Mark Anderson, FHIMSS, CPHIMSS Healthcare IT Futurist. Presented By Our Featured Speaker Mark R. Anderson, FHIMSS, CPHIMS CEO, AC Group

Transcription

1 DRT enabled EHRs Presented By Our Featured Speaker Mark R. Anderson, FHIMSS, CPHIMS CEO, AC Group Mark Anderson, FHIMSS, CPHIMSS Healthcare IT Futurist CEO of AC Group Conducted > 300 Technology Software Searches for Hospital and Physician Organizations National Speaker on EHR > 450 sessions since 2000 Semi annual report on Vendor product functionality and company viability 36+ Years In Healthcare IT CIO Position at Three Multi Facility Regional IDN s Installed over $1B in technologies since 1972 Former CIO of a 2,300+ physician (500+ Practices) IPA Page No: 3

2 The Genesis

3 The Focus is People HITECH Requirements In order to qualify for the incentive payments, both physicians and hospitals have to prove three things: 1. Use of a certified EHR product with eprescribing capability that meets current HHS standards. 2. Connectivity to other providers to improve access to the full view of a patient s health history. 3. Ability to report on their use of the technology to HHS. The second area is meaningful use

4 Value of EHRs EHRs save you time EHRs have proven to save nursing and clerical time but it takes much longer to enter the information On average 9 times longer to enter the data The information is readable True, but the clinical note as expanded from 1 page to 5 pages The critical information is lost in the extensive detail You have more discrete data yes, over 700 data elements but you only use about 3% of these data elements Value of EHRs E & M coding improves In theory, but many EHR vendors have no 3 rd party validation studies. For many specialists, less than 20% of their actual revenues comes from the Basic E & M codes EHRs provide orders and alerts You can get the same results with a DRT enabled EHR. EHRs reduce errors and improve Quality of Care We assume this is true, but with a 4% adoption rate, the actual results are still pending. Why are Practices not using what they Purchased? 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% EMR Purchased EMR Fully Used EMR Light Source: AC Group Annual Survey of buying patterns New England Journal of Medicine

5 Why have EHRs Failed? Cost average over $60,000 per provider over 5 years. Data entry time increases 9 fold with an EHR. Data is not shared between providers, treating the same patient. Training is technical, not operational Simple 1 page note now become 5 pages More failures (73%) than successes (27%) Changes the way the physician practices medicine. So what the answer? DRT Enabled EHRs What is DRT? DRT is Discrete Reportable Transcription Allows the provider to use the EHR for viewing of patient clinical information. After the physical exam, the provider dictates their note like they have the past 20+ years. The dictated report is sent to a transcription service for transcription or via Dragon The Software takes the dictation, creates a clearly defined patient note and then automatically populates the EHR with practice specific discrete recordable and reportable data directly into the practice s EHR.

6 Data Entry Time Number of seconds for data entry of discrete clinical data Source: 573 Patient charts Data Entry Time The average physician spends 33 seconds dictating an establish office visit 92% of all office visits are established If the average physician sees 40 patients a day, total dictation time of 30 minutes plus time to search for the data. Using a traditional EHR application, the same number of patients would require 140 minutes of data entry time. Physicians are not willing to spend an additional 90 minutes per day for data entry. (40 X 92% x 33 seconds) + (40 x 8% x 125) = < 30 minutes per day Estimated Reduction in Transcription Costs Actual Reduction in Transcription Costs by Quarter if you use one of the top EHR products

7 Estimated Reduction in Transcription Costs EHR Vendor Marketing Actual Reduction in Transcription Costs by Quarter if you use one of the top EHR products So How does an DRT enabled EHR Help a Physician? DRT Enabled EHR Allows the physician to continue their current process for charting Allows the practice to collect family history, social history, medical history, Current Meds Allergies Vital Signs

8 DRT Enabled EHR Allows the physician to interact with the patient regarding: ROS HPI Assessment Orders Some physicians have allowed their staff to enter ROS and HPI following approved clinical protocols DRT Enabled EHR Physician conducts their physical exam Physician dictates their PE and their assessment and then places orders. The dictated wave file is sent to transcription for typing. The typed paragraph is sent to the physician for review. Once approved, the transcription section is auto placed in the specific section of the EHR. Additionally, the transcription section runs through natural language processing technology enabling discrete and reportable data to be capture and auto populated into the EHR. DRT Enabled EHR Disadvantages: Does not eliminate all transcription right away But what EHR vendor is eliminating Transcription No E & M Coding But a 20% reduction in productivity offsets any E & M coding enhancement You only capture 70% of the discrete data But the average practice only uses 3 6% of the EHR discrete data today.

9 Natural Language Processing Search tools to optimize both sensitivity and specificity Tools Example Inclusion Rules Exclusion Rules Limit by Feature Numerics Chronology Inclusion: MI, heart attack, infarct Patient suffered an M I Inclusion: ICD, implantable cardioverter defribrillator Exclusion: ICD-9 ICD-9 code for CHF is Inclusion: MI, heart attack, infarct Limit Family History Patient has family history of M I Inclusion: EF, ejection fraction Patient has an EF of 32% A1C: 7.8 on 5/15/2006 LDL: 100 on 4/13/2004 Analyzing the Data Clinical elements are extracted to support both process and outcomes measures. NAME: XXXXXX DOB: XXXXXX MR#: XXXXXX Search Technology - Finds clinical elements within the document DATE: XXXXXX - Populates the structured database CHIEF COMPLAINT: TYPE 2 DIABETES, HYPERTENSION, AND HYPERLIPIDEMIA. - Ability to create/modify searches SUBJECTIVE: THE PATIENT'S BLOOD SUGARS ARE WELL CONTROLLED. WE DISCUSSED HIS GOAL OF MAINTAINING HIS A1C TO REDUCE RISK OF DIABETIC COMPLICATIONS. DIABETES TREATMENT REGIMEN: DIET AND EXERCISE FREQUENCY OF HOME GLUCOSE MONITORING: TWICE-WEEKLY BLOOD GLUCOSE RANGE: DIABETIC FOOT EXAM: NO ABNORMALITIES NOTED. ANNUAL OPHTHALMOLOGIC EXAM: RETINAL EYE EXAM PERFORMED ON 1/1/06, WITH NORMAL EXAM. OBJECTIVE: VITALS: WEIGHT 198 POUNDS, BLOOD PRESSURE 140/78, PULSE 68 THE PATIENT'S BLOOD PRESSURE IS UNCONTROLLED. WE DISCUSSED THE IMPORTANCE OF MAINTAINING Key BP BP Date HIS A1C BLOOD Value PRESSURE TO A1C REDUCE Date HIS RISK OF HEART ATTACK, STROKE, AND KIDNEY DYSFUNCTION. WE DISCUSSED THERAPEUTIC OPTIONS AVAILABLE FOR IMPROVING HIS BLOOD PRESSURE CONTROL /78 12/1/06 WE WILL 6.0 PLAN ON ADDING 10/31/06 HCTZ 25 MG TO THE LISINOPRIL 40 MG DAILY THAT HE CURRENTLY TAKES FOR HYPERTENSION. THE PATIENT'S CHOLESTEROL IS WELL CONTROLLED ON LOVASTATIN 40 MG DAILY. LABORATORY: WE REVIEWED LABS FROM OCTOBER 31, HEMAGLOBIN A1C = 6.0 ON 10/31/06. LDL = 95 ON 2/28/06. MICROALBUMIN = 30 ON 6/20/06. ASSESSMENT: TYPE 2 DIABETES, CONTROLLED. HYPERTENSION, UNCONTROLLED. HYPERLIPIDEMIA, CONTROLLED. PLAN: PATIENT IS TO CONTINUE CHECKING HIS BLOOD SUGARS TWICE WEEKLY. WE WILL SWITCH THE PATIENT'S LISINOPRIL 40 MG DAILY TO LISINOPRIL/HCTZ 20/12.5 MG TWO TABLETS DAILY FOR BLOOD PRESSURE. ELECTRONICALLY VERIFIED AND SIGNED BY JACK SMITH MD Proven Results 62% Reduction in Transcription costs day 1 No change in interaction with patient Ability to capture discrete data via transcription Populate EHR via dictation instead of physician data entry. 70% of discrete data with 18% of the effort Transcription costs decreases on follow up visits by 82%. Note looks and sounds professional versus the 5 page computer generated note that does not sound like a professional ever read it.

10 DRT Disadvantages Does not eliminate all transcription right away But what EHR vendor is eliminating Transcription No E & M Coding But a 20% reduction in productivity offsets any E & M coding enhancement You only capture 30% of the discrete data But the average practice only uses 3 6% of the EHR discrete data today. So which EHR product are DRT enabled today? The Challenge Which Vendors Offer DRT All vendors can offer a DRT enabled EHR Vendors need to realize that the EHR is NOT the solution. Vendors need to realize that the EHR is just a tool to help generate a clear and concise note that can be shared between common providers of care. A combination of Transcription and EHR is the best model for true universal adoption. The EHR vendor that can best enable Transcription in their EHR will WIN!!!

11 Take Home Message EHRs Can Improve Patient Service and Provide Financial Benefits. HITECH will require Meaningful Use DRT Enabled EHRs is the easiest way to meet meaningful use. EHR Implementation is a Bet the Practice Proposition That Requires Adequate Resources and Investments to Achieve Success. The DRT Enabled EHRs provide the best Value today For More Information Mark R. Anderson, FHIMSS, CPHIMS CEO and Healthcare Futurist AC Group, Inc. 118 Lyndsey Drive Montgomery, TX (281) acgroup.org Thank you for joining us. To learn more about HITECH Answers or to signup for our Newsletter to receive information on future webinars, please visit: