THE EMR ADOPTION MODEL: RELATIONSHIPS BETWEEN IT ADOPTION, PATIENT SAFETY AND PERFORMANCE

Transcription

1 Subtitle THE EMR ADOPTION MODEL: RELATIONSHIPS BETWEEN IT ADOPTION, PATIENT SAFETY AND PERFORMANCE PRESENTED BY: UWE BUDDRUS, MANAGING DIRECTOR HIMSS ANALYTICS EUROPE HIMSS HIMSS PARALLEL Analytics SESSION Europe 1 AT EMR THE Adoption 38TH WORLD and Patient HOSPITAL Safety CONGRESS, and Performance 19 JULY, - 1 OSLO2013

2 Subtitle INTRODUCTION TO HAE HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 2

3 HIMSS ANALYTICS EUROPE Subtitle for benchmarking and best practice in the adoption of Healthcare IT in Europe! Data Adopted ehospital Census Data from >1,900 acute hospitals across 18 European countries Information Statistical analyses and reports Benchmarking tools: EMRAM >1,600 hospitals evaluated on EMRAM Intelligence Conclusions Decisions Strategies Cooperation with Healthcare Providers, National and Regional Health Authorities, Associations, HIT Vendors and System Integrators, Consultancies Successful HIT Adoption HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 3

4 Subtitle THE EMR ADOPTION MODEL THE STATUS IN EUROPE VS. U.S. HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 4

5 THE EUROPEAN EMR ADOPTION MODEL Subtitle in 7 Stages to Highest Quality in Patient Care Paperless patient record environment for highest quality of care, data continuity & full HIE Full electronic clinical decision support, and highest medication safety Completely electronic diagnostic image management Electronic order entry with decision support and result reporting Clinical ordering and documentation especially nursing care A patient-centered electronic data repository Electronic diagnostic and pharmacy department information HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 5

6 EMR ADOPTION IN EUROPE AND THE US Subtitle... based on HIMSS Analytics EMR Adoption Model EMRAM Scores, % of Hospitals, Q1/2013 (EU data based latest 24 months, US on latest 12 months, no weighting etc. applied) Stage DE IT NL ES FR* UK* EU US! Stage 7 0.3% 0.0% 0.0% 0.5% 0.0% 0.0% 0.1% 1.9% Stage 6 0.0% 0.6% 3.8% 4.3% 6.3% 0.0% 1.4% 9.1% Stage 5 8.3% 6.6% 34.6% 40.9% 31.3% 16.0% 14.9% 16.3% Stage 4 1.9% 1.8% 3.8% 6.7% 15.6% 0.0% 2.8% 14.4% Stage 3 8.3% 3.4% 1.9% 1.9% 0.0% 0.0% 4.0% 36.3% Stage % 26.7% 55.8% 18.8% 25.0% 36.0% 27.2% 10.1% Stage 1 0.6% 41.4% 0.0% 9.6% 0.0% 24.0% 18.8% 4.2% Stage % 19.5% 0.0% 17.3% 21.9% 24.0% 30.7% 7.8% N ,354 5,441 * Data basis low. Only shown for indicative purposes.! Note: the EMRAM algorithm differs across different regions to reflect HIT implementation of that particular region Europe = Western Europe and Poland Source: HIMSS Analytics Europe Database HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 6

7 Subtitle MASTERING THE KEY CHALLENGES FOR IMPROVED PATIENT SAFETY HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 7

8 CLOSED LOOP MEDICATION ADMINISTRATION Subtitle key components and challenges CPOE and/or e-prescribing Medication orders pass CDS and flow to Pharmacy and/or Ward emar Update and availability for review, override management and future CDSS interactions POC Administration Secure identification of nurse, patient and medication at POC by bar code scanning or RFID POC registration in emar dual signature for critical meds Pharmacy / Nurse Validation of order and dispensing of Unit Doses (e.g. by ADM) with bar code or complete prescription information NB: compounded vs. packaged med. ADM optional HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 8 8

9 CLINICAL DECISION SUPPORT Subtitle 3 levels from error checking to pathway optimisation Level Requirements Level 1: conflict checking during order entry System: low electronic order entry User: low Level 2: rules engine firing during order entry System: medium - CPOE with rules engine User: medium user friendliness; alert fatigue Level 3: rules engine triggered by physician / clinical documentation proposes pathways System: high CPOE, structured documentation, controlled medical vocabulary (CMV) tools, Evidence-based medicine / knowledge management, medical device integration, rules and workflow engines support predictive alerts, order sets and clinical pathways User: high trust, involvement, process design HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 9

10 Subtitle EMR ADOPTION AND ECONOMIC PERFORMANCE HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 10

11 IS EXPENSE BY EMRAM STAGE Subtitle EMR Adoption has a cost 4,00% Average IS Operating Expense 3,50% 3,00% 2,50% 2,00% 1,50% 1,00% 0,50% 1,69% 2,34% 2,42% 2,61% 3,24% 2,72% 3,40% 3,33% 0,00% 2011 HIMSS Analytics Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 based on yearly averages from 2007 through 2011 from HIMSS Analytics TM Database (U.S.A.) HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 11

12 OPERATING MARGIN BY EMRAM STAGE Subtitle EMR Adoption also has a ROI! 6,00% Average Operating Margin 5,00% 4,00% 3,00% 2,00% 1,00% 0,00% -1,00% 1,62% -1,52% 2,84% -0,58% 2,25% 2,35% 0,77% 1,79% 3,53% 1,47% 4,06% 3,91% 2,55% 2,20% 4,91% -2,00% (2008 N = 392; (2008 N = 354; (2008 N = 850; 2011 N=225) 2011 N=171) 2011 N=400) 2011 HIMSS Analytics 3 (2008 N = 1060; 2011 N=1303) 4 (2008 N = 88; 2011 N=369) 5 (2008 N = 55; 2011 N=202) EMRAM Stage In 2008 In (2008 N = 48; 2011 N=144) 7 (2008 N = 0; 2011 N=13) based on data from HIMSS Analytics TM Database (U.S.A.) HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 12

13 ECONOMIC IMPACT OF EMR ADOPTION Subtitle What are the main ROI points? Avoid duplicate medical orders Reduce length of stay Reduce medical errors leading to complications, repeat admissions, etc. Reduce Adverse Drug Events (ADEs) Workflow / process improvements, e.g.: o Coding & Billing o Transcription o Scanning o Storage Stage 6 is where ROI pay off really begins! Source: HIMSS Analytics White Paper, 2008 ( ) HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 13

14 Subtitle EMR ADOPTION AND PHYSICIAN SATISFACTION, CLINICAL PERFORMANCE AND PATIENT EXPERIENCE HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 14

15 PHYSICIAN SATISFACTION Subtitle measured by 26 Standard Questions Quality of patient care Ease of Practice Communication & Collaboration with Leaders Rating Scale 0 = Very Poor 100 = Very Good Data Collection January 1 December 31, U.S. hospitals and 24,879 physicians HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 15

16 PHYSICIAN SATISFACTION RATINGS Subtitle the EMR poses serious challenges Likelihood to Maintain Admissions Staff Concerned re: Patients Quality of Care Recommend Facility to Physicians Recommend Facility to Friends/Family Turnaround Time for Radiology Results Quality of Nursing Scheduling IP Tests & Therapies Turnaround Time for Lab Results Physician/Nurse Collaboration Satisfaction with Facility Staff Reports Patients Condition Caregivers Know Patients' Condition Patient Care Made Easier Timeliness on Written Orders Ease of Scheduling OP Surgery Access to Information on Patients Scheduling OP Tests & Therapies Overall Rating of ED Accessibility/Visbility of Admin. Communication with Admin. Overall Rating of IT Treated as Valued Member Responsiveness of Hospital Admin. Admin Seeks Beneficial Solutions Ease of Using EMR Physicians Involved In Decisions 65,1 64,1 62,4 62,3 70,4 69,3 69,0 67,8 HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance ,1 83,3 81,8 81,6 81,1 80,5 79,8 78,9 78,7 78,6 78,1 77,3 76,4 75,7 75,7 75,6 75,5 75,2 74,3 55,0 60,0 65,0 70,0 75,0 80,0 85,0 90,0 Mean Score FAIR GOOD

17 PHYSICIAN SATISFACTION WITH HOSPITAL MANAGEMENT RELATIONS BY EMRAM STAGE Subtitle advanced EMR capabilities challenge the physician - m ment relationship Communication and Collaboration with Admin. Mean Score 90,0 85,0 80,0 75,0 70,0 65,0 60,0 55,0 73,5 76,3 74,3 Nursing Documentation Introduced 66,6 67,2 69,2 63,7 50,0 Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 17

18 PHYSICIAN SATISFACTION WITH ACCESS TO INFORMATION ON PATIENTS BY EMRAM STAGE Subtitle immediate increase at Stage 4 90,0 85,0 CPOE Introduced Access to Information on Patients 80,0 75,0 70,0 65,0 60,0 55,0 73,9 72,3 74,2 73,3 77,8 78,3 77,1 50,0 Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 18

19 CLINICAL PERFORMANCE AND PATIENT EXPERIENCE Subtitle measured by the U.S. Value-Based Purchasing (VBP) Program Clinical Performance Score Patient Experience Performance Score + = Total Performance Score 70% 30% TPS 100 = High Value Performance TPS 0 = Low Value Performance HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 19

20 CLINICAL AND PATIENT EXPERIENCE PERFORMANCE SCORES BY EMRAM STAGE Subtitle Providers with the most advanced EMR capabilities harness high-tech at the expense of the high-touch 70,0 65,0 64,2 60,0 AVG Score 55,0 50,0 45,0 40,0 39,6 53,3 49,0 43,6 43,7 40,8 45,2 44,7 42,1 39,7 45,6 42,6 49,0 40,7 35,0 30,0 Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 EMR Adoption Model Stage 32,3 AVG Clinical Score AVG Satisfaction Score HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 20

21 SUMMARY & CONCLUSIONS Subtitle EMR adoption has great potential to improve patient safety, economic and clinical performance BUT: is posing multiple challenges beyond technology Process Re-design & Change Management Physician buy-in and satisfaction Patient satisfaction EMR adoption is most likely to stall in EMRAM Stage 2, because of Costs without ROI Unrealized Benefits Impaired relationship with physicians HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 21

22 Subtitle Uwe Buddrus Managing Director HIMSS Analytics Europe Schwägrichenstraße Leipzig, GERMANY ubuddrus@himssanalytics.eu phone: For further information visit: HIMSS Analytics Europe EMR Adoption and Patient Safety and Performance - 22