Industry perspectives on Electronic Medical Record Systems. Andrew G. Ury, M.D. VP and General Manager, Practice Partner McKesson Commissioner, CCHIT

Transcription

1 Industry perspectives on Electronic Medical Record Systems Andrew G. Ury, M.D. VP and General Manager, Practice Partner McKesson Commissioner, CCHIT 1

2 Introduction Founded Practice Partner in 1983 to develop an Electronic Medical Record How I got started Classic boot strap startup First EMR sites here in Seattle in years as an independent company then two months ago merged with McKesson Will use EMR / EHR interchangeably 2

3 Practice Partner Used by over 1500 practices, 20,000 users Used by around 7000 physicians 2004, 2005, 2006 TEPR Best EHR Product very different today than 1986 Current development cycle very rapid, 2 major releases per year 115 employees 3

4 Adoption of EHR EHR adoption rates are still low Approximately 8% of small practices (some think it is 20%) and 35% of larger practices have EHR s The medical office is one of the last bastions of paper in the U.S. Recent Federal study (Health Affairs October 11 th, 2006) on HIT Adoption showed use of a full EHR is less than 10% across the board 4

5 The National Impetus for an EHR Growing national consensus that the EHR is strategically important for U.S. Healthcare Bi-partisan consensus at the highest level of U.S. Government starting in 2003 Major National Medical Societies form similar consensus Private insurance payors make a similar decision Driven by concerns over healthcare quality and costs 5

6 State of the Union Messages EMR - Only software category mentioned in the last 3 State of the Union Messages as a National priority 6

7 The EMR Problem What is the problem that we are trying to solve? As noted, American Medicine is under tremendous pressure to reduce costs and improve quality at the same time A daunting task 7

8 EMR as a tool There are very few true medical breakthroughs each year, and almost all affect only a small percentage of our patients An EMR can be considered a tool, like a stethoscope, a tool that is applicable to all our patients. One thing to keep in mind: just a minute is a very long time to a busy physician 8

9 What is possible: a case study Decatur Internal Medicine Associates 3-provider internal medicine practice in Decatur, AL Productivity Gains: Efficiency increased by 50% per MD (20 patients/day to 30 patients/day) Annual revenue increased from $550K to $800K per MD Quality Improvements: 90% of diabetic patients have HgA1c < 7 (Mean for practice is 6.4% on a diabetic population of 1,000. State average HgA1c is 9%) 9

10 Productivity Anecdotes aside, is there a proven ROI for EMR s? An area that is difficult to quantify UCLA Health Economists study suggests that there is a good ROI 10

11 UCLA Health Economist Study Published in Health Affairs (Volume 24, Number 5) Studied ROI for two EMR s (one was Practice Partner) Intense rigorous study looking at all aspects of costs, analyzed financials before and after, site visits etc. Concluded that there was a full ROI in approximately 3 years Personnel and cost savings Improved Charge Capture and better E and M coding 11

12 Quality At least in theory, EMR s improve the quality of care Field results vary It depends on how you use the tool Many studies are piecemeal, studying single aspects in relatively controlled environments 12

13 Practice Partner Research Network (PPRNet) Research-based quality improvement organization founded by Practice Partner and the Medical University of South Carolina (MUSC) in 1995 Includes over 120 physician practices, representing over 600 health care providers and one million patients in 38 states Quarterly practice reports show performance on 80 separate quality of care indicators 13

14 A-TRIP and PPrNet Accelerating the Translation of Research into Practice Funded through a series of AHRQ grants (just completed a 4 year grant) PPrNet team led by Dr. Steve Ornstein, of the Medical University of South Carolina Last grant was to work on improving the quality of care for almost 80 measures in almost 100 primary care practices: Heart disease / stroke, Diabetes, Cancer screening, Immunizations, Respiratory Illnesses, Mental Health and Substance Abuse, Nutrition and Obesity and Drug Prescribing in the Elderly 14

15 Results of the last A-TRIP study HgbA1C < 7 in Diabetics: National median: 37% Practice Partner median: 58% Across all benchmarks and all practices adherence to guidelines went from 33% to 46% Diabetes care benchmarks improved by more than 10% Heart disease benchmarks improved by 10% Cancer and Immunization benchmarks improved as well 15

16 Quality of Care Case Study Advanzed Health Care, PLC 2-provider internal medicine practice in Arlington, VA Diabetes Population Control % of DM patients with urinary microalbumin measure in past year increased from 4% to 50% % of DM patients with BP < 130/80 increased from 32% to 55% Other Screenings (Using electronic patient notes to remind staff) % of mammogram screening for women over 40 increased from 70% to 85% % of tetanus shot for adult patients increased from 56% to 81% 16

17 Advanzed Health Care, PLC 17

18 Advanzed Health Care, PLC 18

19 Advanzed Health Care, PLC 19

20 Advanzed Health Care Patient-Level Detail 20

21 21

22 22

23 Where product ideas come from Existing customers Prospects (possible future customers) Often quite different than customers who are already in your world Vision 23

24 Concepts about software development Deciding what to do: The hard part is not thinking of good things to do, the hard part is picking and prioritizing among many good things Do the most important things first, not the easy things, not the convenient ones Establish firm feature complete deadlines for each version Make the hard decisions and keep the project moving forwards, avoid decision paralysis 24

25 Concepts (cont.) Remember that just a minute for a physician seeing a patient is a long time No one wants to see the same prompt a hundred times a day Don t constrain the user, let things be flexible so they can use the software in unexpected ways Good judgment comes from experience, experience comes from bad judgment 25

26 EMR Regulation and its impact The price of being a national priority Two HHS secretaries in a row have focused on EMR s (EHR s). Example: On June 6 th, 2005 at a HIMSS summit in New York City, Secretary Leavitt stated that the first three things he thinks of each morning is IT, IT, IT. There is no question that it will influence the evolution of the EMR industry 26

27 Birth of CCHIT Certification Commission on Healthcare Information Technology Why certification? If government and private insurer benefits are going to flow to EHR users, need a way to identify qualifying EHR s Encourage adoption and lower purchaser s risk Promote interoperability A gating item for many public and private efforts In 2004, Dr. David Brailer (ONCHIT), challenged the private community to begin certification efforts (or face a pure governmental process, eg FDA) Subsequently supported by a federal grant 27

28 Certification Commission Certification Commission for Healthcare Information Technology (CCHIT) Web site is Founded by AHIMA, HIMSS, and the Alliance Thirteen Commissioners initially First meeting on September 14 th, 2004 (Disclosure by the speaker: I was one of the initial Commissioners) 28

29 Composition of the Commission Three key constituencies (2 4 from each): Providers Vendors Purchasers/payers/coalitions Other at-large stakeholders (2 4 total): Government HIT leaders (e.g. ONCHIT, CMS) note: ex-officio, nonvoting role Standards development organizations (e.g. HL7) Others, e.g. healthcare consumer advocates, etc. 29

30 Key Points to Clarify Product Certification is different from: Organizational Accreditation Professional Certification Certification is binary, i.e. pass/fail Not a subjective, comparative rating system Competition and innovation can thrive above the line Voluntary process Initial requirements mostly market reality-based A forward-looking requirements roadmap provides the means to influence market direction 30

31 31

32 Adoption of Certification Began in May 2006 A year later, around 50 EMR vendors are CCHIT certified for Ambulatory EHR s Broad distribution of vendors, small and large A $26,000 pass/fail test that requires a vendor to pass 100% of several hundred tests 32

33 Early Benefits of Certification By Executive Order, a new Stark law exemption was created for Certified EHR s Highmark (Pennsylvania Blue Cross / Blue Shield) establishes grants for Certified EHR s Pending legislation is tied to Certified EHR s 33

34 What does Certification Test for Functionality Security and Reliability Interoperability The bar is raised every year 34

35 Certification Themes Year 1: functionality and security Year 2: criteria grow by 50%, Interoperability a bigger theme Year 3: continued focus on Interoperability, support for pay for performance 35

36 Other governmental initiatives HITSP: Standards Harmonization AHIC: A supervising body 36

37 HITSP Health Information Technology Standards Panel Founded by a government contract Intended to pick and harmonize Interoperability Standards A collaboration of many stakeholders including ANSI, HL7, Medical Societies, Many individual vendors and EHRVA Now moving quickly Reports to AHIC Recent progress on Laboratory and Medical Summaries 37

38 American Healthcare Information Community (AHIC) Formed June 6 th, member Community was appointed Personally chaired by Mike Leavitt, Secretary of HHS Four breakthrough areas : Biosurveillance, Chronic Care, Consumer Empowerment, EHR Craig Barrett, Chair of Intel, represents the vendors Partly focused on fostering widespread adoption of healthcare IT (EHR) Technically, CCHIT and HITSP report to AHIC 38

39 EHR (EMR) Vendors Represent a great deal of practical EMR experience Can represent their customers who are the early adoptors of EHR s Until 2004, did not have a real voice 39

40 EHRVA HIMSS Electronic Health Record Vendor Association ( Founded November 10 th, 2004 by Practice Partner / GE / McKesson and others Now 41 companies Includes all major EHR vendors Focused on Interoperability, Standards, Certification, recent initiatives (I am past Vice Chair) 40

41 EHRVA Provides a consensus vendor view for feedback on interoperability standards, certification criteria and scripts, other issues affecting the EHR Industry Leading the way in Interoperability through an Interoperability roadmap and the IHE Connectathon 41

42 Interoperability CCR vs CCD Standardized lab interfaces HITSP / ELINC s (Lab) Immunizations Child Profile - CDC standard CDA 42

43 EHR (EMR) Adoption Widespread adoption appears inevitable Nonetheless, may easily take 5 to 8 more years to be fully adopted Insurance carrier incentives will help Tipping point concept 43

44 Conclusion EHR s are an essential tool for the 21 st century American medical practice After a long period of slow adoption of EHR s, a critical mass of forces is creating the impetus for rapid adoption of EHR s in the U.S. 44

45 Questions 45

46 46