1. Selecting an EHR System Mohtaram Nematollahi,PhD Health Information Management

2. Expected Benefits of EHRs Reduce adverse drug events, medical errors, and redundant tests and procedures Reduce adverse drug events, medical errors, and redundant tests and procedures Help identify illnesses, prescribe drug/treatment and track preventive care Help identify illnesses, prescribe drug/treatment and track preventive care Provide organized patient treatment history Provide organized patient treatment history Improve communication between patients and providers Improve communication between patients and providers Improve office efficiency Improve office efficiency

3. General thoughts about paper versus electronic Paper not always available Paper not always available To a degree, neither is electronic To a degree, neither is electronic Paper not always understandable Paper not always understandable To a degree, neither is electronic To a degree, neither is electronic Paper is difficult to replace if lost Paper is difficult to replace if lost To a degree, so is electronic To a degree, so is electronic

4. General thoughts about paper versus electronic Paper does not support “real time” information about quality and cost control” Paper does not support “real time” information about quality and cost control” To a degree, neither does electronic To a degree, neither does electronic Paper is costly to compile and maintain Paper is costly to compile and maintain To a degree, so is electronic To a degree, so is electronic

5. What is an EHR? Secure, real time, point of care, patient- centric information resource for clinicians Secure, real time, point of care, patient- centric information resource for clinicians Aides decision-making through access to information and decision support Aides decision-making through access to information and decision support Automates/streamlines work-flow, closes gaps in communication Automates/streamlines work-flow, closes gaps in communication Supports collection of data for non-direct care Supports collection of data for non-direct care Billing Billing Outcomes/quality reporting Outcomes/quality reporting Public health reporting Public health reporting

6. Scope of EHRs “Best of Breed” Systems “Best of Breed” Systems Niche systems (e.g. lab, radiology, pharmacy, accounting) Niche systems (e.g. lab, radiology, pharmacy, accounting) Don’t always integrate with one-another Don’t always integrate with one-another Different processes from end-user’s standpoint (e.g. log-on, menus, etc…) Different processes from end-user’s standpoint (e.g. log-on, menus, etc…)

7. Scope of EHRs Prime Vendor Systems Prime Vendor Systems Different systems from one vendor Different systems from one vendor Lower integration costs Lower integration costs More standardization from end user’s perspective More standardization from end user’s perspective

8. Key Considerations Is the time right? Is the time right? Does an EHR realistically fit with our current priorities, needs, and abilities? Does an EHR realistically fit with our current priorities, needs, and abilities? Can we get buy-in and leadership? Can we get buy-in and leadership? What are our system needs? What are our system needs? How do we select a vendor? How do we select a vendor? Can we afford it? Can we afford it?

9. Is the time right? Are there clinical or administrative issues that may be improved through an EHR? Are there clinical or administrative issues that may be improved through an EHR? Results reporting delays? Results reporting delays? Supporting documentation for claims? Supporting documentation for claims?

10. Is the time right? What is our current workflow? What is our current workflow? Scheduling, triaging, registration Scheduling, triaging, registration Documentation of encounter, orders Documentation of encounter, orders Result mgmt, protocols, clinical decision support, referrals Result mgmt, protocols, clinical decision support, referrals Copayment capture, claims processing, billing Copayment capture, claims processing, billing How are we structured? How are we structured? Floor plan (power sources, network connections, hardware) Floor plan (power sources, network connections, hardware) Service sites Service sites

11. Is the time right? What are our “outside” relationships? What are our “outside” relationships? Safety-net networks? Safety-net networks? Can we make the initial investment ? Can we make the initial investment ? More to come More to come

12. Is the time right? What are our future plans/expectations? What are our future plans/expectations? Expansion of care-sites? Expansion of care-sites? Expansion of service types? Expansion of service types?

13. Can we get buy-in? Common Barriers to Buy-In Common Barriers to Buy-In Initial capital cost/time cost Initial capital cost/time cost Confidentiality/Security Confidentiality/Security Maintenance costs Maintenance costs Interference with doctor-patient communication Interference with doctor-patient communication Difficulty of learning new technology Difficulty of learning new technology Lack of technical support in case of system failure Lack of technical support in case of system failure Concern about ability to change the system Concern about ability to change the system Lack of perceived benefits from computerization Lack of perceived benefits from computerization

14. Can we get leadership? Clinician “Champion” Clinician “Champion” Credible Credible Good communicator Good communicator Passionate about the EHR Passionate about the EHR CEO (in small practice, may be the physician) CEO (in small practice, may be the physician) Provide resources Provide resources Clear obstacles Clear obstacles Project Manager Project Manager Ideally, trained and skilled regarding EHRs Ideally, trained and skilled regarding EHRs Prior implementation experience Prior implementation experience

15. Can maintain buy-in? Developing and maintaining buy-in Developing and maintaining buy-in Identify users’ motivation for EHR Identify users’ motivation for EHR Keep people informed and engaged Keep people informed and engaged Involve end-users in tailoring the EHR Involve end-users in tailoring the EHR Involve end-users in workflow re-design Involve end-users in workflow re-design

16. What are our system needs? On-site or Off-site On-site or Off-site Application service providers (ASPs) Application service providers (ASPs) License own software and maintain on off-site servers License own software and maintain on off-site servers EHR accessed through high-speed Internet connection EHR accessed through high-speed Internet connection

17. What are our system needs? Clinical specifications Clinical specifications Documentation of encounters Documentation of encounters Multiple note creation options (templates, dictation, voice recognition, handwriting) Multiple note creation options (templates, dictation, voice recognition, handwriting) Automated chart documentation (problem lists, medication lists) Automated chart documentation (problem lists, medication lists) Decision support tools Decision support tools

18. What are our system needs? Clinical specifications Clinical specifications Order entry (lab, radiology, other) Order entry (lab, radiology, other) Does it track orders? Does it track orders? “Pick lists” of frequently used orders? “Pick lists” of frequently used orders? Tailored forms Tailored forms Prescription-writer database (drug interaction checking) Prescription-writer database (drug interaction checking)

19. What are our system needs? Clinical specifications Clinical specifications Results reporting (lab, radiology, other) Results reporting (lab, radiology, other) Flow charting (labs, vital signs) Flow charting (labs, vital signs) Patient follow up/health maintenance deficiency alerts Patient follow up/health maintenance deficiency alerts Patient handouts (available in multiple languages?) Patient handouts (available in multiple languages?)

20. What are our system needs? Continuity of care Continuity of care Software interfaces with internal and outside labs Software interfaces with internal and outside labs Inpatient reports (downloadable) Inpatient reports (downloadable) Remote access Remote access E-mail integration E-mail integration Telephone message documentation and tasking Telephone message documentation and tasking Patient web portal Patient web portal

21. What are our system needs? Registration and billing specifications Registration and billing specifications Patient registration index Patient registration index Generates appointment lists? Generates appointment lists? Generate a patient summary? Generate a patient summary? e.g. chronic problems, allergies e.g. chronic problems, allergies

22. What are our system needs? Registration and billing specifications Registration and billing specifications Charge entry Charge entry Built in chargemaster? Built in chargemaster? Updates to chargemaster items/services and codes? Updates to chargemaster items/services and codes? Searchable list of codes? Searchable list of codes? Alerts to coding modifiers? Alerts to coding modifiers?

23. What are our system needs? Other administrative specifications Other administrative specifications Scanning in reports Scanning in reports Interface capability Interface capability Data format Data format Security (audit trails, user access hierarchy, passwords) Security (audit trails, user access hierarchy, passwords) Generation of reports allowing for practice analysis Generation of reports allowing for practice analysis Quality reporting Quality reporting

24. How do we select a vendor? Initial considerations Initial considerations Does the vendor’s system interface with your existing systems? Does the vendor’s system interface with your existing systems? Is the particular product usually marketed to your practice size? Is the particular product usually marketed to your practice size? Are others in the area using the product? Are others in the area using the product?

25. How do we select a vendor? Initial considerations Initial considerations Is the vendor’s product certified? Is the vendor’s product certified? The Certification Commission for Healthcare Information Technology (CCHIT) The Certification Commission for Healthcare Information Technology (CCHIT) Evaluate functionality, interoperability, and security Evaluate functionality, interoperability, and security Criteria and listing of certified products Criteria and listing of certified products http://www.cchit.org/index.asp http://www.cchit.org/index.asp

26. How do we select a vendor? Request for Proposals Request for Proposals Background about your practice Background about your practice Ranked functional requirements Ranked functional requirements Vendor information Vendor information History of company History of company Product maturity Product maturity Number of employees Number of employees Financial status Financial status Other clients (references) Other clients (references)

27. How do we select a vendor? Requests for Proposals Requests for Proposals Hardware and network requirements Hardware and network requirements Interface capabilities Interface capabilities Implementation plan Implementation plan Training Training Customer maintenance and support Customer maintenance and support Proposed costs and payment schedule Proposed costs and payment schedule

28. Can we afford it? The average implementation for a sole practitioner The average implementation for a sole practitioner 12 to 18 months, including planning, design, implementation, and training 12 to 18 months, including planning, design, implementation, and training Longer period for small practices Longer period for small practices Lower productivity during initial learning curve Lower productivity during initial learning curve One study estimated $11,200 in first year One study estimated $11,200 in first year

29. Can we afford it? Average implementation cost per full time provider Average implementation cost per full time provider $14,500 - $63,000 $14,500 - $63,000 Network fees, database licenses Network fees, database licenses Training fees Training fees Maintenance Maintenance $7,200 per year $7,200 per year Return on investment Return on investment 2.5 years on average 2.5 years on average

30. Can we afford it? Costs balanced by savings Costs balanced by savings Adverse drug events Adverse drug events Drug utilization Drug utilization Laboratory/radiology utilization Laboratory/radiology utilization Charge capture Charge capture

31. Can we afford it? Costs balanced by savings Costs balanced by savings Billing errors Billing errors Medical records space, paper charting Medical records space, paper charting Bargaining power Bargaining power Pay for performance Pay for performance