e-health Conference May 29, 2013 Rome, Italy Electronic Medical Record Adoption Rates: Italy, Europe, United States, Middle East, Asia Comparisons

Transcription

1 FORUM PA and HIMSS present e-health Conference May 29, 2013 Rome, Italy Electronic Medical Record Adoption Rates: Italy, Europe, United States, Middle East, Asia Comparisons Sotto l Alto Patronato del Capo dello Stato, Presidenza della Repubblica Italiana John P. Hoyt Executive Vice President HIMSS Analytics PATRONAGES SPONSORS SUPPORTING PARTNER MEDIA PARTNER

2 e-health Conference May 29, 2013 Rome, Italy Learning Objectives Understand the HIMSS Analytics EMR Adoption Model (EMRAM) Compare Italy to other leading nations in EMRAM Understand some of the benefits of advanced EMR adoption

3 HIMSS Analytics European EMR Adoption Model Stage Short Description Europe Stage 7 Complete EMR; CCD to share data; Data warehousing for quality assurance, and business intelligence; Data continuity with ED 0.1% Stage 6 Physician documentation with CDSS, Closed loop medication administration 1.4% Stage 5 Radiology PACS, filmless 14.9% Stage 4 CPOE (i.e. eprescribing); CDS based on clinical protocols 2.8% Stage 3 Nursing/clinical documentation PACS available outside Radiology 4.0% Stage 2 Stage 1 Clinical Data Repository (CDR) Clinical Decision Support (CDS) for basic conflict checking Ancillaries Lab, Radiology, Pharmacy All Installed OR processing LIS, RIS, PHIS data output online from external service providers Stage 0 All Three Ancillaries (LIS, RIS, PHIS) Not Installed OR Not processing Lab, Radiology, Pharmacy data output online from external service providers 27.2% 18.8% 30.7% Institutions with valid EMRAM score (based on data from last 24 months, status as of Q1/2013) 1,354

4 e-health Conference May 29, 2013 Rome, Italy Why Does HIMSS Analytics Collect IT Adoption Data? Thought Leadership Research on maturity vs. QSAE (quality, safety, efficiency) Predict where the market is going Serve vendors, consultants Inform government policy decisions

5 e-health Conference May 29, 2013 Rome, Italy Why Does HIMSS Analytics Collect IT Adoption Data? Push the Market Participating Hospitals Practices receive: Their EMR Adoption Model Score Access to the HIMSS Analytics Benchmarking tool consisting of peer comparison reports assists in: IS strategy development Identifying opportunity for investment Improving competitiveness

6 Cross Regional EMRAM Score Distribution, 1 st Q, 2013 Stage Asia Pacific Middle East United States Canada Europe Stage 7 0.2% 0.0% 1.9% 0.0% 0.1% Stage 6 2.2% 7.1% 9.1% 0.5% 1.4% Stage 5 5.3% 14.2% 16.3% 0.3% 14.9% Stage 4 3.0% 5.3% 14.4% 2.2% 2.8% Stage 3 0.4% 19.5% 36.3% 33.6% 4.0% Stage % 19.5% 10.1% 26.9% 27.2% Stage 1 6.1% 13.3% 4.2% 14.8% 18.8% Stage % 21.2% 7.8% 21.7% 30.7% Data from HIMSS Analytics Database N = 508 N = 113 N = 5,441 N = 640 N = 1,354

7 Cross Country EMRAM Score Distribution 1 st Q, 2013 Stage United States Canada Germany Poland Portugal Spain Netherlands Italy Stage 7 Stage 6 Stage 5 Stage 4 Stage 3 Stage 2 Stage 1 Data from HIMSS Analytics Database Stage 0 1.9% 0.0% 0.3% 0.0% 0.0% 0.5% 0.0% 0.0% 9.1% 0.5% 0.0% 0.0% 0.0% 4.3% 3.8% 0.6% 16.3% 0.3% 8.3% 0.0% 26.1% 40.9% 34.6% 6.6% 14.4% 2.2% 1.9% 0.7% 4.3% 6.7% 3.8% 1.8% 36.3% 33.6% 8.3% 0.0% 21.7% 1.9% 1.9% 3.4% 10.1% 26.9% 34.9% 10.3% 4.3% 18.8% 55.8% 26.7% 4.2% 14.8% 0.6% 13.0% 4.3% 9.6% 0.0% 41.4% 7.8% 21.7% 45.7% 76.0% 39.1% 17.3% 0.0% 19.5% N = 5,441 N = 640 N = 324 N = 146 N = 23 N = 208 N = 52 N = 498

8 Cross Country EMRAM Score Distribution 1 st Q, 2013 Stage United States Australia Malaysia Singapore United Arab Emirates Saudi Arabia Italy Stage 7 1.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Stage 6 9.1% 0.0% 0.5% 57.1% 12.8% 3.0% 0.6% Stage % 3.7% 4.7% 14.3% 14.9% 13.6% 6.6% Stage % 0.9% 2.8% 14.3% 4.3% 6.1% 1.8% Stage % 0.5% 0.5% 0.0% 6.4% 28.8% 3.4% Stage % 51.6% 1.9% 14.3% 25.5% 15.2% 26.7% Stage 1 4.2% 4.6% 1.4% 0.0% 21.3% 7.6% 41.4% Data from HIMSS Analytics Database Stage 0 7.8% 38.7% 88.2% 0.0% 14.9% 25.8% 19.5% N = 5,441 N = 217 N = 212 N = 7 N = 47 N = 66 N = 498

9 COUNTRY COMPARISON - NURSING DOCUMENTATION

10 COUNTRY COMPARISON - emar

11 COUNTRY COMPARISON - eprescribing

12 COUNTRY COMPARISON - CPOE

13 COUNTRY COMPARISON - PHYSICIAN DOCUMENTATION

14 COUNTRY COMPARISON - PHARMACY BAR CODING

15 COUNTRY COMPARISON DATA WAREHOUSING - CLINICAL

16 CLOSED LOOP MEDICATION ADMINISTRATION Big Challenge Outside U.S.A.

17 e-health Conference May 29, 2013 Rome, Italy The Closed Loop Medication Administration Process 1. Physician enters the medication order directly allows for CDSS interaction 2. Pharmacist verifies the order 3. Pharmacist dispenses a bar coded unit dose medication or prepared compound 4. Positive patient ID barcode on wristband or RFID 5. Positive medication ID with bar code on the unit dose medication 6. Verification of the five rights

18 CLOSED LOOP MEDICATION ADMINISTRATION emar is updated and available for review 1 2 Medication orders that pass CDSS flow to Pharmacy EMAR CPOE 4, 5, 6 Nurse scans patient ID and medication for five rights CDSS POC Administration Nurse retrieves medication from ADM and takes it to patient ADM Pharmacy 18 3 Pharmacy validates order and dispenses medication to ADM or floor

19 AND WHAT VALUE IS DERIVED? 60% of errors from prescribing & transcribing 1 26% of errors from administration 1 14% of errors from dispensing 1 1 D W Bates, D J Cullen, N Laird, et al., Incidence of Adverse Drug Events and Potential Adverse Drug Events: Implications for Prevention, JAMA, 247 (1995), pp

20 e-health Conference May 29, 2013 Rome, Italy Other Citations With bedside scanning rates of 87%+, an academic medical center in the U.S. decreased their medication errors from 1.2 to 0.3 errors per 1,000 patient days, a 75% reduction 1. With the implementation of CPOE, pharmacist verification and CLMA, order-to-administration times of IV antibiotics experienced a reduction of 1.18 hours (p < ) per order 2. CPOE, electronic dispensing and barcode patient identification reduced prescribing errors by 47% and MAEs by 37%, and increased time spent on medication-related tasks

21 CLOSED LOOP MEDICATION ADMINISTRATION - A KEY ELEMENT OF PATIENT SAFETY IMPROVEMENT 21 Source: Effect of Bar-Code Technology on the Safety of Medication Administration; Poon, Keohane, Bates, Lipsitz, et al, New England Journal of Medicine, 2010;362: , May 6, 2010

22 e-health Conference May 29, 2013 Rome, Italy Summarization Use technology to create a culture of performance excellence Design performance improvement goals into the implementation Define the problems you are trying to solve Standardize care using best practices built into documentation and order sets for specific high risk diagnoses Management by walking around Get out onto the wards to see systems in use, listen to users Encourage, encourage, encourage Measure before & after This is your only chance to measure the effects of system implementation

23 John P Hoyt Executive Vice President HIMSS Analytics jhoyt@himss.org