MANAGING THE TIDES Sean Lunde June 7, 2012 1
Up to 50% of all EMR implementations fail. 2 2 Keshavjee K. Best Practices in EMR Implementation: A Systematic Review. In: ; 2006. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc1839412/ Sean Lunde June 7, 2012 2
Most physicians work in the places least likely to have EMR Systems EMR SYSTEMS IN SMALL PRACTICES 100% 80% 100% Large practices and facilities 60% 40% Small practices 20% 0% Employment place 1 Lee J, Cain C, Young S, Chockley N, Burstin H. The Adoption Gap: Health Information Technology In Small Physician Practices. Health Aff. 2005;24(5):1364-1366. 18% Small practices with EHR system* Sean Lunde June 7, 2012 3
Best practices were developed by combining existing research with the experiences of CIOs and physicians in the trenches Literature Review Sean Lunde June 7, 2012 4
Deciding to Adopt Decision to Adopt Vendor & Product Selection Implementation Value Add Evaluation Have a clear concept of what you want to get from your EMR Find a physician champion Realize that EMR adoption is a complex, difficult process Talk with other physicians and consult available resources Consider all costs Sean Lunde June 7, 2012 5
Selecting a Vendor and Product Decision to Adopt Vendor & Product Selection Implementation Value Add Evaluation VENDOR SELECTION PRODUCT SELECTION Select a vendor based on your practice s needs Get help with your contract Local knowledge: ensure software is interoperable within your community Investigate interfaces with labs, pharmacies, etc. Check with your local Health Information Exchange to ensure interoperability Investigate data abstraction ability for current paper charts Consider a hosted or ASP model to control costs and upkeep All stakeholders should be considered Choose a comfortable interface Easy access to commonly used information Simple E-prescribing Remote login feature Ability to communicate with billing system Ability to easily export and manipulate reports External: P4P, regulatory, etc. Internal: Patient reminders, practice evaluation Sean Lunde June 7, 2012 6
Deciding to Adopt Decision to Adopt Vendor & Product Selection Implementation Value Add Evaluation Examine Workflow Get assistance Use the EMR implementation process to fix broken processes. Prepare for productivity loss Hire a project manager to ease the pain All stakeholders should be considered Realize that traditional roles will change Sean Lunde June 7, 2012 7
Use your EMR implementation to add value Decision to Adopt Vendor & Product Selection Implementation Value Add Evaluation INCREMENTAL-STEP APPROACH 1. Begin with E-prescribing 2. Expand by eliminating dictation 3. Eventually, go fully paperless SHOOT AND ADJUST FIRE Complete initial implementation plan with technology consultants Build a service plan that incorporates additional customization using an agile approach over an extended period of time. Sean Lunde June 7, 2012 8
EMR implementation requires fundamental business changes Ongoing technical support is needed Small practices to not require full-time technical support, but cannot easily hire partial employees Meaningful Use requires high levels of community participation Data must be easily accessed and shared by all parties Standardization is necessary Advanced features are not economical in the current EMR business model Sean Lunde June 7, 2012 9
Business implications of EMR adoption in small to mid-sized practices Issue High costs of EMR systems Lack of standards Added value Not Realized Possible Outcome Practices consolidation ASP Hosting Independent EMR support organizations Practices sacrifice customization for improved data standardization Outside forces, such as insurance companies or government regulation dictate standards New, user-defined tools created Rising healthcare costs demand innovation Physicians that can analyze data will become the new leaders in healthcare Sean Lunde June 7, 2012 10
Concluding thought: On the one hand, current EMR systems are complex and near unaffordable for many practices. On the other hand, a disruptive technology could change the current landscape. Sean Lunde June 7, 2012 11