Electronic Medical Records: Retrieval and Underwriting

1. Electronic Medical Records:Retrieval and Underwriting

2. Texas Medical Dictionary • Artery.............................. The study of paintings • Bacteria.......................... Back door to the cafeteria  • Barium............................. What doctors do when patients die  • Benign............................ What you be, after you be eight  • Caesarean Section......... A neighborhood in Rome   • Cat scan......................... Searching for Kitty  • Cauterize........................ Made eye contact with her  • Colic................................. A sheep dog 

3. Texas Medical Dictionary • Coma.............................. A punctuation mark  • Dilate............................... To live long  • Enema............................. Not a friend  • Fester.............................. Quicker than someone else  • Fibula............................... A small lie • Impotent..........................Distinguished, well know  • Labor Pain....................... Getting hurt at work  • Medical Staff.................... A Doctor's cane 

4. Texas Medical Dictionary • Morbid..............................A higher offer • Nitrates.............................Cheaper than day rates  • Node................................ I knew it  • Outpatient....................... A person who has fainted  • Pelvis.............................. Second cousin to Elvis  • Post Operative............... A letter carrier  • Recovery Room............. Place to do upholstery

5. Texas Medical Dictionary • Rectum...........................Dern near killed him  • Secretion........................Hiding something  • Seizure.......................... Roman emperor  • Tablet............................ A small table  • Terminal Illness............. Getting sick at the airport  • Tumor........................... One plus one more  • Urine............................. Opposite of you're out

6. Sources • ACORD • MIB • PilotFish • Copy Services • Buyers Guide White Paper • Masters candidates in hospital administration Baylor University

7. Today’s Presentation • Introduction to EMR / EHR - glossary of terms • Who’s driving HER adoption? • What’s Law Got To Do With It? • Healthcare • Business - $$$ (who makes / saves money?) • Government’s role • Vendors • How will it affect me? Life insurance underwriting?

8. Glossary • ARRA – American Recovery and Reinvestment Act. Among many other initiatives, the law provides incentive payments for healthcare providers that use EMRs. Incentive payments begin in 2011 and will gradually decrease until 2014 – after which, providers not using EMRs will be penalized. • EMR – Electronic Medical Records. Computerized system that stores notes, prescriptions, and other medical information for a patient in an electronic format rather than on paper. EMRs make searching for, retrieving, and sharing patient data more user-friendly and efficient. A federal mandate, called the Health Information Technology for Economic and Clinical Health Act (HITECH) and introduced in 2009, requires all medical practices and hospitals to adopt the EMR system by 2014.

9. Glossary • EHR – Electronic Health Record. Electronic Health Record attempts to promote a more holistic view of patient records where continuum of care is the key aspect, allowing access to medical information by multiple stakeholders. Many healthcare systems possess pieces of the Electronic Health Record such as computerized physician order entry or electronic medical records within one point of care. However, only 1.5% of hospitals in the United States actually utilize a fully integrated Electronic Health Record • CCR – Continuity of Care Record. A new document standard being developed for EMR software vendors to allow patient data to be easily moved from on eMR vendor in the same format.

10. Glossary • CCDIT – Certification Commission for Healthcare Information Technology. The organization that certifies healthcare IT products, including the certification to qualify EMR software for government incentive payments. • CDR – Clinical Data Repository. A database that consolidates data from a variety of healthcare providers to present a single health record for a patient. • REC – Regional Extension Center. Government funded system that offers technical assistance, guidance, and information on best practices to support and accelerate health care providers’ efforts to become meaningful users of EMR.

11. The Drivers • Healthcare providers - improved healthcare - thorough, fast access to patient records • Studies • John Hopkins University study published in 2009 reviewed 41 hospitals. Those using EMR • 15% lower death rate • 16% fewer complications • Lower operating costs • Arizona State University study in 2010 found that hospitals using latest EMR technology reduced emergency room wait by 22% compared to old or no EMR

12. The Drivers • Minimize dangerous errors / drug interactions – handwriting • Automatically alerts doctors of patient allergies or dangerous drug interactions • National Academy of Sciences’ Institute of Medicine determined sloppy handwriting led to 7,000 deaths every year in the United States. • More focus on patients, less on paperwork • Automatic wellness reminders supports scheduling important tests, exams – treatments screenings and immunizations

13. The Drivers • Data mining – patient notification of drug recall, warnings, etc . • Software assisted diagnosis and treatment suggestions • Improved customer service when patients call with questions. Records are immediately available. Case study in a large practice in the Midwest reduced their patient responses from fifteen to five minutes. • Differential diagnosis • Association of disease and treatment

14. The Drivers • Sharing of data • Communicating with other organizations doctors, hospitals, labs, physical therapists, pharmacists, etc. • Referrals – efficiently generate referral letterandattach patient records • Prescriptions – electronic or autofax prescriptions to pharmacist • Printing of EMR for chart requests (paving the cowpath) • EDI – sharing of actual electronic data

15. The Drivers • Summary • Better care • Safer environment for patients • More efficiency

16. The Drivers • Reduce cost • Increased efficiency • Less wasted time searching for missing charts • Lower operation costs • Better quality of care • Data mining • Predictive diagnosis • Scoring

17. The Drivers • Government regulations • American Recovery and Reinvestment Act (ARRA) of 2009 • $45 billion to fund EMR adoption • Initial payments begin in 2011

18. The Drivers • Incentives for early adopters through 2014 • Increased Medicaid and Medicare reimbursements • Hospitals • Up to $2 million in the first year • More in subsequent years depending on size and number of patients

19. The Drivers • Doctors • $44,000 in Medicare payments of a five year period, or • $63,750 over six years in Medicaid payments (30% of patients) • These payments are given to individual doctors, so different doctors in the same practice can each get payments if eligible • Must start in 2011 or 2012 to receive maximum • Must demonstrate meaningful usage by Centers of Medicare and Medicaid Services by 2015. • Software must be certified by CCHIT Certification Commission for Healthcare Information Technology www.cchit.org

20. The Drivers • Penalties beginning 2015 - doctors and hospitals alike without meaningful use by 2015 will receive decreased Medicaid and Medicare reimbursements • 1% in 2015 • 2% in 2016 • 3% in 2017 • 3% - 5% thereafter

21. The Drivers • Vendors • 210 different providers of EMR solutions • McKesson • General Electric • Cerner • Epic • Allscripts/Eclipsys • Large vendors • Certification – integration and connectivity standards • Security

22. Obstacles • The New England Journal of Medicine has identified five major perceived barriers to adoption of Electronic Health Records: inadequate capital for purchase, unclear return on equity, maintenance costs, physicians’ resistance, and inadequate IT staff.

23. Obstacles • Cost • Only 20% of doctors and 10% of hospitals are currently using EMR. • Short term increased cost • Systems • Software • Lost efficiencies due to training and learning curve Training – doctors, nurses, technicians and aids have not been trained in these systems. Costs associated with training cannot be overlooked.

24. Obstacles • Inadequate technical staff – many times contractors must be hired to support installations. • Conversion of existing paper documents • Long term yet to be determined • CCHIT – Certification Commission for Healthcare Information Technology

25. Obstacles • Physician resistance • With the advent of the Electronic Health Record, physicians are being asked to completely change the way that they practice medicine. • New EHR systems are forcing physicians to use a computer throughout the entire continuum of care forcing the alteration of many habitual processes. • Data must be input into the system rather than through verbal documentation. • Each particular EHR vendor has its own unique terminology for navigation, making the learning curve even steeper.

26. Obstacles • Security • Privacy leaks and data breaches • Access to large quantities of patient history information • Data could be mined • Strict access policies must be written and strictly enforced including password protection, copying of records to external media or portable storage device

27. Effects on Record Retrieval and Underwriting • Sharing of EMR data • Current model requires printing to paper or other electronic image format (pdf, tif, jpg) and sending via mail, fax or other electronic means • Data format standards • Health Level 7 (HL7) is an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information. • Headquartered in Ann Arbor, MI • Archaic standards

28. Effects on Record Retrieval and Underwriting • Clinical Data Repository – new document standard being developed for EMR software vendors to allow patient data to be easily moved from one EMR vendor to another in the same format • New XML standard CCR – needs work, cooperation • Build once compliant with HL7 or CCR standard, integrate with many across vendor systems and healthcare providers

29. Conclusion • Great but how can we benefit without all the downside? • Some of these benefits include: immediate computerized decision support, improved patient continuum of care, and elimination of paper charts. However, these benefits may pale in comparison to the overall cost of implementing and maintaining the system. Installation costs of the actual system, training costs, and opportunity costs such as lost productivity from staff and clinicians make up significant costs of implementation.