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Research and analysis by Avalere Health The Road to Meaningful Use: What it Takes to Implement EHR Systems in Hospitals Final Chart Pack April 26, 2010.

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Presentation on theme: "Research and analysis by Avalere Health The Road to Meaningful Use: What it Takes to Implement EHR Systems in Hospitals Final Chart Pack April 26, 2010."— Presentation transcript:

1 Research and analysis by Avalere Health The Road to Meaningful Use: What it Takes to Implement EHR Systems in Hospitals Final Chart Pack April 26, 2010

2 Research and analysis by Avalere Health EHRs can facilitate communication within and outside the hospital. Core Hospital EHR System Chart 1: EHR Functions and Communication Capabilities CPOE = computerized physician order entry

3 Research and analysis by Avalere Health EHR Hospital EHRs integrate many diverse information components. Chart 2: Sample Connection Points between EHR and Other Systems within the Hospital Ambulatory Care Environment Operating Room Inpatient Pharmacy Services Radiology Source: Avalere Health adaptation based on ProHealth Cares iCare hospital information system and electronic medical record. Dietary Information System Outcomes Mgmt System Utilization Mgmt System Electronic Charge Capture System Registration Auditing System Pathology Clinical Lab Information System Clinical Decision Support Dictation/ Transcription Patient Accounting Emergency Department Electronic Medication Administration Records Cardiology Bar Coding Labor and Delivery

4 Research and analysis by Avalere Health Chart 3: Percentage of Hospitals that Have Implemented Select Electronic Capabilities Across All Units, 2009 Electronic Capabilities Percentage of Hospitals Source: American Hospital Association. (2009). Annual Survey with Information Technology Supplement. Washington, D.C. CPOE = computerized physician order entry Hospitals vary in their specific electronic capabilities.

5 Research and analysis by Avalere Health Many hospitals have already implemented electronic alerts to improve medication safety… Chart 5: Percent of Hospitals that Have Implemented Medication Safety Alerts, 2009 Source: American Hospital Association. (2009). Annual Survey with Information Technology Supplement. Washington, D.C. 60.4% 59.8% 46.3% 44.8%

6 Research and analysis by Avalere Health …as well as electronic patient and medication identification systems. Chart 5: Percent of Hospitals that Use Bar Codes to Identify Patients and Medications, 2009 Source: American Hospital Association. (2009). Annual Survey with Information Technology Supplement. Washington, D.C. 49.0% 33.1%

7 Research and analysis by Avalere Health Spring 2010: Final rule on meaningful use expected The ARRA: Hospitals are eligible for incentive payments in 2011 and subject to penalties in Chart 6: The ARRA Timeline for EHR Incentive Payments and Penalties Source: 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, *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 : Penalties increase for hospitals that have not demonstrated meaningful use : First year to demonstrate meaningful use : Incentive payments continue, but are reduced for later adopters. Requirements become increasingly stringent 2015: Penalties begin for hospitals that have not demonstrated meaningful use 2017 and beyond: Penalties fully phased-in

8 Research and analysis by Avalere Health 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* Source: 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. Estimated Average Maximum Incentive Payment (millions) $2.5 $2.9 $3.6 $4.9 $5.2

9 Research and analysis by Avalere Health Many hospitals expect to incur a financial penalty for failing to achieve meaningful use by Source: 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. Chart 8: Percentage of Hospitals that Expect to Incur a Financial Penalty for Failing to Demonstrate Meaningful Use by 2015

10 Research and analysis by Avalere Health The EHR implementation process is lengthy and complicated and can last multiple years. Chart 9: Sample EHR Implementation Process Source: Ganguly, N. (2009). Healthcare Informatics. Link: informatics.com/ME2/dirmod.asp?sid=&nm=&type=Blog&mod=View+Topic&mid=67D AD3 B204AD35D8F5F780&tier=7&id=AFFF91F92B D8BEF Articulate goals Communicate with staff; gain physician buy-in Model financials Research systems Interview vendors Negotiate agreeable contract with vendor of choice Potential waiting period between contract and implementation Establish new workflows for all clinical departments by analyzing current processes and translating them into an electronic format Customize system where necessary Install and test system Convert paper charts Train staff Inform patients Troubleshoot problems and find solutions Continue to customize system Compare projected costs with actual costs Update system and train staff on an ongoing basis months months12+ months

11 Research and analysis by Avalere Health Medication Management System Override RN signs off/acknowledges order on the paper order sheet Physician writes medication order on paper order sheet RN transcribes the orders onto paper medication administration record (MAR) and writes in scheduled times for medication as applicable Go to medication management system and remove medication If med not in medication management system,then call to pharmacy for stat prep RN checks written order on the old MAR against printed order on the new MAR Medication appears on MAR; sent up for the next 24 hours Medication Administration Workflow Medication sent up to unit Order given to unit pharmacist If present,order faxed or tubed to pharmacy Pharmacist verifies order against other medications and allergies Pharmacy enters order into the pharmacy system Problem identified? Pharmacy calls the physician to discuss order Order changed? Order cancelled? Physician calls floor to speak with RN re changed order Physician calls floor to speak with RN re cancelled order Yes No Yes No Yes Hospital workflows are complex, multi-stage processes. Source: Evanston Northwestern Healthcare. (2004). Transforming Healthcare with a Patient-Centric Electronic Health Record System. Application for Nicholas E. Davies Award of Excellence. Link: Chart 10: Sample Workflow Process for Medication Order Before Redesign No Medication required now?

12 Research and analysis by Avalere Health System performs duplicate therapy check and allergy checks Physician enters medication order into Epic Physician addresses the warnings accordingly and signs order Go to medication management system and remove medication. If med not in system then call to pharmacy for stat prep Medication Administration Workflow Pharmacist verifies order ; medication sent up to unit Yes No Medication appears automatically on the electronic MAR RN clicks acknowledge button to sign off order in order review Chart 11: Sample Workflow Process for Medication Order After Redesign EHR systems can simplify workflows. Medication required now? Medication Management System Override Source: Evanston Northwestern Healthcare. (2004). Transforming Healthcare with a Patient-Centric Electronic Health Record System. Application for Nicholas E. Davies Award of Excellence. Link:

13 Research and analysis by Avalere Health Chart 12: Percentage of Hospitals Reporting Difficulty Accessing Capital in 2009 Source: American Hospital Association. (August 2009). Rapid Response Survey, The Economic Crisis: Ongoing Monitoring of Impact on Hospitals. *Excludes those hospitals indicating that they dont use that source of capital. Many hospitals are finding it more difficult to access capital since the 2008 recession. Percent of Hospitals Reporting Change in Ability to Access Capital Since December 2008 Percentage of Hospitals* Reporting Change in Access to Tax-exempt Bonds, January 2009

14 Research and analysis by Avalere Health 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 Criteria Source: 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.


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