Of those physicians, 79% plan to apply between 2011 and National Center for Health Statistics EHR Growth

10 EHR Growth Primary Care showed the largest growth in EHR adoption through 2010, with nearly 30% of practices adopting an EHR. -National Center for Health Statistics

11 The Great EHR Divide Primary Care Physicians... Largest segment of the physician population Benefit from EHRs being built with their workflow in mind EHRs are template-driven, primarily suited for capturing structured data Specialists... Need to capture the patient story with narrative text Slowed down by the requirement for them to selfedit within the EHR Often have difficulty fitting their traditional workflow into a templated system

are template-driven, primarily suited for capturing structured data Specialists.

12 EHR Adoption Correlates with Practice Size The likelihood of EHR adoption increases in correlation with rises in the number of doctors practicing, number of exam rooms, and average daily patient volume at each site. -SK&A

with rises in the number of doctors practicing, number

13 Complications Inherent with Hospital Employed Groups Mixture of primary care physicians and specialists with different workflow patterns Heavy concentration of doctors practicing at multiple locations Need for a common communication platform Must be able to share information quickly between locations and departments within the physician enterprise

practicing at multiple locations Need for a common communication platform Must be able

14 The Physician Enterprise

15 True Cost of EHR Adoption

16 EHR Growth 78 % of physicians who have yet to adopt an EHR are afraid productivity will be significantly reduced during implementation. -Medical Group Management Association

17 EHR Growth 1 in 3 physicians says their primary concern with adopting an EHR is the inevitable loss in revenue. -CDW Healthcare

18 EHR Growth $120K of potential loss in patient revenue due to workflow disruption. -CDW Healthcare

19 Physician Concerns with EHR Adoption Hardware/Software Costs Time for Staff Training Workflow Readjustment HIPAA Compliance Downtime/Loss of Revenue Internal Management of IT Reliance on Vendors in an Emergency Loss of Patient Care Quality The #1 cost of EHR adoption is lost revenue due to a drop in productivity. Deployment Logistics No Concern CDW Survey

Vendors in an Emergency Loss of Patient Care Quality The #1 cost of EHR adoption is lost revenue

20 [ ] physicians are worried about the costs of hardware and software components when they should focus on implementing a complete solution that reduces the time lost to workflow changes. - Bob Rossi, Vice President of CDW Healthcare

implementing a complete solution that reduces the time

21 Excela s EHR Experience Painful adoption process Disconnect between expectations and reality Delusion of a quick adoption curve and minimal workflow disruptions Unique adoption challenges due to their size, diversity, and current growth rate

24 6min 500,000 50,000 hours More time per physician to complete a patient encounter Average number of patient encounters in a given year In potential lost physician productivity after EHR adoption and a serious impact on revenue $1,250,000 Potential outpatient revenue lost annually

25 Tactics for EHR Adoption

26 Two Common Approaches Physician Centric Physician types or uses front-end voice recognition to capture narrative Physician then self-edits This workflow slows down the physician and often leads to a lack of adoption of the new system

27 Physician-Centric Model Challenges with Front-End Voice Rec and Typing Must be located at a desktop or workstation Doesn t transfer well between facilities Slows down the physician Makes your most valuable employee a clerk

28 Two Common Approaches Physician Centric Physician types or uses front-end voice recognition to capture narrative Physician then self-edits (ie. Dragon on the Desktop) This workflow slows down the physician and often leads to a lack of adoption of the new system Staff Centric Physician continues to dictate outside of the EHR Nurses or staff enter the data into the EHR by copying and pasting the completed text Human element increases the chances for error and often adds new costs as more staff must be hired

29 Rise of the Scribe

30 The Hybrid Approach Nurse or other staff collects and enters structured data manually before the patient sees the physician Physician dictates the narrative portion of the note, which is converted to text via back-end voice rec and inserted directly into the patient encounter within the EHR

31 Excela s Hybrid Approach Workflow for Specialists Before Adopting Allscripts Physicians see patients and dictate clinical narrative from a work list, which is automatically imported from their scheduling system Entrada processes the work through its data center and completes the clinical note Finished and formatted note is returned as a Word document that the staff prints, the physician signs, and the note gets filed in the patient s chart Entrada stores a digital copy in the practice repository and keeps a secure back-up copy on its portal After Allscripts Integration, workflow remains exactly the same, except the review and signature occurs within Allscripts

32 Excela s Hybrid Approach Workflow for Primary Care Physicians After the note is converted to text and delivered to Excela, remote scribes copy and paste sections of the note into their corresponding fields within Allscripts Pending contractual approval from Allscripts, Entrada can insert the clinical narrative directly into multiple text fields of a patient encounter (functionality exists with several other EHR partners) At this point, Excela will be able to streamline its workflow and cut labor costs further by removing the need for remote scribes The goal is to eliminate between two and three minutes (33-50%) of the extra time physicians are spending per encounter

33 Words of Wisdom

34 Words of Wisdom When forecasting the return on investment of adopting an EHR, don t expect the world. Make sure you implement flexible solutions aimed at protecting revenue and physician satisfaction. -Kirk L. Miller, FACHE, VP of Physician Services Why We Supplemented our EHR with Entrada Knew what we wanted to achieve Flexible, mobile solution Vendor agnostic Tight integration Light technology footprint, when possible

35 Thank You! Any Questions?

Achieve Meaningful Use of Entrada Mobile

Achieve Meaningful Use of Entrada Mobile Protect Productivity While Embracing an Expressway to Meaningful Use Technology solutions for achieving Meaningful Use criteria while improving patient care and protecting physician productivity Abstract