Kevin S . Hughes , MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center

1. Electronic Health Records: Are they ready for you?Using Computers to increase Efficiency in a Breast Oncology Practice 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

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 specialty100 internists, pediatricians and family practitioners HemantBhargava, UC Davis Graduate School of Management • 25 to 33 percent drop in MD productivity • Over time • Internists slightly above original productivity • Pediatricians /family practitioners never recovered

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 Documents and Orders Orders Genetic Testing

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

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

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

11. Hereditary Risk Identification CDS

12. Hereditary Risk Identification Click open 4 screens BRCA1+

13. Hereditary Risk Identification

14. EHR Cardiovascular Pathology Anesthesia Generic Mammography

15. EHR RT Interface Breast Surgery Interface Breast MedOnc Interface

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

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

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

20. HughesRiskAppsBreast 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 Repurpose existing data Patient data entry Clinical Decision Support (CDS) Printout with suggested actions Clinician editing/enhancing Clinical Decision Support (CDS) Generate orders and documents

24. Clinical Decision Support 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

25. EHR RT Interface Breast Surgery Interface Breast MedOnc Interface

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

29. HughesRiskAppsBreast Surgery ModuleFree software available at: Kshughes@Partners.org HughesRiskApps.net

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

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

32. Breast Data Overlaps

33. EHR and productivity varies by specialty100 internists, pediatricians and family practitioners HemantBhargava, UC Davis Graduate School of Management • 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

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

35. Electronic Health Records: Are you ready?Using Computers to increase Efficiency in a Breast Oncology Practice 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