Presentation on theme: "The Road to Meaningful Use: What it Takes to Implement EHR Systems in Hospitals Final Chart Pack April 26, 2010."— Presentation transcript:
1 The Road to Meaningful Use: What it Takes to Implement EHR Systems in Hospitals Final Chart Pack April 26, 2010
2 EHRs can facilitate communication within and outside the hospital. Post-Market SurveillanceChart 1: EHR Functions and Communication CapabilitiesReporting Performance MeasuresEmergency RoomLaboratoryNational Health Information ExchangeResearch and DevelopmentSharing Information with the PatientReporting Public Health InformationInformation Exchange with other ProvidersRadiologyDepartment and Ancillary SystemsPharmacyInformation Exchange with other HosptialsCore Hospital EHR SystemCPOE = computerized physician order entry
3 Hospital EHRs integrate many diverse information components. Chart 2: Sample Connection Points between EHR and Other Systems within the HospitalAmbulatory Care EnvironmentOutcomes Mgmt SystemEmergency DepartmentLabor and DeliveryBar CodingClinical Decision SupportPatient AccountingOperating RoomEHRElectronic Charge Capture SystemDietary Information SystemRadiologyUtilization Mgmt SystemClinical Lab Information SystemRegistration Auditing SystemCardiologyDictation/ TranscriptionInpatient Pharmacy ServicesElectronic Medication Administration RecordsPathologySource: Avalere Health adaptation based on ProHealth Care’s iCare hospital information system and electronic medical record.
4 Hospitals vary in their specific electronic capabilities. Chart 3: Percentage of Hospitals that Have Implemented Select Electronic Capabilities Across All Units, 2009Percentage of HospitalsElectronic CapabilitiesSource: American Hospital Association. (2009). Annual Survey with Information Technology Supplement. Washington, D.C.CPOE = computerized physician order entry
5 Many hospitals have already implemented electronic alerts to improve medication safety… Chart 5: Percent of Hospitals that Have Implemented Medication Safety Alerts, 200960.4%59.8%46.3%44.8%Source: American Hospital Association. (2009). Annual Survey with Information Technology Supplement. Washington, D.C.
6 …as well as electronic patient and medication identification systems. Chart 5: Percent of Hospitals that Use Bar Codes to Identify Patients and Medications, 200949.0%33.1%Source: American Hospital Association. (2009). Annual Survey with Information Technology Supplement. Washington, D.C.
7 The ARRA: Hospitals are eligible for incentive payments in 2011 and subject to penalties in 2015. Chart 6: The ARRA Timeline for EHR Incentive Payments and Penalties: Incentive payments continue, but are reduced for later adopters. Requirements become increasingly stringent2011: First year to demonstrate meaningful useSpring 2010: Final rule on meaningful use expected201020122014201620182015: Penalties begin for hospitals that have not demonstrated meaningful useSource: Centers for Medicare & Medicaid Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule. 42 CFR Parts 412 et al. Published January 13, 2010.*In 2015, penalties equal to 1/3 reduction on 3/4 market-basket update. For example, a 2 percent market basket increase would be reduced by 0.5 percentage points to become a 1.5 percent increase. In 2016, penalties increase to 2/3 reduction on 3/4 market-basket update. In 2017, penalties increase to full market-basket reduction.2016: Penalties increase for hospitals that have not demonstrated meaningful use2017 and beyond: Penalties fully phased-in
8 Larger hospitals are eligible to receive higher incentive payments. Chart 7: Estimated Average Maximum Medicare Incentive Payment Per Hospital, by Year and Size of Hospital*Estimated Average Maximum Incentive Payment (millions)$5.2$4.9$3.6$2.9$2.5Source: American Hospital Association analysis of Medicare Cost Report data for fiscal years 2007 and 2008 and 2008 AHA Annual Survey Data. Assumes all hospitals meet qualifying criteria in time to receive maximum possible incentive. *Excluding critical access hospitals and those in Maryland and Puerto Rico.
9 Many hospitals expect to incur a financial penalty for failing to achieve meaningful use by 2015. Chart 8: Percentage of Hospitals that Expect to Incur a Financial Penalty for Failing to Demonstrate Meaningful Use by 2015Source: American Hospital Association analysis of survey data from 795 non-federal, short-term acute care hospitals collected in January and February *Excluding critical access hospitals.Note: Hospital responses based on meaningful use as defined in the proposed rule released by the Centers for Medicare & Medicaid Services in January Responses may change based on final meaningful use specifications.
10 The EHR implementation process is lengthy and complicated and can last multiple years. Chart 9: Sample EHR Implementation ProcessArticulate goalsCommunicate with staff; gain physician buy-inModel financialsResearch systemsInterview vendorsNegotiate agreeable contract with vendor of choicePotential waiting period between contract and implementationEstablish new workflows for all clinical departments by analyzing current processes and translating them into an electronic formatCustomize system where necessaryInstall and test systemConvert paper chartsTrain staffInform patientsTroubleshoot problems and find solutionsContinue to customize systemCompare projected costs with actual costsUpdate system and train staff on an ongoing basis20142012Discovery and Vendor SelectionDesign of Workflows and Software CustomizationTesting and TrainingDeployment and Modifications3-6 months18-30 months12+ monthsSource: Ganguly, N. (2009). Healthcare Informatics. Link:
11 Hospital workflows are complex, multi-stage processes. RN signs off/acknowledges order on the paper order sheetPhysician writes medication order on paper order sheetChart 10: Sample Workflow Process for Medication Order Before RedesignRN transcribes the orders onto paper medication administration record (MAR) and writes in scheduled times for medication as applicableOrder given to unit pharmacistIf present,order faxed or tubed to pharmacyMedication required now?Problem identified?Pharmacist verifies order against other medications and allergiesYesPharmacy calls the physician to discuss orderNoYesNoOrder changed?Pharmacy enters order into the pharmacy systemNoMedication Administration WorkflowGo to medication management system and remove medicationMedication sent up to unitPhysician calls floor to speak with RN re changed orderYesMedication Management System OverrideIf med not in medication management system ,then call to pharmacy for stat prepNoOrder cancelled?Medication appears on MAR; sent up for the next 24 hoursYesPhysician calls floor to speak with RN re cancelled orderRN checks written order on the old MAR against printed order on the new MARSource: Evanston Northwestern Healthcare. (2004). Transforming Healthcare with a Patient-Centric Electronic Health Record System. Application for Nicholas E. Davies Award of Excellence.Link:
12 EHR systems can simplify workflows. Chart 11: Sample Workflow Process for Medication Order After RedesignSystem performs duplicate therapy check and allergy checksPhysician enters medication order into EpicRN clicks “acknowledge” button to sign off order in order reviewPhysician addresses the warnings accordingly and signs orderMedication appears automatically on the electronic MARMedication required now?NoPharmacist verifies order ; medication sent up to unitYesMedication Administration WorkflowMedication Management System OverrideGo to medication management system and remove medication. If med not in system then call to pharmacy for stat prepSource: Evanston Northwestern Healthcare. (2004). Transforming Healthcare with a Patient-Centric Electronic Health Record System. Application for Nicholas E. Davies Award of Excellence.Link:
13 Many hospitals are finding it more difficult to access capital since the 2008 recession. Chart 12: Percentage of Hospitals Reporting Difficulty Accessing Capital in 2009Percentage of Hospitals* Reporting Change in Access to Tax-exempt Bonds, January 2009Percent of Hospitals Reporting Change in Ability to Access Capital Since December 2008Source: American Hospital Association. (August 2009). Rapid Response Survey, The Economic Crisis: Ongoing Monitoring of Impact on Hospitals.*Excludes those hospitals indicating that they don’t use that source of capital.
14 Nearly 70 percent of hospitals cited upfront costs as a barrier to achieving meaningful use. Chart 13: Percentage of Hospitals that Identified Capital Costs as a Barrier to Meeting Meaningful Use CriteriaSource: American Hospital Association analysis of survey data from 795 non-federal, short-term acute care hospitals collected in January and February *Excluding critical access hospitals.Note: Hospital responses based on meaningful use as defined in the proposed rule released by the Centers for Medicare & Medicaid Services in January Responses may change based on final meaningful use specifications.