1. Kevin S. Hughes, MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center Massachusetts General Hospital Associate Professor of Surgery Harvard Medical School Surgeon The Newton-Wellesley Hospital Breast Center Are they ready for you? Electronic Health Records: Are they ready for you? Using Computers to increase Efficiency in a Breast Oncology Practice

2. EHR HIT has tremendous promise as a means of decreasing workload, decreasing cost and improving quality of care

3. EHR and productivity varies by specialty 100 internists, pediatricians and family practitioners 25 to 33 percent drop in MD productivity Over time – Internists slightly above original productivity – Pediatricians /family practitioners never recovered Hemant Bhargava, UC Davis Graduate School of Management

4. Quote from a breast surgeon beginning EHR use …our productivity is down 28% I am the highest paid transcriptionist in the state Each cancer patient chart takes me apprx 1 hour For the first time in my career, I turned down an add- on patient

5. “Computerization hasn't saved a dime, nor has it improved administrative efficiency” 4,000 hospitals 2003 to 2007 Computerization – Weak correlation Quality for MI – No correlation Cost savings Improvements in administrative efficiency Quality for pneumonia Quality for heart failure Overall quality (MI, heart failure, pneumonia) Himmelstein, The American Journal of Medicine (2010) 123, 40-46

6. Currently: Paper + memory Patient completes paper form Reviews data using memory of guidelines Orders Genetic Testing Documents and Orders

7. EHR: Paper + extra work + memory Patient completes paper form Reviews data using memory of guidelines Staff enters data into the EHR Documents and Orders

9. EHR Generic Interface Mostly Filing Cabinet Or Document Management System Small Database Meds Allergies

10. EHR Generic Interface Mostly Filing Cabinet Or Document Management System Small Database Meds Allergies Same interface for every Specialty

11. CDS Hereditary Risk Identification

12. Click open 4 screens BRCA1+ Hereditary Risk Identification

14. EHR Mammography Pathology Generic Anesthesia Cardiovascular

15. EHR Breast MedOnc Interface Breast Surgery Interface RT Interface

16. HughesRiskApps Breast Surgery Module Kshughes@Partners.org www.HughesRiskApps.net

17. Reviews Report Reviews suggested Management Adds clinical information Documents and Orders Patient education al materials Clinical Decision Support Patient enters data : Tablet PC iPad Website Clinical Decision Support EHR

18. HughesRiskApps Breast Surgery Module Kshughes@Partners.org www.HughesRiskApps.net

20. HughesRiskApps Breast Surgery Module Kshughes@Partners.org www.HughesRiskApps.net

21. Quote from a breast surgeon recently on a new EHR …our productivity is down 28% I am the highest paid transcriptionist in the state Each cancer patient chart takes me apprx 1 hour For the first time in my career, I turned down an add- on patient

22. EHR Generic Interface Database Filing Cabinet Or Document Management System

23. HughesRiskApps modules follow a simple workflow Patient data entry Clinical Decision Support (CDS) Printout with suggested actions Clinician editing/enhancing Clinical Decision Support (CDS) Generate orders and documents Repurpose existing data

24. Apply Algorithms/Guidelines to patient data Identify best course of action Results displayed as intuitive Visualizations BRCAPRO Mutation Risk 25% Suggest Genetic Testing Facilitates best action as part of workflow Clinical Decision Support

25. EHR Breast MedOnc Interface Breast Surgery Interface RT Interface

26. Better workflow Reviews Report & Pedigree Reviews suggested management Documents and Orders Patient education al materials Clinical Decision Support Patient enters data Tablet PC iPad Website Clinical Decision Support EHR

27. Current EHRFuture EHR Decrease productivity or neutralIncrease productivity Mostly document repositoryDatabase Mostly free textStructured data Data entered by staff or providerData entered by patient, staff or provider Generic interfaceSpecialty specific interfaces Rudimentary CDS/Drug-Drug interactions Effective CDS for multiple specialties View isolated transactionsView consolidated information about a given problem Proprietary hidden informationOpen access to patient data Monolithic, barely intraoperableInteroperable with multiple ‘best of breed’ systems

29. HughesRiskApps Breast Surgery Module Free software available at: Kshughes@Partners.org HughesRiskApps.net

30. EHR Database Breast MedOnc Interface Breast Surgery Interface Mammography Interface Pathology Interface RT Interface

31. HughesRiskApps Breast Surgery Module Kshughes@Partners.org www.HughesRiskApps.net

32. Breast Data Overlaps

33. EHR and productivity varies by specialty 100 internists, pediatricians and family practitioners Initial implementation – 25 to 33 percent drop in MD productivity Over time – Internists Slightly above original productivity – Pediatricians and family practitioners Remained below original productivity Explanations – Internists review data entered by others EMRs more efficient – Pediatricians/family practitioners data entry and documentation EMR more time-consuming Hemant Bhargava, UC Davis Graduate School of Management

34. EHR HIT has tremendous promise as a means of decreasing workload, decreasing cost and improving quality of care

35. Kevin S. Hughes, MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center Massachusetts General Hospital Associate Professor of Surgery Harvard Medical School Surgeon The Newton-Wellesley Hospital Breast Center Electronic Health Records: Are you ready? Using Computers to increase Efficiency in a Breast Oncology Practice