Emerging Benefits of EMR Use in Community-Based Settings

Transcription

1 Emerging Benefits of EMR Use in Community-Based Settings Simon Hagens, Clinical Adoption Partnership 2013

2 Outline Approach to EMR Benefits Evaluation EMR use in Primary Care EMR Benefits Pan-Canadian Study findings Study Recommendations and Discussion 2

3 Benefits Evaluation Cycle Environmental scan Draft set of potential Benefits & Indicators National BE Forum Indicator Guide Execute Evaluations Pan-Canadian Studies

4 Benefits Evaluation of EMRs Focus Areas and Framework 4

5 Primary care growth of EMR use Canada 70% 60% Family physicians reporting EMR use 56% 64% 50% 40% 37% 41% 30% 20% 10% 16% 23% 24% 0% Data from Commonwealth Fund (2006, 2009 & 2012) and National Physician Survey (2004, 2007, 2010 & 2013) 5

6 International Comparisons 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Primary care physicians reporting EMR use 98% 98% 97% 97% 92% 88% 82% 69% 67% 56% 41% NETH NOR NZ UK AUS SWE GER US FR CAN SWIZ Survey question: Do you use electronic patient medical records in your practice (not including billing systems)? 6

7 Clinical Decisions - International 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% List of all lab results for a patient (easy process) 95% 75% 73% 55% 53% 49% 48% 47% 46% 37% UK AUZ NZ NOR NETH GER US FR CAN SW Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. 7

8 2012 Reported use of EMR multi-functionality Uses EMR Uses EMR with multifunctional HIT capacity % 97% 98% 92% 68% 60% 59% 69% 88% 56% 82% 67% 98% 40 33% 27% 41% 20 12% 11% 10% 7% 6% 4% 0 UK AUS NZ NETH US SWE SWIZ CAN GER FR NOR Note: Multifunctional health IT capacity uses electronic medical record and at least two electronic functions: for order entry management, generating patient information, generating panel information, and routine clinical decision support. Source: 2012 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. 8

9 Advanced EMR functionality use Canada Routine technology use Electronic prescribing of medication 27% 42% Electronic referring to consultants/specialists 25% Electronic alerts or prompts about a potential problem with drug dose or drug interaction 20% 30% Electronic ordering of laboratory tests 18% 28% Source: Commonwealth Fund (2012) 0% 10% 20% 30% 40% 50% % Primary Care Physicians 9

10 Ability to manage patient population Canada 100% 90% Ability to generate information on patient population (easy process) % Primary Care Physicians 80% 70% 60% 50% 40% 30% 20% 10% Paper EMR 0% List of patients by diagnosis List of patients by lab result List of patients List of all due for patients taking a tests/preventive medication care Survey question: With the patient medical records system you currently have, how easy would it be for you (or staff in your practice) to generate the following information about your patients? 10

11 Advanced EMR functionality use 56% Efficiencies in workflow Health system benefits Health outcomes 31% 24% 40% 3% Reduced chart pulls Improved management of diagnostic tests Reduced number of duplicate tests Reduced number of adverse drug events Improved CDM / preventative care Primary care physicians Sources: PricewaterhouseCoopers analysis of Commonwealth Fund Survey

12 Canada Health Infoway Emerging Benefits of Electronic Medical Record Use in Community-Based Care Catherine Hunter Director, PwC Consulting

13 Presenting Questions 1 What types of benefits are experienced through the use of EMRs in community-based practices? 2 To what extent have these benefits been realized in Canada? 3 What actions can be taken to improve the realization of those benefits? 13

14 Approach Project Overview Phase 1: Project Initiation Phase 2: Gather & Synthesize Evidence Phase 3: Model Development Phase 4: Reporting & Communication July 2012 Aug Dec 2012 Sept Dec 2012 Jan Apr 2013 Launch with Working Group Development of work plan and timelines Literature Review Development of hypotheses Review of adoption across Canada Key informant interviews with jurisdictional contacts Advisory Panel meeting Development and refinement of model Advisory Panel Workshop Draft Report Validation of Findings Final Report Stakeholder Engagement Engagement of Working Group and Steering Committee 14

15 Approach Scope Primary care physicians and community-based specialists were in scope. A review of the literature, survey data and new studies provided the foundation for the development of benefit estimates research articles; Commonwealth Fund, National Physician and provincial surveys; 20+ key informant interviews; and Canada Health Infoway funded research (e.g., Physician Value Study). 15

16 Approach Parameters and Considerations The benefit estimates in this study are: a reflection of the research and evidence currently available; intended to be illustrative of the current and emerging impacts of EMRs; and representative of a segment of the full scope and scale of benefits likely being realized. Estimation of national quantitative benefits was feasible for a subset of benefits where associated evidence was available.

17 Summary of benefits 1. Community-based practices experience efficiencies in workflow as staff time is redeployed. 2. EMR use results in health system level benefits, such as reduced numbers of duplicate tests and adverse drug events. 3. Advanced use of EMRs can improve health outcomes and patient safety through preventive care and chronic disease management. 4. EMR use supports improved interactions and communications among care team members and between providers and patients.

18 Summary of benefits 1.Community-based practices experience efficiencies in workflow as staff time is redeployed. 2. EMR use results in health system level benefits, such as reduced numbers of duplicate tests and adverse drug events. 3. Advanced use of EMRs can improve health outcomes and patient safety through preventive care and chronic disease management. 4. EMR use supports improved interactions and communications among care team members and between providers and patients.

19 Efficiency Gains in Community-based Practices Benefits related to reduction in chart pulls and efficiencies in laboratory and diagnostic test management are valued at $800 million ( ) $200 $177M in 2012 $180 Benefit Estimate ($ million) $160 $140 $120 $100 $80 $60 $40 $20 $54 $44 $34 $24 $34 $42 $49 $55 $67 $65 $80 $74 $93 $84 Test management Chart pulls $ Year

20 Reduced Chart Pulls Benefit area Benefits estimate Range Time savings from reduced chart pulls in million hours 1.8 hours per physician per week 3.0 million million hours hours per physician per week Benefit from reduced chart pulls in 2012 $84 million $56 million - $112 million Emerging Benefits Practice Workflow: Positive ROI in an average of 10-months. Enhanced patient scheduling and billing practices and changes in clinical processes, including documentation, order entry, and patient encounter management.

21 Diagnostic test results management Benefit area Benefits estimate Range Time savings in diagnostic test results management in 2012 Benefit from diagnostic test results management in million hours 2.0 administrative hours per physician per week $93 million million hours administrative hours per physician per week $41 million to $103 million Emerging Benefits Practice Workflow: Enhanced patient scheduling and billing practices. Changes in clinical processes, including documentation, order entry, and patient encounter management

22 Physician Value Study EMRs & ROI 15 of 17 primary care clinics report a positive ROI (33 physician practices), and for those, time to break-even averaged 10 months, and ranged from 1-37 months The cost of an EMR implementation & system sustainability as measured by the ROI indicator, should not be a barrier to adoption Source: Lortie, M., Sanche, S., Lapointe, L., Vedel, I., Hughes, J., Simkus, R., Dyck, S., Saragosa, E., Law, S. (2013). The EMR Physician Value Study: The Impact of mature Electronic Medical Record (EMR) implementations on productivity, operational efficiencies and clinical functionalities in Canadian primary care settings. 22

23 Institute for Clinical Evaluative Sciences Billings Study results Physician billings remain stable from the date of EMR implementation over the 18-month follow-up period (from go live ). No decline in overall physician office billings was observed from the date of EMR implementation. Source: Jaakkimainen, L., Schultz, S.E., Tu, K. (2012). Does starting an electronic medical record (EMR) affect family physicians billings? 23 23

24 NPS Perceived impact of electronic records: family physicians Productivity change since implementation of electronic records 3% 14% 27% 34% 11% Greatly Decreased Decreased Did not Change Increased Greatly Increased Productivity change since implementation of electronic records Greatly Increased Increased 4% 23% 6%** 30%* 14%* 37%* Less than a year 1-2 years Over two years Data from National Physician Survey (2013) * % Not sure or No Reponses not reported 24

25 Summary of benefits 1. Community-based practices experience efficiencies in workflow as staff time is redeployed. 2.EMR use results in health system level benefits, such as reduced numbers of duplicate tests and adverse drug events. 3. Advanced use of EMRs can improve health outcomes and patient safety through preventive care and chronic disease management. 4. EMR use supports improved interactions and communications among care team members and between providers and patients.

26 Health system level benefits Benefits from reduced adverse drug events and reduced duplicate tests are valued at $584 million ( ) $140 $123M in 2012 $120 Benefit Estimate ($ million) $100 $80 $60 $40 $20 $7 $10 $42 $44 $13 $55 $16 $67 $19 $74 $21 $93 $24 $99 Adverse drug events Duplicate tests $ Year

27 Reduced duplicate tests Benefit area Benefits estimate Range Benefit from reduced duplicate testing due to EMRs in 2012 $ 99 million 6.5 million fewer duplicates $ 29 - $145 million million fewer duplicates Emerging Benefits: Reduced duplicates increased system connectivity to Electronic Health Records, interoperability and access to data repositories. Reduced inappropriate imaging tests with decision support: e.g. Sinus CTs and head and lumbar MRIs: $5.7M in 2012; 6,000 fewer inappropriate CTs & MRIs.

28 Summary of benefits 1. Community-based practices experience efficiencies in workflow as staff time is redeployed. 2. EMR use results in health system level benefits, such as reduced numbers of duplicate tests and adverse drug events. 3.Advanced use of EMRs can improve health outcomes and patient safety through preventive care and chronic disease management. 4. EMR use supports improved interactions and communications among care team members and between providers and patients.

29 Advanced use of EMRs can improve health outcomes and patient safety through preventive care and chronic disease management

30 NPS Perceived impact of electronic records: family physicians Quality change since implementation of electronic records 4% 1% 24% 44% 19% Much worse Worse No change Better Much better Quality change since implementation of electronic records Much better Better 7% 34% 11%* 23%* 41% 46%* Data from National Physician Survey (2013) * % Not sure or No Reponses not reported Less than a year 1-2 years Over two years 30

31 Advanced use of EMRs can improve health outcomes and patient safety through preventive care and chronic disease management Estimation of Benefits Emerging Benefits Estimation of benefits for the model was limited by: There are inconsistent findings in the literature likely due to variability in maturity of use related to CDM and prevention EMR functionalities Study findings are typically reported in terms of intermediate outcomes (e.g., HbA1C levels) and not long-term outcomes (e.g., mortality, morbidity) 10% increase in mammogram screening rates and 12% increase in cholesterol screening rates 51% of patients with diabetes in EMR-enabled practices received necessary care compared to 7% in practices with paper-based records 10.9% more patients in EMR-enabled practices achieved target HbA1C levels, 11.1% more achieved target blood pressure levels, and 18.1% more achieved target cholesterol levels. Primary care practices with EMRs conducted reviews of all patients (e.g., for medication recall) approximately 30 times more quickly than paperbased clinics.

32 EMRs support proactive management Time to complete six challenges to identify patients who would benefit from evidence-informed intervention: Practices with EMRs are more confident they can contact patients based on reviews to receive evidence-based interventions Estimate based on % of charts reviewed by cut-off times. Source: Liette Lapointe, John Hughes, Raymond Simkus, Michel Lortie, Steven Sanche and Susan Law, McGill University, St.Mary s Hospital and MedBase Research, The Population Health Management Challenge, (2012). 32

33 Advanced use of EMRs can improve health outcomes and patient safety through preventive care and chronic disease management Facilitators Education & Training Leadership & Partnership Workflow & Process Redesign Vendor support & Product Innovation EMR Physician Satisfaction survey reported that 72% of physicians felt they could benefit from more training to advance use of their EMR (Saskatchewan EMR Program, 2012)

34 Manitoba s Physician Integrated Network PIN supports comprehensive, collaborative chronic disease management and preventive practice in primary care EMRs to track a range of primary care clinical process quality indicators PIN sites receive Quality Based Incentive Funding Source: Manitoba s Physician Integrated Network (PIN) initiative, Benefits Evaluation Report, January

35 Improved consistency and comprehensiveness Some of the greatest areas of improvement with PIN: Obesity/Overweight screening Prevention Diabetes Full Fasting Lipid profile screening Nephropathy screening Dyslipidemia screening Colon Cancer screening Fall 2011 Spring % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage of eligible patients (those for whom the test is recommended) who received the specified test or screening Source: EMR extract data from Phase 1 sites; 2008 = 3 sites tracking CDM, 2 sites tracking prevention, 2011 = 4 sites 35

36 Evolving the model of care Additional effort and changing roles in the clinic We have some new admin staff because of PIN. They go over the patient s file at the beginning of the day and see which indicators we need to deal with. They do BMIs and book appointments. PIN Physician A shift in focus Because of the EMR and the PIN headings, we feel now that the everyday promotion of health is brought to the forefront in each patient encounter. Illness prevention and health promotion are now the focus. PIN Physician 36

37 Summary of benefits 1. Community-based practices experience efficiencies in workflow as staff time is redeployed. 2. EMR use results in health system level benefits, such as reduced numbers of duplicate tests and adverse drug events. 3. Advanced use of EMRs can improve health outcomes and patient safety through preventive care and chronic disease management. 4.EMR use supports improved interactions and communications among care team members and between providers and patients.

38 Improved interaction and communication among care team members and between providers and patients Fosters a collaborative team environment Better enables the sharing of comprehensive, legible and accurate patient histories among teams onsite or remotely Allows more opportunity for patient education trending of test results over time

39 Recommendations 1. Continue to increase adoption and maturity of EMRs 2. Support change management and best practices 3. Enhance connectivity and system interoperability 4. Extend applied approaches to population management 5. Address priority research areas

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41 Post Implementation Support Program

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43 Executive Summary and Full Report available at PwC