Health eRecords Maintaining Document Quality and Clarity with a Certified EHR Dale Kivi, MBA

1. Health eRecords Maintaining Document Quality and Clarity with a Certified EHR Dale Kivi, MBA

2. Presentation Overview • EHR Adoption Rates – what is the current national profile? • EHR Adoption Realities – the good, the bad & the ugly. • EHR Quality –what works, what doesn’t & why? • The Blended EHR Approach – what is it & how does it work? • Improving EHR Quality – practical steps for every platform.

3. National EHR Adoption Rates Basic EHR: Includes functions such as clinician notes. Certified EHR: Platform is certified for Meaningful Use. ONC Data Brief No 9: March 2013

4. Certified EHR Adoption Rates National Average: 44% Wisconsin: 63% Illinois: 49% Michigan: 56% Minnesota: 59% South Dakota: 71% Rhode Island: 69% Colorado: 68% New Hampshire: 21% New Mexico: 26% Kansas: 26% ONC Data Brief No 9: March 2013

5. Eligibility for Meaningful Use Incentives 44.4% Basic w/o clinical notes Basic with clinical notes Comprehensive 16.9% ONC Data Brief No 9: March 2013

6. EHR Adoption Realities: The Good The Bad The Ugly 62 Federal regional centers assist with EHR adoption Hospital adoption rates have tripled since 2009 December 2012 MU incentive payments hit $1.25B 17% of organizations already want to switch their EHR’s Documentation time increases mean fewer patient seen Data capture increases lead to higher bills/rejects/audits Auto alerts average 63/day and 30% of them are missed Mounting pressure in congress to eliminate incentives Patient count loss costing physicians up to $100K/year Stage 2 MU and ICD-10 are both scheduled for 2014 1,300 Vendors certified for Stage 1, only 100 for Stage 2

7. EHR Quality: What Works • Liability management through improved report consistency • Improved charge trace-ability through automation & CAC • Ease of analytics/quality reviews through if/then queries • Greater control/efficiency for e-prescriptions, labs & CPOE • Better inter-office messaging, data access & interoperability • Easy to generate CIO & CFO spreadsheet Shangri-La

8. EHR Quality: What Doesn’t Work • Increased physician documentation time leads to shortcuts • Highly templated output can be viewed as cloned reports • More content/less specificity impacts clarity & patient care • Copy forward functions result in condition & billing errors • In room documentation negatively effects patient experience

9. Document & Process Quality Depend On Communication Efficiency Physicians dictate more than 2.5 times faster than they can type.

10. Blended EHR Workflow Approach Narrative Reports Discrete Data Structured Data Meaningful Use NLP • EHR Reports • Med lists • Problem lists • Allergies • Immunizations • Vital signs • Output to CAC + + + + • Clinical decision support • Quality measures • Educate material triggers • Data exchange reporting + + + + + • Diagnoses • Procedures • Heart Rate • Temperature • Height • Weight • Prescriptions + + + + Data Imports • Lab results • Diagnostics • Medications + + + + EHR Input

11. EHR Impact on User Satisfaction

12. Blended EHR Quality Advantages • Physician productivity is not hampered by EHR data entry • Patient satisfaction improves with no in-room documentation • Fewer claims rejected due to EHR copy/paste abuse • Document clarity is ensured with traditional narrative • Certified EHR data advantages & funding goals remain intact • Addresses satisfaction issues for all process participants

13. Improving EHR Quality – Practical Actions • Monitor patient volumes & billed amounts to address change • Minimize point & click time with blended approach if possible • Incorporate supplemental dictation if NLP not available • Turn off copy forward function to prevent billing errors • Utilize documentation specialists for pre-signature QA • Cost justify satisfaction issues for all process participants

14. Health eRecords Maintaining Document Quality and Clarity with a Certified EHR Dale Kivi, MBA FutureNet