Enhancing EMR Value Through Collaboration: HIM and IT CTHIMA Meeting August 14, 2016 Carol R Selvey, MHSA, FHIMSS, FACHE
Learning Objectives Recognize opportunities for HIM to enhance skills through collaboration with IT, transforming its role in the healthcare enterprise Examine research indicating that the most successful EMR adoptions occur when HIM plays a greater role in the implementation Recognize stages of electronic medical record functionalities improving care delivery processes (as defined by the HIMSS EMR Adoption Model) Introduce the Continuity of Care Maturity Model
Shared Vision IT HIM Better health through information technology
HIM Involvement in EHR Implementations Percent of HIM professionals involved in EHR implementations, by role EHR Implementation Factor % Involved Manage amendments to records 69% Participate in document improvement program 67% Serve on EHR steering or comparable committee 61% Test legal admissibility of records 50% Design or revise reports 50% Participate in development of EHR functionality specifications 49% Serve as EHR project manager or on project management team 44% Audit changes in electronic documentation for correctness 39% Participate in quality improvement programs 39%
Early Adopter Hospital Findings Early adopters recognized the essential role HIM could play in the implementation of Electronic Medical Records especially in these key areas: Document Management essential need to integrate paper documents with electronic data (scanning) Patient Care Charting affinity for data quality provided exceptional partner to provide design, workflow and auditing expertise (coding and regulatory knowledge) Computerized Order Entry- data quality management Correlation between HIM involvement and better/best outcomes
Correlation between HIM Involvement and EHR Success EHR Functionality Best Outcomes* *System use that met or exceeded benchmarks as defined by the study **System use did not meet benchmarks of system use Document Management (N=265) 85% 38% 62% Workflow or process improvement in HIM department 95% 75% Responsible for paper record retention following adoption of system 90% 81% Workflow or process improvement in clinical care setting 70% 46% Responsible for implementing and training for system 69% 54% Responsible for planning or selecting system vendor 50% 42% No role 0% 3% Other Outcomes** Patient Care Charting (N=270) 86% 60% 40% Active participant in data quality management 52% 35% Active participant in workflow and process improvement 50% 44% Active participant in planning and selecting the system 33% 36% Active participant in designing screens and templates 28% 29% No role 20% 31% Computerized Provider Order Entry (N=243) 78% 17% 83% Active participant in data quality management 42% 27% No role 42% 50% Active participant in workflow and process improvement 37% 23% Active participant in planning and selecting the system 15% 22%
Meaningful Use (MU) Stages Stage 1: Meaningful use criteria focus on Data Capture and Sharing** Electronically capturing health information in a standardized format Stage 2: Meaningful use criteria focus on Advance Clinical Processes More rigorous health information exchange (HIE) Stage 3: Meaningful use criteria focus on Improved Outcomes Improving quality, safety, and efficiency, leading to improved health outcomes Using that information to track key clinical conditions Increased requirements for e-prescribing and incorporating lab results Decision support for national high-priority conditions Communicating that information for care coordination processes Electronic transmission of patient care summaries across multiple settings Patient access to self-management tools Initiating the reporting of clinical quality measures and public health information More patient-controlled data Access to comprehensive patient data through patient-centered HIE Using information to engage patients and their families in their care Improving population health
MU Collaboration and the Digital Shift The quest for MU achievement brought the value of HIM skills and collaboration with IT into view in several areas: Data integrity assurance (accuracy and consistency of content) Effective management of referral data (through Health Information Exchange, Secure Health Messaging or E-Fax) Patient Portal assistance and proactive management of confidentiality and privacy and participation in Health Information Exchange (HIE) development Integrating voice recognition software and reducing transcription Overall life cycle management of patient medical record policy transparency and ethical stewardship
Digital Shift Stages New Skills HIM Stages: Reliance on Paper Records Transitional Hybrid System Electronic Medical Record integration Skills migrate from clerical to digital focus Filing to Indexing and Scanning Data integrity coaches Data analytics and knowledge of technological trends
Common Objective Ensure the most relevant clinical information is available to the clinician at the right place and at the right time
Purpose of Adoption Model Thought leadership Quality, Safety, Efficiency improvements To reflect the market Where is the market heading To inform government policy Contributor to architecture of Meaningful Use program Used around the world to gather data for policy formulation To drive the market A useful roadmap for CIOs, governance boards, public policy
ARRA Q2 2009 2015 Final Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 0.3% 4.2% Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS 1.0% 27.1% Closed loop medication administration 4.5% 35.9% CPOE, Clinical Decision Support (clinical protocols) 3.6% 10.1% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable 38.4% 31.6% 16.4% 2.6% Ancillaries - Lab, Rad, Pharmacy - All Installed 7.2% 1.7% All Three Ancillaries Not Installed 13.4% 2.1% Data from HIMSS Analytics Database 2015 2016 HIMSS Analytics N = 5167 N = 5460 12
Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP Q2 2011 MU Payments 2015 Final 1.1% 4.2% MU Stage 3* Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS Closed loop medication administration 4.0% 6.1% 27.1% 35.9% MU Stage 2 CPOE, Clinical Decision Support (clinical protocols) 12.3% 10.1% MU Stage 1 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 46.3% 16.4% CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable 13.7% 2.6% Ancillaries - Lab, Rad, Pharmacy - All Installed 6.6% 1.7% All Three Ancillaries Not Installed 10.0% 2.1% Data from HIMSS Analytics Database 2015 HIMSS Analytics N = 5441 N = 5490 13
Ambulatory EMR Adoption Model SM HIE capable, sharing of data between the EMR and community based EHR, business and clinical intelligence Q2 2012 Q2 2015 0.00% 7.40% MU Stage 3* Advanced clinical decision support, proactive care management, structured messaging 1.20% 9.17% Personal health record, online tethered patient portal 0.04% 7.93% MU Stage 2 CPOE, Use of structured data for accessibility in EMR and internal and external sharing of data 0.41% 0.99% MU Stage 1 Electronic messaging, computers have replaced the paper chart, clinical documentation and clinical decision support 10.92% 12.03% Beginning of a CDR with orders and results, computers may be at point-of-care, access to results from outside facilities 34.10% 24.68% Desktop access to clinical information, unstructured data, multiple data sources, intra-office/informal messaging 5.29% 33.98% Paper chart based 48.04% 3.82% Data from HIMSS Analytics Database 2015 HIMSS Analytics N = 9,247 N = 34,115 14
Patient Portals The use of patient portals by tethered ambulatories has increased by over 15 percentage points since 2012 Data from HIMSS Analytics Database 2015 HIMSS Analytics Total N size for each year is based on number of tethered ambulatories scored in the A-EMRAM; this is the number of ambulatories answering the ambulatory EMR function questions asked in the HIMSS Analytics Database.
Summary Profile of a Stage 6 and 7 Organization Use data to drive improved outcomes related to Process, Financial, Clinical, Quality & Safety Are paperless, or near paperless (create no paper) All clinically relevant data is in the EMR Are fully committed to continuous process improvement through collaboration Strong IT leadership and executive champions Clinician / end-user champions
Representation of Hospitals with an "A" Leapfrog Hospital Safety Grade by EMRAM Stage Source: HIMSS Analytics
Financial Performance (Profitability) Source: HIMSS Analytics
Stage 7 Is Just The Beginning!! So, What s Next?
The Industry Challenge Continuity of care
What is Continuity of Care? Citizens perspective Non-disruption of care provided to a patient throughout his/her care journey, across care settings and care givers Industry perspective Alignment of healthcare resources across care settings orchestrated in a way that delivers the best healthcare services and value possible for a defined population under your care
Ultimate Objective A multidimensional approach to continuity of care
Continuity of Care Maturity
This is NOT an IT project A multi-stakeholder roadmap Administrators CEO/COO/CFO/ CSO/CPO Clinical/Medical Leaders CMIO/CNO/CNIO Technology & Information Leaders CIO/CPO/HIM
References Article citations: Fenton, Susan H.; Amatayakul, Margret; Work, Mitch. "HIM Impact on EHRs: Newly Released Study Links HIM Professionals and Successful EHR Implementations." Journal of AHIMA 77, no.9 (October 2006): 36-40. Eramo, Lisa A. Hello EHR, Good-Bye HIM? Rethinking the Role of HIM Professionals in an Electronic Environment. For The Record, Vol. 25 No. 5 P. 18 (March 2013) Dimick, Chris. "Health Information Management 2025: Current Health IT Revolution Drastically Changes HIM in The Near Future" Journal of AHIMA 83, no.8 (August 2012): 24-31. Cassidy, Bonnie, and Susan P. Hanson. "HIM Practice Transformation." Journal of AHIMA 76, no.5 (May 2005): 56A-B. Online EHR Incentives & Certification resource: https://www.healthit.gov/providersprofessionals/how-attain-meaningful-use
THANK YOU Carol R Selvey, MHSA, FHIMSS, FACHE Vice President, First Health Advisory cselvey@fcp.com