1 1 IT/EMR: A Measure of Need, Value, and ROI At Vanderbilt Compared to HCA Submitted to: Paul King Date of Submission: 28 October 2010 Date of Project: October 2010-April 2011 Alexandra Newton M. Davis Wedgworth Biomedical Engineers Vanderbilt Unviersity 2301 Vanderbilt Place Nashville, TN 37235
2 2 Abstract The Patient Protection and Affordable Care (the Act) was created and signed into law in 2010 in an effort to make quality, affordable health care and health insurance more universally accessible in the United States. The purpose of this project to determine the 7 steps outlined by the government to be accomplished by 2014 pertaining to information technology (IT) and electronic medical records (EMR). The study will compare and contrast the implementation of four of these biotechnological endeavors in terms of a public, not for profit program to an investor owned, for profit program. This comparison will focus on value, ROI and common expectations. We are still in the early planning stages of this process but once we begin these comparisons between Vanderbilt University Hospital and HCA, it is our belief that other health care providers in the area will become interested in the results of the analysis for use in their facilities. Two student workers, Alexandra Newton and M. Davis Wedgworth, both biomedical engineering majors at Vanderbilt University, will work on this project. VU School of Engineering s computer systems administrator, Ray Erlandson, as well as HFR Design s Senior Vice President Jim Easter will act as team advisors. The student team wishes to gain a better understanding of the managerial aspect of health care and experience in using our biomedical engineer knowledge for a more intangible aspect of research and design. If we are able to complete all of the tasks we have set for ourselves 100% and have created a comprehensive analysis by the end of the grant period, we will consider this project a success.
3 3 Introduction On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) into law. The 2400 page ACA is a major reform of the current health care system, making large amendments to pre-existing legislature like the Social Security Act, the Public Health Service Act, and the Internal Revenue Code, in an effort to make health insurance and health care more universally accessible in the United States. It is divided into nine main sections, or titles, that dictate the main focus of the reform: affordable health care, public programs, the quality and efficiency of health care, prevention of chronic disease and improving public health, health care workforce, program integrity, access to innovative medical therapies, community living assistance services and supports, and revenue provisions. Within each title, there are a number of provisions and alterations. These provisions are organized into a timeline based on the complexity of the task, ranging from immediately after the bill was signed to January The purpose of this study is for the student team with the help of their staff advisor and HFR Design to determine the steps outlined by the government to be accomplished by 2014 that relate to information technology (IT) and electronic health/medical records (EMR) and how these steps/applications apply to biomedical engineering. The study will compare and contrast 4 biotechnological endeavors and explain the automated factors that compare and contrast to a public, not for profit program to an investor owned, for profit program in value, ROI and common expectations. The themes include time, cost, lean applications and relevance to the 4 endeavors selected. History and Context Throughout the Affordable Care Act, there are several references to health information technology (IT) and EMR reform, including implementing meaningful use of EMR and providing grants to facilities to help set up EMR technology. The intent is to make medical
4 4 records easier to access, manage, and share with other health care providers; this allows for faster, more accurate diagnosis and prevents complications like mixing medicines and allergic reactions. The language of the ACA, however, is difficult to understand and often references outside sources. To take the burden off of individual health care providers, our team will analyze the legislature and compile the new regulations relating to IT and EMR into an abbreviated document. For the purpose of this project we will choose to explore four of these regulations and how the style of the health care provider dictates how they should be implemented. HFR Design, this project s sponsor, is an architecture and engineering company based out of Nashville, TN. In their Healthcare Planning division, they offer workplace re-engineering services, which include service and organizational re-design, and systems and technology audit. As January 2014 approaches, HFR will need to adapt these services to ensure that their clients are in accordance with the new IT/EMR regulations. Their projects range from large public acute care hospitals to small private senior living facilities, so the same approach will not fit every situation. Rather than try to create an entirely unique approach to each project, it is advantageous for them to have multiple approaches already planned out and analyzed for efficiency and cost. The project is still in planning stages, so the team has only just begun to meet with our HFR Design contact and conduct research on the background of the ACA. Once we have finished our comparison, HFR Design will be able to consult our results in future projects to quickly determine the best and most cost effective way to restructure their clients technology systems. Team Alexandra Newton: Senior Biomedical Engineer - Co-Leader
5 5 - Research and analysis of topic - Compilation of information - History of performing research in the Vanderbilt Medical Center M. Davis Wedgworth: Senior Biomedical Engineer - Co-Leader - Research and analysis of topic - Compilation of information - History of shadowing emergency room doctors in Montgomery, Alabama. Ray Erlandson: Staff Advisor - Computer systems administrator for the VU School of Engineering - Has worked with Information Technology at both the VU Medical Center and HCA, worked with the development and deployment of EMR systems at HCA. - Will be able to help the design team with: o Contact info at Vanderbilt for programmers and medical providers using EMR. o Better understanding of the differences in management and business practices. between for-profit and non-profit organizations. o Help with an understanding of the IT portion of the project including Star Panel, EPIC and other Vanderbilt EMR programs. o Web site advice. Jim Easter, Jr.: Requester of Project - Primary liaison between the student team and HFR Design - Senior Vice President and Director of Healthcare planning for HFR Design - Will be able to help the design team with: o Navigating the Patient Protection and Affordable Care Act Work Plans and Outcomes By completing this design project, we wish to gain a better understanding of the managerial aspect of health care. We also like to gain experience in using our biomedical engineer knowledge for the intangible aspect of research and design, like creating protocol,
6 6 instead of medical devices. It is our goal that the analysis we provide with be utilized by multiple health service providers in the area in an effort to minimize the time and cost required to implement the new biotechnological endeavors detailed in the Act. After the grant period has expired, this project will have proven to be successful and it will continue to include analysis of other endeavors until all of the provisions affecting health care providers are clearly compared between public and private institutions. A more detailed work plan can be seen below.
7 7 ID Task Research the Patient Protection and Affordable Health Care Act Determine the 7 steps outlined by the government to be accomplished by 2014 Determine how these steps apply to biomedical engineering Choose 4 biotechnological endeavors based on these steps Research the fundamental differences between an public program and a for profit program For endeavor 1, compare and contrast value, ROI, and common expectations. For endeavor 2, compare and contrast value, ROI, and common expectations. For endeavor 3, compare and contrast value, ROI, and common expectations. For endeavor 4, compare and contrast value, ROI, and common expectations. 1st Half (2010) 2nd Half (2011) Oct Nov Dec Jan Feb Mar Apr Evaluation and Sustainability Plan We will measure our success based on the number of milestones outlined in the Gantt chart above that are completed. If we complete each task at 100% and produce a clear, concise analysis that is ready to be utilized in hospitals across the country, we will have succeeded.
8 8 Appendix Budget Budget Template..page 8 Budget Justification.....page 9 Resumes Alexandra Newton...page 10 M. Davis Wedgeworth.page 11
9 9 DETAILED BUDGET PERSONNEL (Applicant organization only) FROM TO 10/20/2010 5/01/2011 DOLLAR AMOUNT REQUESTED (omit cents) NAME Consultant (TBD) ROLE ON PROJECT Months Devoted to Project INST.BASE SALARY SALARY REQUESTED FRINGE BENEFITS TOTAL Liaison between student team and HFR Design 6 $0 $0 $0 $0 SUBTOTALS $0 $0 $0 CONSULTANT COSTS No other personnel will be hired. $0 DURABLE EQUIPMENT (Itemize) None SUPPLIES (Consumable; Itemize by category) None $0 TRAVEL Gas for car trips around the greater Nashville area: $2.50/gallon (Provided by the student team) ALTERATIONS AND RENOVATIONS (Itemize by category) None OTHER EXPENSES (Itemize by category) None $0 $0 $0 $0 Total Direct Costs $0 Indirect Costs $0 Total Direct & Indirect Costs $0
10 10 The only foreseeable cost is the price of gasoline used to drive the team to and from meetings with HFR Designs and possibly local hospitals if necessary. This should not be a large value, and the team will cover it.
11 11 Alexandra L. Newton Current Permanent VU Station B Box Pine Mark ct Nashville, TN Orange Park, FL (904) (904) Education Vanderbilt University Nashville, TN Bachelor of Engineering May 2011 Major: Biomedical Engineering Minor: Neuroscience Honors and - Delta Delta Delta Sorority Activities - Club Volleyball Relevant - Neuroanatomy - Systems Physiology Coursework - Biomedical Instrumentation - Cellular Neurobiology Research Vanderbilt University Institute of Imaging Science Nashville, TN Reducing Subject Leg Movement During MRI January 2010 May Designing and building a platform compatible with the existing MRI bed that immobilizes patients' leg during MRI procedures. Comparison of Protocols for Measuring Rate of PCr Resynthesis August 2010-Present - Researching standard protocols for measuring the rate of phosphocreatine resynthesis in muscle after exercise and comparing these results with experimental spectroscopy protocols. Work Vanderbilt University School of Engineering Dean's Office Nashville, TN Experience Office Assistant August 2007 Present - Organizing and maintaining all records of undergraduate and graduate students working in the School of Engineering. Skills - Mathematica - Microsoft Office Suite
12 12 Morgan Davis Wedgworth, III Off-Campus Address Permanent Address 106 Acklen Park Dr Vaughn Lane Apartment 1 Montgomery, AL Nashville, TN (334) (334) OBJECTIVE To obtain a job in Healthcare with background knowledge of biomedical engineering. EDUCATION Vanderbilt University Nashville, TN Bachelor of Engineering in Biomedical Engineering Fall May 2011 Brown University Providence, RI Fall 2007-Spring 2008 Auburn University Auburn, AL Summer Session, Summer 2009 Montgomery Academy High School Montgomery, AL Fall 2003-Spring 2007 SELECTED COURSES Biomechanics, Biomedical Instrumentation, Physical Transport Phenomena, Tissue Engineering, Biomedical Service Learning and Leadership, Survey of Entrepreneurship EMPLOYMENT Baptist Medical Center Montgomery, AL, Spring Break 2010 & EXPERIENCE - Shadowed Emergency Medicine Doctors: John Moorehouse, Julio Rios, and James Bradwell Southern Electrical and Mechanical / Sabic Innovative Plastics Lowndesboro, AL, Summer OSHA Certified - Safety Team Leader for part of an $800,000 project at Sabic. National Youth Leadership Forum, Medicine Invited participant at Harvard and New England Medical Centers, Summer 2007 Aderson Law Firm Runner, Summer 2005 ACTIVITIES KEY SKILLS REFERENCES Biomedical Engineering Society, Member 2008-Present, Committee Chair 2010 Project C.U.R.E. Volunteer, Calibrated Medical Equipment for shipment to developing countries Varsity Baseball, Brown University, Relief Pitcher Club Baseball, Vanderbilt University, Club Co-President 2009 Ducks Unlimited, Active Conservationist National Rifle Association, Active Member National Forensics League, Inducted Member Sigma Alpha Epsilon Fraternity Great people skills, Leader, Motivator, Strong work ethic, Organized, Detail oriented, Self-driven, and Self-disciplined Microsoft Word, Excel, PowerPoint, Mathematica, LabVIEW Available Upon Request