What if we had a fully integrated EHR?

1. What if we had a fully integrated EHR? Vance Brown, MD Asher Kramer, FHFMA January 22, 2009

2. Presentation Goals • To describe the current ambulatory care environment and processes • To envision the Electronic Health Record Future State • To articulate the planned and desired benefits of a fully integrated clinical system in MaineHealth • To seek your input into the ideas and uses of the system

3. Current “Modern” Medical technology tends to fragment rather than integrate care Multiple disconnected practice centric records Providers burdened with manual processes Patients not connected to healthcare system Future AEMR reconnects patients with providers of care Technology builds connected patient centric records Give patients greater involvement, understanding and empowerment in their healthcare High Tech – High TouchCreate High Touch Using Technology

4. The Patient’s Experience - Today

5. The Patient’s Ambulatory Experience - Tomorrow

6. Imagine A fully integrated EHR from the patients experience

7. Patient Online The Patient’s Ambulatory Experience - Tomorrow

8. The Patient Portal: MyChart

9. Proxy Access Proxy Access allows authorized individuals to access the medical records of patients whose health they are responsible for monitoring. Parents commonly use this feature to view their children’s medical records for immunizations, schedule appointments, and send messages in regards to their children. Adult children can also use this feature to stay well-informed of, and participate in, an elderly parent’s health care. Individuals designated as proxies do not have to be patients themselves to view data through MyChart. 

10. History Summaries Provides patients access to the historical information contained in their records, including: Medical History Surgical History Family Medical history Social History Family Status

11. History Questionnaires With MyChart, patients can complete and submit history questionnaires online prior to their appointment. The completed history questionnaire appears in a Visit Navigator form in EpicCare, from which clinicians can quickly review and automatically update the EMR with a single click. You can also include history questionnaires as links in the main MyChart menu or as tasks sent with secure patient messages.

12. Medications MyChart gives patients access to detailed information concerning the medications they are taking and the ability to request prescription renewals. Patient can send a secure message to the caregiver that authorized the medication to renew a prescription.

13. Test Results Displays patients’ laboratory tests, the physician who authorized each test, and the status of any test results. This feature can be a quick and easy way for patients to get the results of their lab tests. Graphing data is available for lab results. This gives patients a quick and easy way to monitor their health over time .

14. Disease Management: Diabetes Patients can closely monitor their diabetes at home using features that allow detailed monitoring of glucose testing, a listing of current diabetes medications, and summaries of recommended preventive care procedures. Physicians can have the patient-entered data sent to them at specified intervals or when an abnormal entry is recorded.

15. Registration/Scheduling • Direct Appointment Scheduling • MyChart allows patients to directly schedule new appointments with providers via MyChart. Patients have the option to: • Select which provider they want to see • Select a date range and time preference for the appointment

16. Patient Check In • Multi-lingual touch screen kiosk for patients’ use • Self check in with directions to department. Walk-in scheduling. • Credit card payments for copays and balance due • E-signing of requested documents (privacy notice, consents, etc) • Health Summary Questionnaires

17. The Patient Visit • Integrated office work flow, point of service testing coordination, CIR reporting • Fully developed clinical documentation & alerts tools reflecting best practice • Preference lists and ordering tools to improve provider efficiency • Point of care access to patient information from all sources

18. The Patient Visit • e-Prescribing • Direct communication (orders and results) with laboratory, cardiology, pulmonary and other ancillary services • Medical equipment interface with EMR

19. Billing for Services • Coding built into preference lists within system • 90% + of services auto billed at time of discharge without manual intervention • Provider specific reporting facilitated through integrated data warehouse

20. Post Discharge • Clinical Improvement repository for all specialties and EMR’s in MaineHealth community • Patient centric reporting • Patient communication enhanced though portal • Patient connected to system

21. PrimaryCare OB/GYN Cardiology Imagine… … Providers connected by technology … Patient information shared … PCP’s & specialist communicating effectively PrimaryCare … Communities of care … Care Everywhere … More time for patient

22. The FutureThe Physician Office Relationship to Technology • Quality metrics automatic and fully integrated into care processes • Standardization • Tie in to inpatient, long term care, other resources • Use of Kiosks • Support for Research • Support for staff and patient needs • Billing automated, coding built into system, process streamlined • Reimbursement – Pay for performance, tie in of clinical to administrative/financial • Seamless information flow across all care environments

23. Better Care Delivery • Provider • Staff • Patients

24. Provider Perspective • Short Term • Opportunity to partner with patients • Opportunity to increased information access • Time Equality • Long Term • Care Everywhere • Time Savings • Tool for Provider Collaboration

25. Patient Perspective • Short Term • What they hear they should expect • Curiosity • Codification of instructions • Long Term • Access • Asynchronous communications • Partnership through technology

26. Questions?