if not for “meaningful use”, then…….why?
DESCRIPTION
Ms. Drury outlines the EHR world for these Davies Winners before ARRA and the EHR Incentive Program existed, sharing the environment and the motivation for these privately owned physician practices who have been recognized by HIMSS as Davies Ambulatory Award Winners. The HIMSS Nicholas E. Davies Award of Excellence recognizes excellence in the implementation and use of health information technology, specifically electronic health records (EHRs), for healthcare organizations, independent physician practices and public health systems. The HIMSS process of evaluating applications from these practices and validating the use and value of HIT is rigorous for the applicants and for the HIMSS Ambulatory Award Committee.TRANSCRIPT
San Luis Valley Health Information Technology Symposium, November 4, 2011 1
If NOT for “meaningful use”, then…….Why?
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The material in this tutorial is copyrighted as indicated in each slide footer and any references made by the author.Companies and individuals may only use this material in accordance with copyrights expressly stated. Contact the speaker directly for further informationNeither the Author nor the Presenter is an attorney and nothing in this presentation is intended to be nor should be construed as legal advice or opinion. If you need legal advice or legal opinion, please contact an attorney.The information presented herein represents the Author’s personal opinion and current understanding of the issues involved. The Author, the Presenter and the San Luis Valley AHEC do not assume any responsibility or liability for damages arising out of any reliance on or use of this information.NO WARRANTIES, EXPRESS OR IMPLIED. USE AT YOUR OWN RISK.
San Luis Valley AHEC Legal Notice
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Barbara Drury, FHIMSSPresident, Pricare Inc.Professional Development Chair, Colorado Chapter of HIMSS
If NOT for “meaningful use”, then……Why
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• Independent consultant, national practice, primarily for physician offices, since 1982
• EHR Risk Manager for COPIC (Colorado) and TDC (Oregon/Washington/Idaho)
• HIMSS Fellow, new appointee for 2011-2013 HIMSS Public Policy Committee, Current member of Davies Ambulatory Award Committee, Professional Development Chair for the Colorado Chapter, Spirit of HIMSS 2004, 2009.
• Appointed to the ONC’s Technical Expert Panel on Unintended Consequences of HIT/EHR.
• Author of many of the Colorado Medical Society ARRA tools, webinars. Editor of the COPIC Benchmarks for EMRs.
Speaker: Barbara Drury
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Talking Points• The EHR world ‘before and without ARRA’– What’s different– What’s the same
• Highlights from Davies Ambulatory winners– Practices ‘like yours’– Common reasons to adopt– Degrees of success
• Some insights and reflections
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Before Incentives & Meaningful Use• Adoption of EHRs was at a natural pace and
evolutionary (COPIC = 10 yrs, 5% to 30%)• Practices determined important issues to
develop ‘reasons’ to consider an EHR solution• Capability of paying for the system and
keeping staff were paramount• Vendors could respond naturally to the
market• Your practice was your kingdom
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After Incentives (Stark, PQRI, ARRA, MU)• Adoption of EHRs has been artificially
accelerated• Incentives (or penalties) have
become the over-riding ‘reason’ to consider an EHR solution
• Meeting someone else’s criteria for the system is now paramount
• Vendors must delay or abandon market needs to respond to other requirements
• Your practice is one cog in a complex healthcare ‘wheel’
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And these Davies Winners?• They excel without external incentives (and may
not be MUs)• They improve the health of their patients and
the wealth of their practices• They measure everything• They actively engage with their chosen vendors• They always have a plan “B” (or create it)• MU is too narrow for the goals of these
Winners and the benefits continue to be advantageous to clinicians and their patients!
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Talking Points• The EHR world ‘before and without ARRA’– What’s different– What’s the same
• Highlights from Davies Ambulatory winners– Practices ‘like yours’– Common reasons to adopt– Degrees of success
• Some insights and reflections
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HIMSS Davies Award for Excellence:• The HIMSS Ambulatory Care Davies Award: designed to
recognize the most exemplary implementations and utilizations of electronic health records in independent ambulatory practices.
• Applicants must be independent, physician-owned (not hospital-owned) ambulatory practices and must have leveraged technology to impact patient-centric practice of medicine and derived value.
• The four categories of the HIMSS Davies Awards program are: hospitals and health systems, independent physician practices, public health, and community health organizations.
• Each winner has successfully achieved value from electronic health records to improve healthcare delivery.
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Update from HIMSS for 2012 Davies• Case-study format rather than ‘your story’– You get to pick area where you excel
• Two categories = two committees– Enterprise (5 case studies)– Ambulatory: Enterprise-owned, physician-owned,
community health organizations, and public health (4 case studies)
• Rolling application, anytime throughout year• Virtual and some on-site visits by HIMSS Committee• www.himss.org/davies/
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“Practices like me?”
OB/Gyn, Rheumatology, Family Practice, Orthopaedics
Practice MetricsYear of Implementation
Davies Winner YearNumber of Physicians/Mid-
levelsNumber of OthersNumber of Sites
Method of Paying for Initial Costs
Go-live Team 'old' roles
Go-live Approach
Go-live Schedule/Patient Flow Planning
Expanded Services: tests, subspecialty
Technical interaction with PMS System
PMS from same or different vendor
Personal or Practice Standards
Form-factor for EHR use
Full Davies Applications at:http://himss.org/davies/pastRecipients_ambulatory.asp
Two winners from Colorado (2006-Alpenglow, 2010 Miramont)
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Virginia Women’s CenterPractice Metrics VA Women's
Year of Implementation 2005Davies Winner Year 2009
Number of Physicians/Mid-levels 37
Number of Others 161Number of Sites 5
Method of Paying for Initial Costs Loan/7 yrs
Go-live Team 'old' rolesMD, MA, Operations
Go-live ApproachModule or two at a time
Go-live Schedule/Patient Flow Planning
Month 1 at 50%, Mo. 2 at 66%, Mo. 3 at 100% pre-
EHR volume.Expanded Services: tests,
subspecialtyResearch, US, Mammo,
Nutrition, PsychTechnical interaction with PMS
System BidirectionalPMS from same or different
vendor Same vendor
Personal or Practice StandardsPractice standard,
customized
Form-factor for EHR use Notebook, wireless, stylus, cell cards
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Oklahoma Arthritis CenterPractice Metrics OK Arthritis
Year of Implementation 2006Davies Winner Year 2008
Number of Physicians/Mid-levels 5
Number of Others 26Number of Sites 1
Method of Paying for Initial Costs Self-funded
Go-live Team 'old' rolesMD, OffMgr, RN, Part-time
IT
Go-live ApproachModule or two at a time
Go-live Schedule/Patient Flow Planning
Two months of reduced schedule
Expanded Services: tests, subspecialty
Infusion, Radiology, Clinical Lab
Technical interaction with PMS System
One-way to EHR. Tickets used.
PMS from same or different vendor Same vendor
Personal or Practice StandardsPractice standard,
customized
Form-factor for EHR use Convertible notebook, wireless, stylus
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Village Health PartnersPractice Metrics
Village Health Partners, TX
Year of Implementation 2003Davies Winner Year 2007
Number of Physicians/Mid-levels 3
Number of Others 7Number of Sites 1
Method of Paying for Initial Costs Loan/4 yrs
Go-live Team 'old' rolesMD plus ALL
Go-live ApproachBig Bang (100% of users
and visits)
Go-live Schedule/Patient Flow Planning
Picked a 'light' month, no FU appts allowed, 6 weeks
back to 100%Expanded Services: tests,
subspecialty Traditional Family PracticeTechnical interaction with PMS
System BidirectionalPMS from same or different
vendor Same vendor
Personal or Practice StandardsPractice standard, minimal
customization
Form-factor for EHR useThick client (PCs), monitor
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Sports Medicine & Orthopedics of BirminghamPractice Metrics
Sports Medicine & Ortho, AL
Year of Implementation 2003Davies Winner Year 2005
Number of Physicians/Mid-levels 4
Number of Others 15Number of Sites 1
Method of Paying for Initial Costs Loan/60 mos low interest
Go-live Team 'old' rolesMD, RN
Go-live ApproachBig Bang (100% of users
and visits)
Go-live Schedule/Patient Flow Planning
2 weeks at 50%, back to 100% at 6 weeks
Expanded Services: tests, subspecialty Digital X-ray
Technical interaction with PMS System Bidirectional
PMS from same or different vendor Different vendor
Personal or Practice StandardsPersonal
Form-factor for EHR useNotebook docked outside exam rooms - unreliable
wireless.
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Common Threads for "why did you do it?"
VA Women's
OK Arthritis
Village Health
Partners, TX
Sports medicine & Ortho,
AL
Access in office, remote, everywhere
Quality of Documentation, organization, completeness, defensibility
Information Exchange outside the practice
Patient Safety, including care management, deliquencies
Monitoring of in-house adherence to clinical guidelines and metrics
Reduce costs or be more efficient with staff, transcription, supplies, space
Forward-thinking planning
Point of Care clinical support and planning
Customer service and communication (patient and/or referral sources)
Practice and individual user "happiness quotient"
If NOT for “meaningful
use”, then WHY? MU
MU
MU
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Common Threads for "why did you do it?"
VA Women's
OK Arthritis
Village Health
Partners, TX
Sports Medicine & Ortho,
AL
Access in office, remote, everywhere
Quality of Documentation, organization, completeness, defensibility
Information Exchange outside the practice
Patient Safety, including care management, deliquencies
Monitoring of in-house adherence to clinical guidelines and metrics
Reduce costs or be more efficient with staff, transcription, supplies, space
Forward-thinking planning
Point of Care clinical support and planning
Customer service and communication (patient and/or referral sources)
Practice and individual user "happiness quotient"
Degree of success, based on “why”:
Nailed it!
Not quite!
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Talking Points• The EHR world ‘before and without ARRA’– What’s different– What’s the same
• Highlights from Davies Ambulatory winners– Practices ‘like yours’– Common reasons to adopt– Degrees of success
• Some insights and reflections
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23 HIMSS Winners and Incentive $$$ ?
• Family Practice/Internal Medicine = 7, YES• Multi-specialty = 3, YES• Cardiology = 2, YES• Ortho/Sports Medicine = 1, NO• OB/Gyn = 3, (1 Y, 2 N)• Peds = 5, NO• Rheumatology = 1, YES• Diabetes = 1, NO
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On the ‘lighter’ side, from these winners:• EHR implementation is a commitment to a
process, not necessarily to perfection (Craig Carson MD, OK Arthritis)
• It was difficult to accept failure and financial burden of the unused technology. Knowing when to quit was a challenge. (Kay Stout MD, VA Women’s)
• I was finishing my MBA in May, 2003. My wife was expecting our first child a few months later in September. Everything had to be done in-between. (Chris Crow MD, Village Partners, TX)
• In spite of recommendations from others, the Managing Physician refused to reduce the schedule. The number of patients scheduled at implementation was not adjusted significantly. This would later be a decision that we regretted. (Sam Goldstein MD, Sports Med & Ortho, AL)
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And Some Questions for Your Practice:
• What are your ‘right’ reasons and how will you know?
• It’s too expensive to change your mind, so are you prepared for a long-term arrangement?
• How well do you (and your practice) handle course corrections?
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In spite of incentives, you must findYOUR “right reason”
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Talking Points• The EHR world ‘before and without ARRA’– What’s different– What’s the same
• Highlights from Davies Ambulatory winners– Practices ‘like yours’– Common reasons to adopt– Degrees of success
• Some insights and reflections• Discussion
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