selecting an ehr system mohtaram nematollahi,phd health information management

Selecting an Selecting an EHR SystemEHR System

Mohtaram Nematollahi,PhDMohtaram Nematollahi,PhD

Health Information ManagementHealth Information Management

Expected Benefits of EHRsExpected Benefits of EHRs

Reduce adverse drug events, medical Reduce adverse drug events, medical errors, and redundanterrors, and redundant tests and procedures tests and procedures

Help identify illnesses, prescribe Help identify illnesses, prescribe drug/treatment and track preventive caredrug/treatment and track preventive care

Provide organized patient treatment history Provide organized patient treatment history Improve communication between patients Improve communication between patients

and providersand providers Improve office efficiencyImprove office efficiency

General thoughts about paper General thoughts about paper versus electronicversus electronic

Paper not always available Paper not always available To a degree, neither is electronic To a degree, neither is electronic

Paper not always understandable Paper not always understandable To a degree, neither is electronic To a degree, neither is electronic

Paper is difficult to replace if lost Paper is difficult to replace if lost To a degree, so is electronicTo a degree, so is electronic

General thoughts about paper General thoughts about paper versus electronicversus electronic

Paper does not support “real time” Paper does not support “real time” information about quality and cost information about quality and cost control” control” To a degree, neither does electronicTo a degree, neither does electronic

Paper is costly to compile and Paper is costly to compile and maintain maintain To a degree, so is electronicTo a degree, so is electronic

What is an EHR?What is an EHR?

Secure, real time, point of care, patient-Secure, real time, point of care, patient-centric information resource for clinicianscentric information resource for cliniciansAides decision-making through access to Aides decision-making through access to

information and decision supportinformation and decision supportAutomates/streamlines work-flow, closes Automates/streamlines work-flow, closes

gaps in communicationgaps in communicationSupports collection of data for non-direct careSupports collection of data for non-direct care

BillingBillingOutcomes/quality reportingOutcomes/quality reportingPublic health reportingPublic health reporting

ScopeScope of EHRsof EHRs

““Best of Breed” SystemsBest of Breed” SystemsNiche systems (e.g. lab, radiology, Niche systems (e.g. lab, radiology,

pharmacy, accounting)pharmacy, accounting)Don’t always integrate with one-anotherDon’t always integrate with one-anotherDifferent processes from end-user’s Different processes from end-user’s

standpoint (e.g. log-on, menus, etc…)standpoint (e.g. log-on, menus, etc…)

Scope of EHRsScope of EHRs

PrimePrime Vendor SystemsVendor SystemsDifferent systems from one vendorDifferent systems from one vendorLower integration costsLower integration costsMore standardization from end user’s More standardization from end user’s

perspectiveperspective

Key ConsiderationsKey Considerations

Is the time right?Is the time right?Does an EHR realistically fit with our Does an EHR realistically fit with our

current priorities, needs, and abilities? current priorities, needs, and abilities? Can we get buy-in and leadership?Can we get buy-in and leadership?What are our system needs?What are our system needs?How do we select a vendor?How do we select a vendor?Can we afford it?Can we afford it?

Is the time right? Is the time right?

Are there clinical or administrative Are there clinical or administrative issues that may be improved through issues that may be improved through an EHR?an EHR?Results reporting delays?Results reporting delays?Supporting documentation for claims?Supporting documentation for claims?

Is the time right?Is the time right?

What is our current workflow?What is our current workflow? Scheduling, triaging, registrationScheduling, triaging, registration Documentation of encounter, ordersDocumentation of encounter, orders Result mgmt, protocols, clinical decision support, Result mgmt, protocols, clinical decision support,

referralsreferrals Copayment capture, claims processing, billing Copayment capture, claims processing, billing

How are we structured?How are we structured? Floor plan (power sources, network connections, Floor plan (power sources, network connections,

hardware)hardware) Service sitesService sites

Is the time right? Is the time right?

What are our “outside” relationships?What are our “outside” relationships?Safety-net networks?Safety-net networks?

Can we make the initial investmentCan we make the initial investment ??More to comeMore to come

Is the time right?Is the time right?

What are our future What are our future plans/expectations?plans/expectations?Expansion of care-sites?Expansion of care-sites?Expansion of service types?Expansion of service types?

Can we get buy-in?Can we get buy-in?

Common Barriers to Buy-InCommon Barriers to Buy-In Initial capital cost/time costInitial capital cost/time cost Confidentiality/SecurityConfidentiality/Security Maintenance costsMaintenance costs Interference with doctor-patient communicationInterference with doctor-patient communication Difficulty of learning new technologyDifficulty of learning new technology Lack of technical support in case of system Lack of technical support in case of system

failurefailure Concern about ability to change the systemConcern about ability to change the system Lack of perceived benefits from computerization Lack of perceived benefits from computerization

Can we get leadership?Can we get leadership?

Clinician “Champion” Clinician “Champion” CredibleCredible Good communicatorGood communicator PassionatePassionate about the EHRabout the EHR

CEO (in small practice, may be the physician)CEO (in small practice, may be the physician) Provide resourcesProvide resources Clear obstaclesClear obstacles

Project Manager Project Manager Ideally, trained and skilled regarding EHRsIdeally, trained and skilled regarding EHRs Prior implementation experience Prior implementation experience

Can maintain buy-in?Can maintain buy-in?

Developing and maintaining buy-inDeveloping and maintaining buy-inIdentify users’ motivation for EHRIdentify users’ motivation for EHRKeep people informed and engaged Keep people informed and engaged Involve end-users in tailoring the EHRInvolve end-users in tailoring the EHRInvolve end-users in workflow re-design Involve end-users in workflow re-design

What are our system needs?What are our system needs?

On-site or Off-siteOn-site or Off-siteApplication service providers (ASPs)Application service providers (ASPs)

License own software and maintain on off-License own software and maintain on off-site serverssite servers

EHR accessed through high-speed Internet EHR accessed through high-speed Internet connectionconnection


Clinical specificationsClinical specificationsDocumentation of encountersDocumentation of encounters

Multiple note creation options (templates, Multiple note creation options (templates, dictation, voice recognition, handwriting)dictation, voice recognition, handwriting)

Automated chart documentation (problem Automated chart documentation (problem lists, medication lists) lists, medication lists)

Decision support toolsDecision support tools


Clinical specifications Clinical specifications Order entry (lab, radiology, other)Order entry (lab, radiology, other)

Does it track orders?Does it track orders?““Pick lists” of frequently used orders?Pick lists” of frequently used orders?Tailored formsTailored formsPrescription-writer database (drug Prescription-writer database (drug

interaction checking)interaction checking)


Clinical specificationsClinical specificationsResults reporting (lab, radiology, other)Results reporting (lab, radiology, other)

Flow charting (labs, vital signs)Flow charting (labs, vital signs)Patient follow up/health maintenance Patient follow up/health maintenance

deficiency alertsdeficiency alertsPatient handouts (available in multiple Patient handouts (available in multiple

languages?)languages?)


Continuity of careContinuity of careSoftware interfaces with internal and Software interfaces with internal and

outside labsoutside labsInpatient reports (downloadable)Inpatient reports (downloadable)Remote accessRemote accessE-mail integrationE-mail integrationTelephone message documentation and Telephone message documentation and

tasking tasking Patient web portalPatient web portal


Registration and billing specifications Registration and billing specifications Patient registration indexPatient registration index

Generates appointment lists?Generates appointment lists?Generate a patient summary? Generate a patient summary?

e.g. chronic problems, allergiese.g. chronic problems, allergies


Registration and billing specificationsRegistration and billing specificationsCharge entryCharge entry

Built in chargemaster?Built in chargemaster?Updates to chargemaster items/services and Updates to chargemaster items/services and

codes?codes?Searchable list of codes?Searchable list of codes?Alerts to coding modifiers?Alerts to coding modifiers?


Other administrative specificationsOther administrative specificationsScanning in reportsScanning in reportsInterface capability Interface capability Data formatData formatSecurity (audit trails, user access Security (audit trails, user access

hierarchy, passwords)hierarchy, passwords)Generation of reports allowing for Generation of reports allowing for

practice analysis practice analysis Quality reportingQuality reporting

How do we select a vendor?How do we select a vendor?

Initial considerationsInitial considerationsDoes the vendor’s system interface with Does the vendor’s system interface with

your existing systems?your existing systems?Is the particular product usually Is the particular product usually

marketed to your practice size?marketed to your practice size?Are others in the area using the Are others in the area using the

product?product?


Initial considerationsInitial considerations Is the vendor’s product certified?Is the vendor’s product certified?

The Certification Commission for Healthcare The Certification Commission for Healthcare Information Technology (CCHIT) Information Technology (CCHIT)

Evaluate functionality, interoperability, and Evaluate functionality, interoperability, and securitysecurity

Criteria and listing of certified productsCriteria and listing of certified productshttp://www.cchit.org/index.asphttp://www.cchit.org/index.asp


Request for ProposalsRequest for ProposalsBackground about your practiceBackground about your practiceRanked functional requirementsRanked functional requirementsVendor informationVendor information

History of companyHistory of companyProduct maturity Product maturity Number of employeesNumber of employeesFinancial statusFinancial statusOther clients (references)Other clients (references)


Requests for ProposalsRequests for ProposalsHardware and network requirementsHardware and network requirementsInterface capabilities Interface capabilities Implementation planImplementation planTrainingTrainingCustomer maintenance and supportCustomer maintenance and supportProposed costs and payment scheduleProposed costs and payment schedule

Can we afford it?Can we afford it?

The average implementation for a The average implementation for a sole practitioner sole practitioner 12 to 18 months, including planning, 12 to 18 months, including planning,

design, implementation, and trainingdesign, implementation, and trainingLonger period for small practicesLonger period for small practices

Lower productivity during initial Lower productivity during initial learning curvelearning curveOne study estimated $11,200 in first One study estimated $11,200 in first

yearyear


Average implementation cost per full Average implementation cost per full time providertime provider$14,500 - $63,000 $14,500 - $63,000 Network fees, database licensesNetwork fees, database licensesTraining feesTraining fees

MaintenanceMaintenance$7,200 per year$7,200 per year

Return on investmentReturn on investment2.5 years on average2.5 years on average


Costs balanced by savingsCosts balanced by savingsAdverse drug eventsAdverse drug eventsDrug utilization Drug utilization Laboratory/radiology utilizationLaboratory/radiology utilizationCharge capture Charge capture


Costs balanced by savingsCosts balanced by savingsBilling errors Billing errors Medical records space, paper chartingMedical records space, paper chartingBargaining powerBargaining powerPay for performance Pay for performance

selecting an ehr system mohtaram nematollahi,phd health information management

Documents

electronic paper

electronic slide

available paper

understandable paper

lost paper

real time information

vendor different systems

cost control paper