emr with integration focus
TRANSCRIPT
Electronic Medical Records and Systems Integration
Today's Event Sponsored by: Emdeon Practice Services helps practices meet the challenges of
healthcare with innovative solutions, including electronic health records, encounter documentation, document and image management, and wireless and Internet connectivity.
For more information:Call: 877.WEBMD.01Visit: www.webmdps.com
Visit Emdeon's Virtual Trade Show exhibit at:hdm.unisfair.com/prd.jsp?booth_id=13
As President and CEO of The Quammen Group, Robecca is an accomplished senior executive in healthcare information systems, combining extensive healthcare administration, software vendor, and consulting practice experience. She has over 25 years experience in healthcare to include business development, sales, strategic and tactical planning, operations and organizational development, product development and delivery and emerging healthcare initiatives. With a career history and reputation for superior quality business solutions and customer service, Robecca has held senior management positions for large healthcare delivery organizations, the nation’s largest healthcare software vendor, and a large private healthcare consultancy. Most recently she founded The Quammen Group as a full-service healthcare consulting firm specializing in business planning and development, strategic planning, large-scale software and hardware implementation, software acquisition, outsourcing, and organizational development.
Robecca Quammen
Do We Have an Electronic Medical Record Yet?
• Systems integration issues that arise when adopting an EMR– Hospitals dealing with integrating legacy systems with new
systems, with departmental systems etc.– Stitching together EMR and Practice Management software at a
clinic and then connecting them to the hospital data– Data Security challenges, single sign-on, etc.– The role of technology and standards in creating interoperability
and data sharing across systems
• ESPECIALLY lessons learned on key hurdles and practical strategies that work...
Today’s Presentation
• Automation of current paper chart
• Repository of financial and clinical data
– Easily accessed, reviewed, updated
– Concurrent and retrospective use
• Clinicians
• Physicians
• Support personnel
• By-product of data gathered in HIS, CIS, and PM/EMR systems
Defining an EMR
Attending PhysicianNursingConsulting Physician(s)Respiratory CareCase ManagementNutritional ServicesRisk ManagementIV TeamPatient Financial ServicesInfection ControlWound ManagementPastoral CareClinical Process ImprovementCardiologyPT/OT/SpeechOthers
BARRIERS:• Access• Availability• Acceptance• Integration
ELECTRONICPATIENTDATA
EMR Focus on All Care Providers
• This frequently elusive metaphor for the traditional paper chart has been challenging to accomplish in every clinical setting, primarily due to
– Cost and availability of solutions
– Impact on the clinician workflow/practice
– Implementation
– Integration with Existing and Planned Solutions
Easier Said Than Done
Heightened Demand for SolutionsMultiple Unique User Demands
Clinical Reporting DemandsImpatience for Solutions
Financial & Operational ResultsCompetitive Market PressuresCapital & Operational Funding
Physician Affinity
CostAccess
Security Standards & Tools
Integration & Interoperability
EMR - The Balancing Act
EMR Adoption is a broad topicthat encompasses……
Systems
EMR Adoption is a topic that transcendsthe collection, storage, reporting,
and transmittal of data.
People
Business Practice
Why is Integration So Important?
Clear Vision and Priorities
Strategic PlanWork FlowsProcess vs. Task Orientation
Data OwnershipAccess and Security
Patience and Time
Big PictureCultureIntegration vs. Functionality
Individual Motivation
Personnel CostFear of Computerization
SystemsPeople
Business Practice
Legacy Vs. NewAvailabilityBest of BreedVendor StrategiesIntegrationInteroperabilityDevices/MobilityPortals/Single Sign-on
Compromise
Compromise
Compromise
Inherent Challenges for EMR Adoption
Legacy Laboratory and Radiology Systems (upgrade or replace?)
Orders/Results Upgrade/Replacement in preparation for CPOE or to Create Integration with Planned Clinical Documentation Projects
Results Repository Made Available to Remote and Mobile User
E-signature for Physician Signature of Medical Records
Physician Practice Management and EMR Systems
Advanced Clinical Documentation(workflow, rules)
Specialty Documentation (Critical Care and Women/Children’s)
Departmental/Multi-Disciplinary Systems (Rehab, Respiratory, Surgery, etc.)
Departmental Systems Impacting Care Process (Emergency, Pharmacy)
Where Does your EMR Journey Begin?
• Paperless or Partial Paperless System
• Population of a Data Warehouse for Clinical Reporting
• Comprehensive Clinical Decision Support (Rules, Workflow)
• Integration of Solutions for Continuum of Care
• Complete Remote Access for Physicians and Clinicians
• Complete or Partial Nurse Documentation
• Integration of IT with BioMed
• Multidisciplinary Charting
• Clinically Driven Revenue Cycle
Where Is your EMR Journey Taking You?
• COST - EMR Systems are Expensive to Implement and Support
• LEGACY SYSTEMS – Integrate, Displace, Replace
• INTEGRATION - Best of Breed/Disparate/Closed Systems
• DATA SHARING & Interoperability – Information Available As Needed
• STANDARDIZATION - Adoption of Nomenclature/Data Dictionary
• ACCESS – Device Strategy, Mobility, Remote
• SECURITY – Network, Application, Single Sign-On
• DATA INTEGRITY – Who Owns It?
• WORKFLOW – Enhance It, Don’t Break It!
• TRAINING – Of Just About Everyone – What Works?
Common Hurdles Along the Journey
Efforts have been arduous, lengthy, and expensive, but
effective EMR Adoption is within reach when completed as a series of initiatives.
So, How Are We Doing?
• Goal: Provide an Online Medication Administration Record (MAR)
– 1800+ bed integrated delivery system with multiple campuses and outreach clinics
– Orders/results/repository in place with clinical documentation system implementation underway
– MAR integration between HIS (third party) and RX (in-house developed)• Vendor usage of record format that did not 100% comply with HL7 standards,
resulting in a significant amount of custom code in the interface
• Complex nature of medications compounded the issue
• Change management becomes critical to insure systems are in sync
• Outcome: Through integration, this organization was able to accomplish its goal. Change management continues to be critical to the success of this initiative.
Real World Experiences #1
Brand XBrand X Brand XBrand X Brand XBrand X Brand XBrand X Brand XBrand X Brand XBrand X Brand XBrand X
OrdersOrders ResultsResults PharmacyPharmacy(MAR)(MAR)
DocumentationDocumentation•AssessmentsAssessments•I & OI & O•Progress NotesProgress Notes•Vital SignsVital Signs
Alerts and Alerts and RemindersReminders
Electronic Electronic Medical Medical RecordRecord
Care Care ProtocolsProtocols
CLINICAL DOCUMENTATION PROJECTCLINICAL DOCUMENTATION PROJECT
FUNCTIONSFUNCTIONS
PRODUCTSPRODUCTS
KEY:KEY: Proposed Phase IProposed Phase IProposed Phase IIProposed Phase II
Real World Experiences #1
FINANCE
RECEIVABLES
RADIOLOGY RESPIRATORY
MRIMRI CISCIS
INTEGRATIONINTEGRATION ENGINE
Scheduling
PACS
Ambulatory
Other Systems
Drug Dispenser
ER System
Dietary
Lab
Pharmacy
Reporting
Clin. Dec. Support
RepositoryRegistration/ADT/Results/
Orders/Order Status Update/Master Files
ADT/Orders/Order Status Update/Charges/Master Files
Registration/ADT/
Orders/O
SU Results
Regi
stra
tion
/AD
T/Ad
d-on
Ord
ers/
OSU
/Cha
rges
/Res
ults
Fin a nc ial Dat a
Fina
ncia
l / Cl
ini c
al D
ata
Registration/ADT
Registration/ADT/Orders/Results
Registration/ADT/Lab Orders/ Radiology Results
Pharmacy
Registration/ADT/Orders/OSU
Add-on Orders/OSU/Results
Registration/ADT/Orders/OSU
Registration/ADT/Lab Results
Registration/ADT
Charges
Transcribed Results
Pharmacy
LEDGEND
Bi-directional data flow
Unidirectional data flow
Existing Products #1
after
before
Impact of Integration on the MAR
• Goal: To Provide Cardiology Functionality to a New Specialty Facility
– Primary organization has implemented a third party clinical orders/results/documentation system
– Specialty (cardiology) organization selected a different third party vendor for their Cardiology Information System
• Lack of outbound charting records from specialty system effectively isolating data to that system
• Necessitated printing of record to transfer with patient
• Investigating CCOW single sign on utilizing industry available products
• Outcome: This organization accomplished the goals of the specialty area but did not provide a solution that meets the organizational requirements for having access to clinical data by anyone who needs it. They will be faced with manual solutions such as chart printing until they determine a method to populate a central EMR with integrated or scanned data from the specialty system. Additionally they are facing a common user issue in the need to allow single sign-on to multiple systems and are attempting to solve that problem with technology.
Real World Experiences #2
• Goal: To Provide Specific Departmental Functionality to the Respiratory Department with Emphasis on Charging and Work Scheduling
– Third party clinical orders/results/documentation
– Purchased and implemented specialty niche respiratory system
• Lack of outbound charting records from specialty niche respiratory system, effectively isolating data
• Necessitated printing of record to transfer with patient
• Interdisciplinary care charting was not accomplished
• Outcome: By permitting a departmental solution to be purchased and implemented to solve the specific problems of the respiratory department, this organization has lost significant opportunity to meet regulatory guidelines for interdisciplinary charting and to insure that all care givers have access to the complete patient experience as they are performing their specific functions.
Real World Experiences #3
• Goal: To Provide a Comprehensive EMR Solution in a Small Community-Based Facility in Which Funding was Challenging
– Purchased a single source solution for all departmental and nursing functions and a third party specialty ER system
– Chose to implement the comprehensive solution in three distinct phases over several years
• Phase 1 included the population of a repository for local and remote access by physicians and care givers
• Phase 2 introduced Medical Records, Pharmacy and Radiology functionality with a sub-phase to introduce an ER system
• Phase 3 will introduce clinical documentation
• Outcome: This organization knew its limitations with funding and staff to support multiple systems from multiple vendors and chose to purchase and implement a single source solution for departmental, advanced clinical and electronic medical record functions. They faced competitive pressures in their community to retain ER physicians and consequently purchased a niche ER system to meet their requirements. They chose to implement in relatively small increments to provide functionality and benefit to end users at various milestones.
Real World Experiences #4
Legacy HIS/CISRad/Orders/Rx
PA/Payroll/HR/ADT
ERPMM/GL
Integration Engine
Drug Dispensing
Medical RecordsCoding
OR Scheduling
EKGLAB
TV
ADT
ADTADT
ADT
ADT
(Ord
ers)
Orders
Results
Charges
Ord
ers
Resu
lts
Char
ges
ICD9(tape)ICD9
(tape)
ADT
ADT
Resu
lts
Charges
Current State (2004)Real World Experiences #4
Legacy HIS/CISRad/Orders/Rx
PA/Payroll/HR/ADT
ERPMM/GL
Integration Engine
Drug Dispensing
MR Coding
OR Scheduling
EKGLAB
TV
ADT
ADT
ADT
ADT
ADT
(Ord
ers)
Orders
Results
Charges
Ord
ers
Resu
lts
Char
ges
ICD9(tape)ICD9
(tape)
Transcription Transcription
Integration Engine
Clinical Data Repository
ADT
Orders (statuses)
ADTResults
(text/discrete)
Transcription Tran
scrip
tion
(RAD
Res
ults
)
Tra nscri ption
Results(Tex t/d iscre te)
ADT
Orders
(statuses)
Resu
lts (t
ext/d
iscr
ete)
Orde
rs (s
tatu
ses)
ADT
ADT
Resu
lts
Charges
Phase 1Real World Experiences #4
Legacy HIS/CISRad/Orders/Rx
PA/Payroll/HR/ADTERP
MM/GL
Integration Engine
Medical Devices
EKG
LABPhysician Billing
Orders - ResultsCharges
Transcription
Open EngineClinical Data Repository
Orders w/ statuses Results (Rad)
Results(Text/discrete)
ADT
Orde
rs
Lab R
esult
s (tex
t/disc
rete)
ED System
Results (ECG)
Results (RT/ECG)Orders (w/statuses)
Clin
ical D
ata
(text
) OrderStatuses
MDI(TP
R/BP)
Physician Billing
ADT
ADT
ADT
Orders - ResultsCharges
Phase 2
Example Second Phase #4
HospitalHome
or Office
Clinical Data Repository
RespiratoryTherapy
Radiology
Cardiology Registration
Laboratory
Medical RecordsOrders w/statuesResults
Orders w/statues
Results
Orders w/statues
Results
Orders w/st
atues
Results
Dem
ogra
phic
sVi
sit H
isto
ry
H & Ps · Op Reports
Discharge Summaries
EEGs
Sample Information Flow Diagram #4
• Goal: To Provide a Comprehensive EMR Solution in a Community-Based Facility in Which Funding was Challenging and Many Initiatives Were Already Defined and Underway
– Faced many projects to upgrade or replace existing functionality before moving forward with advanced clinical functionality
– Identified sum total of initiatives required to achieve the desired electronic medical record
• Established strategy to guide all purchasing decisions and align organization around key vendors and solutions
• Formulated 5 year budget projections to educate the organization on priorities based on funding availability
• Gained consensus from organization regarding pending and future EMR initiatives
• Outcome: This organization now has a roadmap to guide their information technology activities according to their operational strategic plan for the next 5 years. Annual review and validation of the plan is scheduled. This organization fully understands the implications of their short and long term activities as they relate to deployment of an EMR. Further they understand that the EMR deployment is a series of projects.
Real World Experiences #5
• Establish Health System Objective
– Completely paperless
– Hybrid medical record (part electronic/part paper)
• Establish relationships with all ancillary departments and vendors
• Future purchases: disparate systems versus integration
• Decisions driven from critical data to be available in the EMR based on feedback from advisory groups
• Development and adherence to Information Systems Strategic Plan
Strategies for Success: Establish Goals & Objectives
• Development of Current State Model
– Inventory of all departmental systems
– Inventory all existing interfaces
– Understand the mix of integrated and disparate systems
– Understand the integration limitations with various systems
• Evaluate Clinical Workflow
– Understand impact of decisions on current and proposed clinical workflow
• Patient Movement• Interdisciplinary • Nursing• Physician
Strategies for Success: Understand Current State
• Maintain Focus on Strategic Direction
– Unrelenting focus on goals
– Executive leadership
• Be realistic
• Be objective
• Be concrete (how & when questions)
– Clinician and physician involvement
• Seek Outside Advice and Counsel (these decisions are expensive and have huge organizational impact)– Experiences from staff who have worked in other environments– Vendor References– Internet– Consultants
Strategies for Success: Acquiring Systems
• Disparate Systems
– Potentially more robust functionality
– HL7 Compliance for Interfacing to EMR
– Cost of Ownership
• Additional Interfaces to support
• Additional application support fees
• Additional Upgrades
Strategies for Success: Disparate Systems
• Integrated Systems vs. Interoperability
– Departmental/user specific functionality
– Support and maintenance (impact on technical architecture)
– Data availability/sharing
– Clinical workflow
– Short and long term use of data
• Discreet data vs. textual
Strategies for Success: Integration & Interoperability
• Establish EMR Timelines
– Map out timelines for each project
– Overall timeline is driven by labor and financial resources
– Start with basics to ensure initial success
• ADTs
• Laboratory results (discrete and text)
• Radiology results (text)
• Cardiology results (text)
• Respiratory results (discrete)
• Documentation (H&Ps, Op Rpts, Discharge Summaries, Consults, etc.)
Strategies for Success: Establish Rational Expectations
• Choose an EMR product strategy that offers the greatest potential for success in your particular circumstances
– Choose as many modules as possible that are integrated into a suite of products
– Carefully choose products that have a strong history of integration with other products
– Use disparate system integration as sparingly as possible to accomplish your EMR goals
– Leverage a variety of technologies to create visual, functional, and database integration
• Gradually phase in the EMR to lessen the impact– Understand that the EMR is a series of projects and initiatives– Take best advantage of available technologies– Group products/modules in a way that allows users to recognize incremental
victories and obtain functionality in shorter time frames
Strategies for Success Summary
Successful adoption is measured by the user and validated in the meaningful application of data in the care delivery process.
encompasses much more than the relationship between the physical parts of the system.
Health OutcomesCost
In Closing, The Successful EMR Adoption
Robecca QuammenPresident/CEO
The Quammen Group1400 S. Orlando Avenue, Suite 204Winter Park, FL 32789407-758-3390 (cell)407-539-2040 (fax)
E-mail: [email protected]
Today's Event Sponsored by: Emdeon Practice Services helps practices meet the challenges of
healthcare with innovative solutions, including electronic health records, encounter documentation, document and image management, and wireless and Internet connectivity.
For more information:Call: 877.WEBMD.01Visit: www.webmdps.com
Visit Emdeon's Virtual Trade Show exhibit at:hdm.unisfair.com/prd.jsp?booth_id=13