Presentation is loading. Please wait.

Presentation is loading. Please wait.

Adoption of Electronic Healthcare Records

Similar presentations

Presentation on theme: "Adoption of Electronic Healthcare Records"— Presentation transcript:

1 Adoption of Electronic Healthcare Records
Alexander Flores Arin Halicki Tiangan Lian Damien Mar Chong Mahesh Seethraman

2 Solution: What can EHR do for you?
Introduction State of US Healthcare Rising Costs Quality of Care Recent Legislation Public good, Damien will talk about it later Solution: What can EHR do for you?

3 Network Good EHR is a Network good with it’s own delicate eco-system…. Benefits Insurance Companies Patients Medical Groups EHR (platform) EHR is a Network good (talk about what benfits they derive) describe as eco-system…. Patient Doctors (can have flexibility, who afflilate with and how run practice) Hospitals (labs, billing, emergencies) Payers ( insurance companies, claims management) Government – no “benefit” – relatively new player but doesn’t’ derive true value Insurance companies authorize the different procedures, in that sense, they are more closely associated with the patients and doctors than they are with medical groups themselves * Government supports the network/platform w/ subsidies - but the benefits derived from the network is questionable. (Govt. is the largest provider of medicare and medicaid, so they derive a big benefit from the network) Doctors Hospitals Government Benefits

4 Interoperability and Scalability Can Drive EHR Success
EHR Platforms Different versions Formats Language Service offerings Different pricing models Size Bundles Incentives EHR as a concept/platform provides benfefits to rest of network. Platforms Different versions Formats Language (CCHIT, HL7) Service offerings Different pricing models Size Based - Scalability Wide Variety of Schemes (Take Cost links/data from Wiki page) Interoperability and Scalability Can Drive EHR Success

5 Language/ Interoperability
Products Scalability / Cost Language/ Interoperability EPIC Systems Corporation Ambulatory & Inpatient Specialties / Departments / Ancillaries Health Information Management (HIM) Medical Groups to Practices or Organizations of any Size Health Level Seven (HL7 ) ANSI X12 XML Allscripts-Misys Healthcare Solutions, Inc. Practice Mgmt Systems Electronic Prescribing Document Imaging Patient Access Individual Practices to Practices or Organizations of any size CCHIT Certified Open Source Connect written in Java Cerner Corporation Hospitals /Health Systems Private Practice Pharmacy Employers Home Care Services & Devices The Digital Imaging and Communications in Medicine (DICOM) GE Healthcare Peer Vision Processing & Planning Integrating the Healthcare Enterprise (IHE™)

6 What’s driving EHR adoption?
American Recovery and Reinvestment Act of 2009 2011 – 2015 scaled payment incentives to hospitals and physicians By 2015 scaled reimbursement penalties from Medicare plus escalation Reporting treatment outcomes and other metrics Physician Quality Reporting Incentives (PQRI) State Reporting Requirements eg. CA DMHC/OPA/OSHPD Pay for performance Improved Quality – error reductions Cost reduction We spend more than OECD nations in healthcare as a percent of GDP but with lesser doctors, professionals, hospitals etc…Per capita we spend more and we are measured last in quality by Commonwealthfund. $80billion savings.

7 Top Motivating Factors for EHR Adoption (75% of Hospitals)
Share patient-record info among healthcare practitioners and professionals Improve clinical processes or workflow efficiency Reduce medical errors; improve patient safety Improve quality of care State and Pattern of HIT Adoption, RAND, 2005

8 Factors Influencing EHR Adoption
System-level factors Regional factors Hospital type Hospital-bed-size Medicare and Medicaid Physician practice and size

9 By System-Level Factors
Importance of Network Externalities in the decision to adopt HIT. Network Externalities – the value of technology investment for the provider depends on whether other providers have adopted this technology. The majority of community hospitals belong to multi-hospital systems; thus, their adoption behavior is related to their system’s adoption behavior. MSA – Metropolitan Service Area EMR – Electronic Medical Records CPOE – Computerized Physician Order Entry PACS – Picture Archiving Communications System (e.g., Radiology)

10 By Regional Factors Key takeaway: Systems with up to 5 hospitals is likely to adopt HIT than systems with more than 5 hospitals. Why? - The investment might become more difficult to coordinate as the hospital system gets larger.

11 By Hospital Type Academic and Pediatrician hospitals – why?
Academics – easy Pediatrics – Higher benefits of EMR and CPOE while caring for children (i.e., children are not as reliable a source of their medical histories, medications, etc., as adults) Critical Access – tiny size and rural location; offer limited range of services Long-term – small size; exempt from Medicare payment system which is a drive in increasing adoption of HIT

12 By Hospital-Bed-Size Category

13 By Medicare Hospitals with majority of patients’ claims paid by Medicare are less likely to adopt EMR. Why? Lower reimbursement rates of Medicare compared with other insurers explains, at least in part, its negative effect on hospital investment in HIT.

14 By Medicaid Hospitals with a large share of Medicaid patients are generally considered disadvantaged and often receive grants and other financial help, which could be devoted to HIT investment.

15 By Practice and Size Size effect is very important in the ambulatory clinics. Practices with over 30 physicians are 3 times as likely to adopt an EMR system as is a solo practitioner. Leaders in EMR adoption in ambulatory practice are multi-specialty clinics. They are larger organization and have financial resources; and there is greater organizational value to be derived in exchanging info among doctors in multi-specialty clinics.

16 Barriers to EHR Adoption
Older Records Costs of conversion Ownership Other challenges (Tech/Human) Patient rights & Privacy HIPAA regulations Digital security Theft of information Significant investment needed to convert old paper records to ehr How do we do it ? Scan them in ? Type ‘em in anually ? What about human / machine errors that may be introduced during this process Whose responsibility is it to upload all this info from the past into an Ehr Whose responsibility is it to payfor the capacity needed to store all the past information ? HIPAA rights – even if the patient is not part of your network. How can you provide 24x7 access, if you don’t invest in infrastructure How long do you have to keep the data if the patient is not part of your network ? How do you ensure that the only authorized personnel view patients’ records How do you validate authentication to a requestor, that the patient authorized it ? What legal consequences / preventive mechanisms does a hospital/clinic need to put in place ? What do you do when the info is available 24x7, with a higher probablity of theft due to hacking ?

17 Barriers to EHR Adoption
Other reasons Lack of support from medical staff Resistance to change One system does not fit all needs Fragmentation & customization ROI impact Why this lack of progress in ehr, even though it was proposed in the 60s Technological back seat? Resistance to change, Customization – costly process, exposes inefficiencies in the existing process, Hospitals have to change their routine – retraining, reduction in productivity in the earlier stages of adoption State and Pattern of HIT Adoption, RAND, 2005

18 Barriers to EHR Adoption
Interoperability Synchronization Hardware Costs Who pays for it Startup costs Maintenance costs Hardware – High fixed costs Process change Many systems for EHR, billings, admissions, discharges, prescribing. For example, there’s EPIC, Eclipsys, GE, AllScripts systems. And then on top of that someone might EPIC for billings but Eclipsys for EMR. Cannot communicate across other systems in other hospitals or clinics. So hospitals and doctors may hesitate to invest if their systems may not communicate with one another. Hardware compatibility, if moving systems. There are many players and many health plan payers. How to get them to pay in? Big startup costs. $10,000’s to $millions. Ongoing maintenance costs for small facilities might be high. High fixed costs. 18

19 Recommendations Single payer system Create interoperability standard
Public-private ownership for patient information Financial incentives for EHR Adoption Leasing of EHR solutions or SaaS Pay for performance Free/Subsidized basic System Train new healthcare practioners about EHR. At Medical schools Single payer system Federal gov’t subsidizes a basic system ViSTA Create interoperability standard CCHIT certification with HITSP standard Government oversight Public-private partnership/RHIOs California eHealth Collaborative Public-private ownership that addresses who owns the patient information Leasing of EHR solutions Lower Setup costs. SaaS - NextGen Providing financial incentives to hospitals, clinics, etc.. Go into academia and train new physicians about EHR.

Download ppt "Adoption of Electronic Healthcare Records"

Similar presentations

Ads by Google