The Benefits Realization Potential ti of IT in Acute Care Hospitals Uwe Buddrus, Managing Director HIMSS Europe Lederforum, Oslo, 17 October 2013 HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 1
AGENDA Introduction to HIMSS Europe The EMR Adoption Model Key IT Challenges for Improved Patient Care Benefits Realization Potential and Examples EMR Adoption and Physician Satisfaction, Clinical i l performance and Patient t Experience HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 2
INTRODUCTION TO HIMSS EUROPE HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 3
HIMSS GLOBAL non-profit, member-based, mission-driven Conferences & Events (examples) >50.000 individual members 565 corporate members 327 organization affiliates HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 4
HIMSS ANALYTICS IN EUROPE Mission Methods Data collection in hospitals Data Adopted ehospital Census Information Statistical analysis and reports Benchmarking & EMRAM Score Free for Hospitals Intelligence Conclusions Decisions Strategies Successful HIT Adoption HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 5
THE EMR ADOPTION MODEL MODEL ROLE IN EHR AND PHR STATUS IN EUROPE HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 6
THE EUROPEAN EMR ADOPTION MODEL in 7 Stages to Highest Quality in Patient Care Paperless patient record environment for highest quality of care, data continuity & full HIE Full electronic clinical decision support, and highest medication safety Completely electronic diagnostic image management Electronic order entry with decision support and result reporting Clinical ordering and documentation especially nursing us gcare A patient-centered electronic data repository Electronic diagnostic and pharmacy department information HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 7
FROM SILOS TO CARE CHAIN toward truly integrated care coordination & delivery Electronic Patient / Medical Personal Health Record (EPR / EMR) Record (PHR) = GATHER&STORE data =EMPOWER the patient Electronic Health Record (EHR) = SHARE data HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 8
EMR ADOPTION IN EUROPE... based on HIMSS Analytics European EMR Adoption Model EMRAM Scores, % of Hospitals, Q2/2013 (based on data from latest 24 months, no weighting etc. applied) Stage DE ES NL NO* EU* Stage 7 0.3% 0.4% 0.0% 0.0% 0.1% Stage 6 0.0% 3.8% 8.9% 0.0% 1.6% Clinical Decision Support Stage 5 8.9% 40.2% 33.9% 12.5% 15.6% More than IT! Stage 4 2.5% 7.7% 3.6% 0.0% 3.5% Stage 3 6.9% 1.7% 1.8% 0.0% 4.0% Stage 2 32.1% 17.5% 51.8% 87.5% 26.1% Stage 1 1.3% 10.3% 0.0% 0.0% 17.6% Stage 0 48.1% 18.4% 0.0% 0.0% 31.5% Clinical Documentation Key Clinical Departments N 393 234 56 8 1,581 * Please note: data for Norway represents only HSO! Source: HIMSS Analytics Europe Database, Q2/2013 HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 9
MASTERING THE KEY CHALLENGES FOR IMPROVED PATIENT OUTCOMES CLINICAL C DECISION CSO SUPPORT, CLOSED LOOP MEDICATION PROCESS, CHRONIC DISEASE MANAGEMENT HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 10
Clinical Decision Support 3 levels from error checking to pathway optimisation Level Level 1: conflict checking during order entry System, User and Management Requirements Low Level 2: rules engine firing during order entry Medium Level 3: rules engine triggered by physician / clinical documentation proposes pathways High HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 11
Closed Loop Medication Process key components and challenges CPOE and/or e-prescribing Medication orders pass clinical decision support emar Complete medication administration documentation Pharmacy / Nurse Validation of order and dispensing of Unit Doses (e.g. by ADM) PoC Administration Secure identification of nurse, patient and medication at Pointof-Care (PoC) Automated Dispensing Machine (ADM) HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 12
Chronic Disease Management... Healthcare IT in the operational process Datawarehousing, Business Intelligence, Quality Management Screen & enroll Electronic Patient / Health Record (EPR / EHR) Population reporting - process - results Intake - best practice - guidance Devices and Apps, Telemedicine Monitoring - targets - multi- disciplinary - actions -selfmanagement - regular consultations Care Plan Electronic Medical Record (EMR) with care planning and decision support functionalities HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 13
BENEFITS REALIZATION POTENTIAL HIMSS HEALTH IT VALUE SUITE AND `STEPS FRAMEWORK HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 14
HIMSS Health IT Value Suite Health IT Value STEPS Framework 2013 Healthcare Information and Management Systems Society (HIMSS). HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 15
HIMSS Health IT Value Suite first evidence-based data from 500 case studies (globally) HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 16
Benefit Realization Example 1 from speciality department systems and material management (Stage 0/1) Västerås Central Hospital, Cardiology Department, 2013 (Sweden) Benefit described quantified 54.000 Euros Annual operational savings n/a Full analysis of inventory items -33,50% Reduction in average stock levels per quarter 90.000 Euros Savings from reduction in average inventory stock level (in Euros) per quarter 90.000 Euros One-time immediate savings (in Euros) from inventory reduction 4.500 Euros Annual reduction of inventory costs (in Euros) n/a 18.000 EurosDecrease in average hours per week spend on inventory management 32.000 Euros Annual labor expense reduction (in Euros) n/a Inventory re-order form is always available -1,70% Decrease in annual purchasing n/a Fewer inventory items expire before use due to automated tracking Savings from reduction in expired inventory items No clinical benefits just economic HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 17
Benefit Realization Example 2 from digital order-and-result result communication (Stage 3) Onkologikoa San Sebastian Cancer Institute, 2013 Case Study (Spain) Benefit described d quantified 43,0% Reduction in average time between initial evaluation and biopsy 4,0% Reduced average time between diagnosis and start of treatment 36,0% Increase in biopsy report completion 15,0% Reduced surgery report delay Clinical benefits but just related to time to treatment, not to patient safety HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 18
Benefit Realization Example 3 from digital image management, CPOE and CDSS (Stages 4-6) Badalona Healthcare Services, 2013 Case Study (Spain) Benefit described d quantified 9,1% Reduced adverse drug reaction 28,7% Reduced drug interactions 85,0% Decreased time to receive test results 18,0% Increased medication compliance 99,6% PACS reduced duplicate imaging 57,0% CDSS reduced d time from cancer diagnosis i to treatment t t 69,42% Reduced Department of Archives expenses 117,113 Euros Digitalized imaging reduced costs of films and disposable materials 30,000 Euros Diagnostic support system has saved 30,000 Euros/year in diagnostic coding Clinical & economic benefits error reduction, time to treatment,expenses, HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 19
EMR ADOPTION AND PHYSICIAN SATISFACTION, CLINICAL PERFORMANCE AND PATIENT EXPERIENCE HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 20
PHYSICIAN SATISFACTION measured by 26 Standard Questions Quality of patient care Ease of Practice Communication & Collaboration with Leaders Rating Scale 0 = Very Poor 100 = Very Good Data Collection January 1 December 31, 2011 275 U.S. hospitals and 24,879 physicians HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 21
PHYSICIAN SATISFACTION RATINGS the EMR poses serious challenges Likelihood to Maintain Admissions Staff Concerned re: Patients Quality of Care Recommend Facility to Physicians Recommend Facility to Friends/Family Turnaround Time for Radiology Results Quality of Nursing Scheduling IP Tests & Therapies Turnaround Time for Lab Results Physician/Nurse Collaboration Satisfaction with Facility Staff Reports Patients Condition Caregivers Know Patients' Condition Patient Care Made Easier Timeliness on Written Orders Ease of Scheduling OP Surgery Access to Information on Patients Scheduling OP Tests & Therapies Overall Rating of ED Accessibility/Visbility of Admin. Communication with Admin. Overall Rating of IT Treated as Valued Member Responsiveness of Hospital Admin. Admin Seeks Beneficial Solutions Ease of Using EMR Physicians Involved In Decisions 65,1 64,1 62,4 62,3 70,4 69,3 69,0 67,8 84,1 83,3 81,8 81,6 81,1 80,5 79,8 78,9 78,7 78,6 78,1 77,3 76,4 75,7 75,7 75,6 75,5 75,2 74,3 55,0 60,0 65,0 70,0 75,0 80,0 85,0 90,0 Mean Score FAIR GOOD HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 22
PHYSICIAN SATISFACTION WITH HOSPITAL MANAGEMENT RELATIONS BY EMRAM STAGE advanced EMR capabilities challenge the physician - m ment relationship 90,0 on with ollaboratio n Score tion and C dmin. Mean ommunicat Ad Co 85,0 80,00 75,0 70,0 65,0 60,0 55,0 50,0 73,5 76,3 Introduction of Clinical / Nursing Documentation 74,3 66,6 67,2 Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 69,2 63,7 No data available HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 23
PHYSICIAN SATISFACTION WITH EMR BY PHYSICIAN AGE AND TIME OF DEPLOYMENT Time may be the healer Ease of Using EM MR Mea an score MR Ease of Using E Me ean Score 90,0 80,0 70,0 60,0 50,0 90,0 80,0 70,0 60,0 50,0 68,9 61,9 59,7 <35 yrs. 35-49 yrs. 50+ yrs. Physician's Age 63,4 51,4 0-2yrs yrs. 3+ yrs. Years Nursing Documentation Application has been Installed HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 24
PHYSICIAN SATISFACTION WITH ACCESS TO PATIENT INFORMATION O BY EMRAM STAGE immediate increase at Stage 4 90,00 Informatio on on Patie ents Access to 85,0 80,0 75,0 70,0 65,0 60,0 55,0 50,0 73,9 72,3 74,2 73,3 Introduction of CPOE 77,8 78,3 Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 77,1 No data available HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 25
CLINICAL PERFORMANCE AND PATIENT EXPERIENCE measured by the U.S. Value-Based Purchasing (VBP) Program Clinical Performance Score Patient Experience Performance Score Total + = Performance Score 70% 30% TPS 100 = High Value Performance TPS 0 = Low Value Performance HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 26
CLINICAL AND PATIENT EXPERIENCE PERFORMANCE SCORES BY EMRAM STAGE Providers with the most advanced EMR capabilities harness high-tech at the expense of the high-touch 70,00 65,0 64,2 60,0 AVG Sc core 55,0 50,0 45,0 40,0 39,6 53,3 49,0 43,6 43,7 40,8 45,2 44,7 42,1 39,7 45,6 42,6 49,0 40,7 35,0 30,0 Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 EMR Adoption Model Stage 32,3 AVG Clinical Score AVG Satisfaction Score HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 27
SUMMARY OF KEY TAKE-AWAYS and food for discussion EMR adoption has great potential to improve patient safety, economic and clinical performance BUT: is posing multiple challenges beyond technology Process Re-design & Change Management Physician buy-in and satisfaction Patient satisfaction EMR adoption is most likely to stall in EMRAM Stage 2, because of Costs without ROI Unrealized Benefits Impaired management relationship with physicians HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 28
MANAGEMENT ROLE IN SUCCESS What can hospital administrators do to facilitate the changes needed to realize the benefits made possible by the systems? Value Centre NOT Cost Centre = adjusting inputs to optimize output value Sustainable Budget Amplification NOT Defined / Predictable Budget = input = output = stakeholder and asset management Optimized Value / Benefit Realization NOT Total Cost of Ownership Strategic Core Competency NOT Utility or Technology Supplier HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 29
KEY PITFALLS What are the most important/common pitfalls/challenges in the introduction of these systems, and how can they be handled? No strategy, but ad hoc system growth Ivory tower strategy Unrealistic time frames (deployment and life span) Implementation without user involvement Unmanaged expectations HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 30
Uwe Buddrus Managing Director HIMSS Analytics Europe Schwägrichenstraße 9 04107 Leipzig, GERMANY e-mail: ubuddrus@himssanalytics.eu phone: +49 341 333 95 111 For further information visit: www.himssanalytics.eu HIMSS Europe - Benefits Realization Potential of IT in Acute Care Hospitals 31