UAE Progress on the Acute Care EMRAM Prepared by HIMSS Analytics Presented by Jeremy Bonfini
2013 Q3 2013 Q4 Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 2.2% 2.9% Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS 11.1% 12.5% Closed loop medication administration 20.9% 22.0% CPOE, Clinical Decision Support (clinical protocols) 15.1% 15.5% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries - Lab, Rad, Pharmacy - All Installed 31.9% 8.4% 3.5% 30.3% 7.6% 3.3% All Three Ancillaries Not Installed 6.9% 5.8% Data from HIMSS Analytics Database 2012 HIMSS Analytics N = 5437 N = 5458
Outside of North America, Closed Loop Medication Administration is in Stage 6 and Radiology PACS is in Stage 5 We switched them to more reflect the market
Middle East EMR Adoption Model SM Stage Stage 7 Stage 6 Stage 5 Stage 4 Stage 3 Stage 2 Stage 1 Stage 0 Short Description Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP Physician documentation (structured templates), full CDSS (variance & compliance), closed loop medication administration Full complement of R-PACS displaces all film-based images CPOE, Clinical Decision Support (clinical protocols) Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology Clinical Data Repository (CDR), Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries Lab, Radiology, Pharmacy All Installed All Three Ancillaries (LIS, RIS, PHIS) Not Installed Data from HIMSS Analytics Database 2013 HIMSS Analytics
Middle East EMR Adoption Model SM, Abu Dhabi Hospitals Stage Short Description 20 AUH Hospitals Stage 7 Stage 6 Stage 5 Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 0% Physician documentation (structured templates), full CDSS (variance & compliance), closed loop medication administration 55% Full complement of R-PACS displaces all film-based images 15% Stage 4 CPOE, Clinical Decision Support (clinical protocols) 0% Stage 3 Stage 2 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 10% Clinical Data Repository (CDR), Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable 10% Stage 1 Ancillaries Lab, Radiology, Pharmacy All Installed 10% Stage 0 All Three Ancillaries (LIS, RIS, PHIS) Not Installed 0% Data from HIMSS Analytics Database 2013 HIMSS Analytics
Middle East EMR Adoption Model SM - Dubai Hospitals 2011 2012 Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 0.0% 0.0% Physician documentation (structured templates), full CDSS (variance & compliance), Closed Loop Med Admin Full Complement of Radiology PACS 0.0% 0.0% 0.0% 7.4% CPOE, Clinical Decision Support (clinical protocols) 4.3% 7.4% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries Lab, Rad, Pharmacy All Installed 4.3% 30.4% 39.1% 3.7% 37.0% 33.3% All Three Ancillaries Not Installed 21.7% 11.1% Data from HIMSS Analytics Database 2012 HIMSS Analytics N = 23 N=27 6
The Payoff on Investment Occurs at the Upper Stages Investments in Stages 2 through 5 are like a construction project Messy Complicated Setbacks, errors Frazzled Stage 6 begins to have payoffs Stage 7 truly stands out as having ROI
We Are Making Progress 30.00% % DHA Hospitals at Stage 4+ 25.00% 25.0% 20.00% 15.00% 14.8% 10.00% 5.00% 4.3% 0.00% 1 2 3 2011 2012 2013
All hospitals within each EMRAM Stage Representation of TJC Top Performing Hospitals BY Number of Quality Metrics Excelling In, within each EMRAM Stage 50.0% 45.0% 39.8% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 20.7% 18.1% 30.1% 16.3% 12.9% 10.6% 12.8% 6.5% 6.2% 10.0% 2.3% 6.4% 6.4% 1.7% 10.1% 8.1% 4.8% 4.2% 6.5% 7.9% 9.7% 0.4% 1.9% 0 1 2 3 4 5 6 7 EMRAM Stage 3 or less 4 or more Source: HIMSS Analytics
All hospitals within each EMRAM Stage Representation of Hospitals with an "A" Leapfrog Hospital Safety Grade by EMRAM Stage 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 62.6% 30.8% 20.1% 21.8% 12.8% 14.3% 5.9% 0.0% Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
*Program from U.S. Medicare to earn additional reimbursement 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
AVG Clinical Score Value-based purchasing (vbp) projected Clinical score 70.0 65.0 60.0 Tipping Point 64.3 55.0 50.0 45.0 Tipping Point 45.5 44.6 45.9 45.9 42.7 49.0 40.0 38.9 35.0 30.0 Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 EMR Adoption Model Stage
So, What is This Saying? Government incentives seems to be helping grow healthcare IT investment Without incentives, progress will be much slower Not just money, but incentives and disincentives Quality Safety Efficiency 13
Some Real Benefits from Stage 7 Health Care Systems Prepared by HIMSS Presented by Jeremy Bonfini
SOME CLINICAL & PROCESS IMPROVEMENTS OF STAGE 7 HOSPITALS
Legacy Health Reduction in Transcription Costs
Legacy Health 62% Reduction in Hospital Acquired Infections
Rules & Alerts Drive Best Practices
Improvements in Immunizations: 77% to 97%
Frequent Fliers in the Emergency Department (more than 7 visits in 6 months) Through proactive case management reduced visits in target population by 50%
Obtaining HA1C Testing in Office
Mammogram Protocol Conformance 55% to 71% in 1 year
Overall, Where are the Benefits Coming From? Benefit N of Organizations Decreased transcription costs 23 Improved documentation quality 22 Decreased cost of paper forms and storage 16 Reduced medication errors or adverse drug events 16 Clinical cost reduction 13 Reduced staffing 10 Improved reimbursement inpatient or outpatient 9 Increased use of preventive care 8 Reduction in drug use and/or cost 7
HOW ABOUT OPERATING MARGIN BY EMRAM STAGE?
Average Operating Margin Source: HIMSS Analytics TM Database Trends: EMR Adoption Profitability By Stage for 2008 and 2011, 2013 7.00% 6.00% 6.19% 5.00% 4.00% 3.53% 4.06% 3.91% 4.91% 3.00% 2.00% 1.00% 0.00% -1.00% -2.00% 1.62% -1.52% 0 (2008 N = 392; 2011 N=225) 2.84% 2.25% -0.43% -0.34% -0.58% 1 (2008 N = 354; 2011 N=171) 2.35% 1.53% 0.77% 2 (2008 N = 850; 2011 N=400) 2.56% 2.32% 1.79% 1.47% 3 (2008 N = 1060; 2011 N=1303) 4 (2008 N = 88; 2011 N=369) In 2008 In 2011 2013 2.55% 1.66% 5 (2008 N = 55; 2011 N=202) 2.52% 2.20% 6 (2008 N = 48; 2011 N=144) 7 (2008 N = 0; 2011 N=13)
HOW ABOUT HOSPITAL EFFICIENCY BY EMRAM STAGE?
Oh, You Wanted to Know About the Ambulatory EMRAM?
Ambulatory EMR Adoption Model SM US HIE capable, sharing of data between the EMR and community based EHR, C&BI Advanced CDS, proactive care management, population health management Patient portal and patient engagement CPOE, physician documentation with CDS, external data exchange Nursing documentation with CDS, E-prescribing 1.23% 3.62% 6.73% 0.97% 8.72% CDR, access to results from outside facilities Access to clinical information, unstructured data, multiple data sources Paper chart based 24.55% 5.27% 48.91% N = 20,529
Noteworthy on A-EMRAM 16 organizations have earned Stage 7 Representing over 1,100 locations Some stellar examples of patient engagement (Stage 5) Reducing CHF readmission rates by 40% Improving asthma protocol adherence from 17% to 78% Competing cohorts on weight loss Two examples of multi vendor PHRs
30 Employee Satisfaction
Proof that good planning works
P4P Outcomes BP Interventions
PROBLEM: The total economic burden of diabetes in the United States is estimated at $245 billion, a 41% increase from 2007 1 Reliant s Diabetes HbA1c Screening Rate and Control Rate did not change significantly with EHR implementation 1. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033 1046.
Yes, Stage 7 sites are driving significant benefits. HIMSS Analytics requires candidates to present at least three case studies of quality and efficiency improvements both inpatient and outpatient services
Yes, Stage 7 sites are driving significant benefits. HIMSS Analytics requires candidates to present at least three case studies of quality and efficiency improvements both inpatient and outpatient services
Jeremy Bonfini Executive Vice President, HIMSS International jbonfini@himss.org