EMR - The Time is Now: Physician Alignment through IT

1. EMR - The Time is Now:Physician Alignment through IT Richard Eshbach & Bill Moran Panel Discussion

2. “Every American will have access to an electronic health record by 2014” The President’s Bold Vision for HIT

3. EMR and our Connected Care Community • What is our Definition of an Electronic Medical Record • WHS and MSHA Current/Future State of the EMR • In-Patient • Out-Patient • Stark Safe Harbors • Regional Out-reach Programs/Opportunities

4. Definition of an EMR CPR EMR Are we all speaking the same language…..? EHR PHR

5. Components of a Patient Record Scanned Images of Documents History & Physical Physician Notes Demographic Information Care Giver Notes Prior Encounters Pharmacy Cardiology/Pulmonary Discharge Summary Laboratory Boxed Components are Unstructured Information Radiology

6. EMR Adoption Model Q2 2008 5%

7. Hospital involvement in community EMR Deployments Hospitals will represent 38% of all EMR purchases up from 11% in 2007 – AC Group, Feb 2008

8. Electronic Medical Record Industry – Only 22% of Hospitals across the country have successfully deployed an EMR

9. EMR Scores by Comparison EMR Scores by Bed Size EMR Scores by State

10. How will we get there? Who will take the lead?

11. Electronic Medical Record

12. MSHA EMR Strategies Inpatient / Outpatient EMR In 2003, strategic EMR initiative launched to build upon a new integrated technology solution powered by a workflow engine $40+ million committed by MSHA Board for a multi-year implementation Physician Office EMR Implemented Misys EMR in practices in 2005 and now offering as an MSO hosted service to non-employed physician practices Regional Integration Varying levels of integration with physician practice EMRs depending on their status of EMR adoption Exploiting CCHIT compliant inter-operability tools Collaboration in regional connectivity initiatives such as CareSpark RHIO 11/17/2014 12

13. Computerized Patient Record JourneyPhases I-III Increasing Value On Journey to Patient Safety, Quality and Efficiency 2009-11 2009-10 Bar Coding - MAK Live 2008-09 Interdisciplinary Charting 6 months ED Rad Upg PACs >6 months 2007 Cardiology eHIM Orders Pharmacy Network ClinicalAccess Monitors Single Sign On Hardware Wireless

14. MSHA In/Out-Patient Approach Mountain States EMR consist of the following: (We are 75% deployed) An electronic Clinical Data Repository - √ Completed (Soarian Clinical Access) Contains 8 years of detailed clinical data An electronic Order Management System - √ Underway (New Soarian Orders) A Picture Archival Communication (PACs) System which allows the capture of medical images – √ Completed (GE Radiology PACs and Siemens Cardiology PACs (echos, caths, nuclear studies…) An electronicflow sheets of vitals and I/O - √ Completed (Soarian Critical Care and MegaCare) An electronic Pharmacy System - √ Completed (Soarian Pharmacy) An electronic Radiology System - √ Completed (Siemens Radiology) An electronic Transcription System - √ Completed (Dolby with Voice Recognition) An electronic Laboratory System - √ Completed (Cerner Classic, replaced w/ SoftLab) An electronic Nursing/Ancillary documentation System - √ Completed (Soarian Clinical Team) An electronic Paper Medical Record - √ Completed (Soarian HIM) eHIM helps you fill gaps in areas throughout your hospitals, where you do not have electronic functionality by scanning, storing and retrieving the paper medical record. Also allows on-line abstraction, coding and completion management and signature by physicians from any location. electronic workflow engine is “listening” to any care event or condition and can be automatically triggered to pro-actively monitor, notify and escalate steps in the care process across all caregivers. Hardwired process workflows minimize lag-time between care handoffs and eliminate “dropping the ball!” 11/17/2014 14

15. MSHA In/Out Patient Approach • What’s Next……………….. • In order to have a “Completed” Electronic Medical Record, these components are scheduled for implementation: • Nursing Plans of Care • CPOE/ Physician Orders • Physician Progress Notes • Continued/Enhanced Integration to Physician Office EMR’s • Deployment of Home Health Clinical Documentation • On-going enhancement of workflows as more clinical information is available and more clinicians are on-line 11/17/2014 15

16. Progress Notes Timeframe for Implementation Foundation Systems Clinical Repository Monitors Wireless Single-sign-on Replace Ancillaries • Pharmacy • MAK • eHIM • Dictation • ED • PACs • Rad • EKG • Cardio Orders and Documentation Orders Alerts Workflows Vital Signs Assessments Documentation Forms Plans of Care Physician Order Entry Clinical Decision Support

17. MSHA Ambulatory Approach Physician Office EMR • Over a decade of utilizing the Misys office management system in all physician practices and providing as contracted MSO service • Implemented Misys EMR in practices in 2005 and now offering as a service to private physician practices (under Stark Safe Harbor guidelines)

18. MSHA Connectivity Approach Regional Integration • Varying levels of integration with physician practice EMRs depending on their status of EMR adoption • Exploiting CCHIT compliant inter-operability tools • Collaboration in regional connectivity initiatives such as CareSpark RHIO

19. Electronic Medical Record

20. EMR – Approach • Understanding how WHS EMR Strategies • In-Patient EMR (76% completed) • Our In-patient EMR consists of several software applications that make up the chemistry of a EMR.  • Out Patient EMR • Our Out reach (out-patient) EMR currently consists of a purchased package – AllScripts product • Ancillary Strategies around EMR’s • Complexity surrounding multiple EMR strategies – allows us to take advantage of true interoperability through Relay Health.

21. WHS EMR Strategies Inpatient / Outpatient EMR 99.2% of Positive adoption through our WHS/Physician Portal – our connectivity tool for our Physicians. Over 1,000 Physician Population Our Physician voice is critical in shaping our outcomes. Physicians ‘decide’ how our electronic medical record is defined – through Physician Technology Committees. Board initiative to commit information technology and the exchange of health record exchange for the improvement of patient care within our community. Physician Office EMR Today we have over 60+ physician clinics/offices affiliated with Wellmont. We currently Implemented Misys practice management EMR, and currently have installed AllScripts as our out patient clinical EMR solution. Regional Integration Continued education and participation in sharing health exchange information to every town/city/and region within our community Regional Quarterly IT collaboration initiatives Hosting service, regional/industry benchmarking, best practices Establishing a Chime/HIMSS chapter within our Region 11/17/2014 21

22. Navigating through the technology “Nobody said it would be easy”

23. EMR evolution…. Phase 5 EMR In Patient - EMR Phase 4 Physician Office,CPOE Phase 4 Horizon Lab, Anesthesia, ER Phase 3 Nursing Doc (HED), AdminRx (barcoding) Phase 2 LAB (Cerner), Pharmacy (HMM), Cardiology Phase 1 PACS (AGFA), RIS (STAR), OR (HSM),Transcription/Dictatn.

24. EMR – In Patient Approach… Wellmont’s EMR consist of the following: (We are 76% deployed) • An electronicOrder Management System - √ Completed(STAR HOM/Orders) • An Picture Archival Communication (PAC’s) System which allows the capture of medical images – √ Completed(PAC’s) • An electronicPharmacy System - √ Completed(HMM) • An electronicRadiology System - √ Completed(Star RIS) • An electronicTranscription System - √ Completed(Cquence, Star/HPF, Lanier) • An electronicLaboratory System - √ Completed(Cerner Classic) • An electronicNursing documentation System - √ Completed (HED) • An electronicHorizon Patient Folder Application - √ Completed(HPF) • HPFhelps you fill gaps in areas throughout your hospitals, where you do not have electronic functionality. This application allow scanned documents and having them back available in ‘REAL-TIME electronically.

25. WHS EMR – What’s Next… In order to have a “Completed” Electronic Medical Record, these components are scheduled for implementation: CPOE/Orders Physician Notes Integration to Physician Office EMR’s and Clinician Care Plans Cardiology products have to be fully integrated (90% done) Emergency Departments need to be fully integrated Anesthesia needs to be fully integrated 11/17/2014 25

26. Ambulatory Strategy Ambulatory Strategy and Solution Update

27. Traditional Methods of Delivering Test Results/Transcriptions Fax or Mail Manual Process and Costly – Not Actionable Portal Passive Notification – Requires Provider to Search for Result – Not Actionable Point to Point Interfaces HL7 Interfaces IT Overhead- Costly to Maintain – Not Actionable

28. Interoperability through RelayHealth RelayHealth provides an intelligent network that enables constituents across healthcare to connect interactively, share information, and collaborate to improve the quality and efficiency of care. • Improves clinical communication, • Enhances business performance • Facilitates the delivery of high-quality care

29. RelayHealth Connectivity Hospitals Physicians Patients Retail Rx Payors Financial Institutions Connectivity Through the RelayHealth Network Physician-Hospital- Pharmacy-Patient Clinical Interaction Physician-Patient AdminInteraction Physician-Retail RxConnectivity Hospital-PhysicianConnectivity Physician-to-PhysicianNetworking • Emergency Dept connectivity • Care mgmt • Results distribution • Electronic prescriptions • Renewals • Appointment scheduling • Billing questions and online payments • Test results • webVisit consultations • Rx renewals • Personal health records • Referrals • Patient care collaboration

30. Connected and Actionable Network Patient Specialist Bi-directional Communication HL7 RH Network Primary Care Patient

31. Physician Practice EMR Adoption 11/17/2014 31

32. Congress Passes Medicare Bill with e-Prescribing Incentives (July 15, 2008) Medicare physicians who use e-prescribing technology will be eligible for incentive payments: • 2% in fiscal year 2009 and 2010 • 1% in 2011 and 2012 • 0.5% in 2013 Physicians participating in Medicare who do not e-prescribe: • 1% payment cut in 2012 • 1.5% payment cut in 2013 • 2% in subsequent years Provision exempts physicians who infrequently use prescriptions

33. Stark Safe Harbors – “Rules of Engagement” 11/17/2014 33

34. Stark: Long-awaited Regulatory Relief • On August 8, 2006, the U.S. Department of Health and Human Services (HHS) published the final rules regarding provisions in the Medicare Modernization Act. • Facilitate the distribution and adoption of HIT related to electronic prescribing and electronic health records (EHRs) • Rules address ambiguity in current prohibitions to physician self-referral (known as the Stark laws) and anti-kickback statutes

35. Overview of the Regulations • Permitted technology • Minimum technology standards • Permitted donors • Permitted recipients • Payment obligations • Technology not duplicative • Documentation

36. Regional Out-reach Programs/Opportunities 11/17/2014 36

37. Regional Out-Reach Programs/Opportunities Hospital Patient Connected Community Physicians Payor Financial Institution Pharmacy

38. Hospital involvement in community EMR Deployments “…hospital organizations are trying to figure out how they are going to … propel EMR solutions to community physicians” – Jared Peterson, VP, ResearchKLAS, June 2008, when asked about the biggest EMR trends in the next few years

39. Regional Connectivity Initiatives Gaining Momentum • Integration with existing physician EMRs at various levels • Encouraging the adoption by physician practices • Offering EMR hosting (within SSH guidelines) • Adoption of CCHIT standards and “exchange” technologies • Charter involvement in CareSpark (RHIO) initiative 11/17/2014 39

40. QUESTIONS ?