Disclosures Electronic Health Records in Ophthalmology None Michael V. Boland, MD, PhD Assistant Professor, Wilmer Eye Institute and Health Sciences Informatics Director of InformationTechnology, Wilmer Eye Institute Johns Hopkins University Overview Survey of AAO Members regarding EHRs Adoption Satisfaction Meaningful Use EHRs at Wilmer Past Present Future Survey of AAO Members (2007) 12% of practices were using EHR 69% satisfied/extremely ifid/ satisfied ifid 64% increased or stable productivity 51% stable or decreased costs 76% would recommend their EHR Methods (2011) - Sample Random sample of 1500 AAO members Distributed ib dby zip code E mail sent asking for participation If no response Repeated contact by e mail and phone Methods Survey Practice Demographics Adoption of computerized systems Practice management, documentation (EHR), billing, imaging i Readiness for Meaningful Use Satisfaction if i
Results - Demographics 492 Responses (30%) Practices with ihehr were: Larger than those without (8 v. 4, p<0.001) Less likely to be ophthalmology only (p<0.001) Less likely to be physician owned (p<0.001) Results - Adoption EHR Adoption All Physicians: i 32% Some Physicians: 2% In Process: 13% Within 2 years: 31% More than 2 years: 22% Results - Satisfaction Increased No Change Decreased Unknownn Productivity 11% 31% 31% 27% Costs 40% 14% 5% 41% Would recommend EHR: 55% Satisfaction with Clinical Systems Results - Benefits and s Practice Management (N=463) Realized those with EHR Perceived those without ih EHR EHR (N=243) Image Management (N=367) 40 20 0 20 40 60 Extremely Unatisfied Unsatisfied Neutral Satisfied Extremely Satisfied
Perceived and Realized s to EHR Perceived and Realized Benefits of EHR Loss of productivity * Capital resources * Ease of importing old data * Return on investment * Time to select/contract/implement * Handling medication refills * Access to medical records * Selecting billing codes * Clinical decision making * Training of staff * Medication errors * Ability to integrate imaging * Evaluation of systems * Ability to draw * Willingness of physicians to enter data * NoEH R EHR Costs of transporting medical records * Charge capture Claim submissions NoEHR EHR Support from physicians Transcription costs * Ability to meet practice needs * Physician recruitment Support from staff Support from other providers Ability to integrate with other systems * Cost of medical record storage * Patient communication * Support from administration * Staff costs associated with medical records * Impact on privacy * Work flow * 100 50 0 50 100 50 0 50 50 0 50 100 50 0 50 100 Significant Somewhat of a Unsure Not a Negative Impact Unsure No Impact Positive Impact Meaningful Use As part of the ARRA, congress allocated $27B for EHR adoption The money is to be made available via CMS (Medicare/Medicaid) to: Eligible Professionals (EPs) physicians, optometrists, podiatrists, dentists, chiropractors Hospitals What do you have to do? It will NOT be easy Broad categories of requirements: Collect data electronically Do useful stuff with that data Share data with others (connectivity) Core Objectives (15) Menu Objectives (5 of 10) Meaningful Use - Readiness EHR is Ready 30% Planning for Install or 25% Upgrade Undecided 18% Not Pursuing 18% Not my problem 6% Does not apply 3%
Ophthalmology as a whole EHR adoption by ophthalmology practices has increased from 12% (2007) to 34% (2011) Ophthalmology practices are generally less satisfied with their electronic systems now compared to 2007 More than half of ophthalmologists are pursuing Meaningful Use incentives Electronic Health Records @ Wilmer Sunrise ( POE ) was partially deployed @ Wilmer Glaucoma Plastics Optometry Green Spring Station GES Clinical volume can be maintained Things we learned from Sunrise k per Week Patients 300 400 200 00 2 10 EH HR Before EHR (11041 Patients) After EHR (11897 Patients) Pre loading data into a new system is important 6 12 months of blank screens will be painful Ancillary staff are important The failures of Sunrise were all associated with clinics/providers that have no technicians or inadequate technicians EHR training needs to be focused and rigorous 0 Jul Oct Jan Apr Jul Epic the Company It s Epic Not EPIC Not E.P.I.C. Think poetry an Epic is a complete life story Also explains Haiku (phone app) and Canto (ipad app) and Cadence (scheduling) and Prelude (registration) The girl with kaleidoscope eyes
Epic the Company The Plan Where are we now? Completed deployments @ Wilmer Bayview, Bel Air, Bethesda, Frederick, Green Spring Station, Odenton, White Marsh, Wyman Park Still to come on June 27 Columbia, JHH Clinics Peri operative care will remain a significant gap until JHH goes live now 2016(?)