WHITE PAPER INTEGRATED CLINICAL TECHNOLOGY: DRIVING CLINICAL OUTCOME, PATIENT EXPERIENCE. by: THOMAS PECK, FACHE PRESENTED BY

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1 WHITE PAPER INTEGRATED CLINICAL TECHNOLOGY: DRIVING CLINICAL OUTCOME, PATIENT EXPERIENCE by: THOMAS PECK, FACHE PRESENTED BY

2 Copyright 2015 EmCare, Inc. All rights reserved. This publication may not be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without prior permission of the copyright owner. This White Paper is an informational document. Readers should note that this document does not represent an endorsement by any entity. All page headers and custom graphics are service marks, trademarks and/or trade dress of Envision Healthcare, Inc. Emcare, Inc. is an Envision Healthcare company. All other trademarks, product names and company names or logos cited herein are the property of their respective owners. Any comments relating to the material contained in this document may be sent to: EmCare Marketing Department: marketing@emcare.com Mail: EmCare, Inc. Marketing Director Noel Road Dallas, Texas PAGE 2 WHITEPAPER INTEGRATED CLINICAL TECHNOLOGY

3 TABLE OF CONTENTS The promising future of clinical integrated technology...4 Data, data everywhere, but how do I benefit considering the cost?...4 Converging technology drives clinical outcomes, patient experience...6 Leading the way to maximize the value of integrated clinical technologies...6 Closer integration between health system and clinicians... 7 Improved communications cut E.D. boarding times... 8 Enhanced documentation improves billing accuracy... 8 Expedited radiology reporting improves patient experience...9 Integrated clinical technology making healthcare work better WHITEPAPER INTEGRATED CLINICAL TECHNOLOGY PAGE 3

4 The promising future of clinical integrated technology After decades of slow adoption, information technology is beginning to make transformative changes to healthcare. Realizing the potential to decrease costs and improve productivity and quality, healthcare organizations are embracing technology to integrate business and clinical operations. Data, data everywhere, but how do I benefit considering the cost? Nearly half (49 percent) of hospital executives say their largest capital investment over the coming year will be in health IT. The healthcare industry has never lacked data patient data, physician data, cost data. It hasn t clearly understood how to make sense of this mountain of information and to convert it into actionable strategies that will improve efficiency and quality. But cost pressures and the laserlike focus on quality and outcomes are shaping the new lens through which healthcare organizations are viewing the use of technology to their benefit. The fact that healthcare organizations are realizing the true value of technology is evident in the ever-increasing percentage of the operating budget being consumed by IT investments. An August 1, 2014, article in Becker's Hospital Review, 25 Things to Know about Hospitals, Health Systems' Investments in IT, notes several reasons for the rapidly rising acquisition of IT products by these organizations: Nearly half (49 percent) of hospital executives say their largest capital investment over the coming year will be in health IT. According to a HIMSS survey, the most cited reasons for increasing IT budgets were an increase in the number of and complexity of IT systems followed by a need to comply with regulatory changes and an overall budget increase. Moody's says that hospitals that invest in IT, along with those that invest in outpatient services, are most likely to survive challenging operating conditions. EHRs are the focus of IT investments by hospitals and health systems with the primary consideration being if the technology can help PAGE 4 WHITEPAPER INTEGRATED CLINICAL TECHNOLOGY

5 optimize the EHR followed by infection surveillance, outreach services and patient acuity apps. To improve care coordination and meet meaningful use stage II requirements, it is very helpful for nearby and affiliated physicians to use the same EHR system as the hospital. The next big investment areas for hospitals and health systems will be in technology analytics solutions that can help use data collected in EHRs to fuel accountable care measures or improve hospital efficiency. 1 The IT driven telehealth market is projected to grow to $1.9 billion in 2018 from $240 million in 2014, an annual growth rate of 56 percent. 2 EHRs offer a hint of an integrated vision of care, but they fall short of impacting patient flow and care delivery. Broader research suggests that when companies inject technology and analytics deep into their operations, they can deliver productivity and profit gains that are 5-6 percent higher than those of the competition. Because of the fragmented nature of many hospitals and health systems, purchasing decision-making, organizations are struggling to acquire emerging technologies. Not only are new technologies more complex and challenging to evaluate, many are now classified as disruptive technologies those that change existing business models or work processes. Estimating the impact of these technologies on clinical programs, operating costs and workforce and facility needs is particularly problematic. Disruptive technologies make it difficult to construct a business case for investment. They also make it hard to conduct return on investment analysis. Physicians' preferences continue to dominate the decision-making about new technologies. Accordingly, healthcare organizations are highly focused on aligning their technology The IT driven telehealth market is projected to grow to $1.9 billion in 2018 from $240 million in 2014, an annual growth rate of 56 percent. investments with their physicians. 3 1 Gregg, H., 25 things to know about hospitals, health systems investments in IT, Becker s Hospital Review, Aug. 1, Graham, J., 3 Coye, M.J, Kell, J., How Hospitals Confront New Technology, Health Affairs, Vol. 25, No. 1, , Jan WHITEPAPER INTEGRATED CLINICAL TECHNOLOGY PAGE 5

6 Converging technology drives clinical outcomes, patient experience A National Bureau of Economic Research report, Health Information Technology and Patient Outcomes: The Role of Organizational and Informational Complementarities, points out that the adoption of new IT solutions in general can lead to cost reduction, enhanced communication and productivity gains at many organizational levels within many types of institutions. The report's authors conclude that health IT generally improves patient care by facilitating communication and coordination among providers who must manage clinical information coming from a number of different sources. Such IT innovations improve outcomes for A National Bureau of Economic Research report... points out that the adoption of new IT solutions in general can lead to cost reduction, enhanced communication and productivity gains... patients with complex and severe diagnoses. 4 Leading the way to maximize the value of integrated clinical technologies One company has emerged as an innovator and leading partner for a variety of stakeholders in terms of maximizing the value of integrated clinical technologies. EmCare is pioneering the development of an integrated operating structure that helps its client hospitals and health systems deliver improved patient care and experiences while positively impacting financial performance. Their focus on maximizing the value of integrated technologies leads to: better communication among clinicians and between clinicians and administrators; more efficient practices; better quality of care and clinical outcomes; enhanced patient, medical staff and referring physician satisfaction; improved metrics; and better financial results. Integrated clinical technology has the ability to impact the health system on many levels, said Francisco Loya, MD, chief executive officer of 4 McCullough, J., Parente, S., Town, R., Health Information Technology and Patient Outcomes: the Role of Organizational and Informational Complementarities, National Bureau of Economic Research Working Paper No PAGE 6 WHITEPAPER INTEGRATED CLINICAL TECHNOLOGY

7 EmCare Hospital Medicine. Admissions from the community, admissions through the emergency department, improved communications between referring physicians and radiologists and hospital medicine physicians, improved patient satisfaction, improved patient experience, improved charge capture all of these are examples of integrated clinical technologies ability to enhance overall hospital performance. We are on the cutting edge of figuring out what makes the life of a physician easier so he or she can practice more cost-effective, higherquality medicine, said Loya. We create tools that improve the physician's quality of life with simple, easy-to-use technologies that facilitate workflow and allow him or her to get the job done without a lot of red tape or hang-ups. By helping physicians do their job more efficiently, we in turn help our hospital clients realize their goals of delivering higherquality, lower-cost, patient-focused care. Closer integration between health system and clinicians EmCare offers a number of clinical technologies aimed at various components of the healthcare system. The company's proprietary DASH application is a prime example. DASH Direct Admit System for Hospitals enables referring physicians to click on the DASH button, complete a direct admit form and confirm the bed assignment in only 10 to 15 minutes versus an average of 60 to 90 minutes for the traditional admitting process. The application is accessible on laptops, tablets and smartphones and generates a convenient hospital boarding pass for the patient. DASH enables referring physicians to click on the DASH button, complete a direct admit form and confirm the bed assignment in only 10 to 15 minutes... DASH has proven to be a very popular application because it streamlines what has historically been a time-consuming process for the referring physician and the receiving hospital, explained Loya. While the benefits are obvious for the physician and the hospital, the patient and his or her family are also satisfied with the early stages of the experience because it eliminates up-front hassles and significantly reduces the time it takes for the patient to receive care. WHITEPAPER INTEGRATED CLINICAL TECHNOLOGY PAGE 7

8 Improved communications cut E.D. boarding times EmCare s Door-to-Discharge service complements DASH. Door-to- Discharge, when deployed in conjunction with the company's Rapid Admission Process and Gap Orders (RAP&GO ) evidence-based software, can significantly decrease boarding time for patients awaiting disposition in the emergency department and can create an opportunity for new E.D. volume and metric improvement.* RAP&GO uses proprietary pathways to help emergency department physicians determine if a patient meets specific criteria for admission to the hospital. RAP&GO supports communication and integration between hospital departments and clinical services by breaking down silos between the emergency department physician and the hospital medicine physician, said Loya. These integrated technologies are a big differentiator for EmCare and for our hospital clients. RAP&GO uses proprietary pathways to help emergency department physicians determine if a patient meets specific criteria for admission to the hospital. If the patient meets the criteria, the software uses automated communication techniques to quickly and efficiently coordinate patient throughput from the emergency department to a bed in the appropriate care unit in the hospital. This is possible because EmCare emergency physicians and EmCare hospital medicine physicians practice using the same guidelines and protocols supported by a common technology platform. Enhanced documentation improves billing accuracy EmCare has developed CMORx, a technology that evaluates patient data related to severity and complexity of care to improve outcomes and capture appropriate reimbursable charges. Hospital clients are especially interested in this feature because it enhances their ability to accurately charge for the correct diagnoses and related treatments across the entire episode of care. The use of this type of integrated technology generates data that helps align physicians and hospitals, explained Loya. Regardless of where they practice the emergency department or in the hospital care *Potential New Hospital Revenue is representative of a decrease in LWOT/LPMSE rates and/or improved bed availability which in turn contributes to an increase in E.D. volume, which likely means improved revenue for the hospital through charges for the additional patients in the E.D. Historical data suggests that admission rates under the D2D program remain essentially flat compared to the time period immediately prior to implementation of the D2D program and thus the additional E.D. volume would result in additional admissions as well and potential increased revenue for the Hospital. PAGE 8 WHITEPAPER INTEGRATED CLINICAL TECHNOLOGY

9 unit physicians see these data sources as credible and consistent important characteristics that encourage increased physician buy-in and utilization. Expedited radiology reporting improves patient experience A common bottleneck in the patient experience is the time lapse between the time imaging studies are performed and the time they are delivered to the patient's physician and ultimately the patient. EmCare's VidRay and RaysTracker applications address bottlenecks by fortifying the power of digital imaging with real-time video interpretation by the radiologist and capturing that in the patient record. We developed the patented VidRay technology that creates and saves an on-demand consult between the radiologist and referring physician. It works by recording the radiologist's summary interpretive narration that includes showing where the radiologist is focusing via mouse clicks and cursor locations, said Greg Rose, M.D., Ph.D., chief executive officer of EmCare Radiology Services and Rays. Digital images are instantly saved in the patient's record as is the radiologist's video consult. Productivity is significantly enhanced because the video can be tailored to the referring physician. The referring physician can let the patient and family see and hear the radiologist reviewing the critical elements of the radiographic study. Then, he or she can discuss implications and treatment options. This affords a closer connection between the radiologist and the patient. The stress of the unknown is reduced as is the waiting for information, resulting in more satisfied patients and families. The video can also be shown to residents for teaching purposes. EmCare's VidRay and RaysTracker applications address bottlenecks by fortifying the power of digital imaging with real-time video interpretation by the radiologist and capturing that in the patient record. The RaysTracker technology aggregates data flow from multiple hospitals and radiologists into a central repository that stores and sorts the information quickly. The technology negotiates 2,000 cases per day, said Rose. Radiology information is highly structured, clean and descriptive. RaysTracker maximizes the opportunity to digitize information, manage it and monitor it. The technology tracks metrics, produces dashboards and reports and maintains historical and live data. The bottom line is that we are strategically using big data and analytics to improve productivity, enhance accuracy and increase patient and family satisfaction. RaysTracker is essentially a digital imaging warehouse. WHITEPAPER INTEGRATED CLINICAL TECHNOLOGY PAGE 9

10 It receives radiographic studies, negotiates, cleans up and organizes the information, creates and stores VidRay consultation videos for the radiologist, clinician, and patients. It provides the referring physician with a platform to view the radiologist's report and provide any feedback including questions and points of clarification to the radiologist. Integrated clinical technology making healthcare work better Integrated clinical technologies can create improved clinical, operational and financial efficiencies that drive health system performance. Technology represents a path for adapting to the rapidly changing care delivery environment. Integrated clinical technologies can create improved clinical, operational and financial efficiencies that drive health system performance. Optimally, these enhance physician effectiveness and satisfaction as they improve the patient experience. That s one more way EmCare is making healthcare work better. For more information about these applications, visit emcare.com/technologies. There you will find details about each of these programs, calculators to model the impact on your organization s performance and success stories from hospitals and health systems across the country who are putting these to work in their facilities. Or, call (877) PAGE 10 WHITEPAPER INTEGRATED CLINICAL TECHNOLOGY

11 About EmCare EmCare is a leading national physician practice management company and provider of clinical department outsourcing services, including physician recruiting, credentialing, scheduling, leadership, training and education and billing, for hundreds of hospitals nationwide. Integrated services include: Emergency Medicine Hospital Medicine Acute Care Surgery Anesthesiology Radiology / Teleradiology The company focuses on helping each client with efficiency, quality of care and creating outstanding patient experiences. In short, EmCare is making healthcare work better. For more information about EmCare and its services, call or visit Int Authors and Contributors Author: egrated Thomas Peck, clinical FACHE technologies can Contributors: create improved Mark Hamm, MBA clinical, operational and Martin Heath, FACHE financial efficiencies Francisco Loya, M.D., M.S. that drive health Greg Rose, M.D., Ph.D. system performance. WHITEPAPER INTEGRATED CLINICAL TECHNOLOGY PAGE 11

12 Local Practice. Divisional Support. National Resources. Integrated Services: Emergency Medicine Hospital Medicine Acute Care Surgery Anesthesiology Radiology / Teleradiology EmCare is an Envision Healthcare company. Mission Statement: EmCare exists to serve and support clinicians, hospitals, health systems and other healthcare clients in providing high-quality patient care efficiently and affordably. Vision Statement: EmCare s vision is to create a new, integrated model of physician services through: The Science of Clinical Excellence The Art of Customer Service The Business of Execution This requires several strategic imperatives: Medical Leadership Service Excellence Hardwiring Flow Evidence-Based Patient Safety Protocols Teamwork WHITEPAPER INTEGRATED CLINICAL TECHNOLOGY 04/2015 EmCare, Inc. All rights reserved.