EMR Sharing Health Information

1. EMRSharing Health Information By: Gregory-Thomas C. Stanger BUS 550 The Contemporary Firm Spring 2013, Dr. Minder Chen

2. Intro • EMR: 1970s • Allow for electronic exchange of patient histories with other HP • Reduce medical errors • Bring better consistent care • 2005: only 41% US hospitals • Rising Trend in “health consumerism” • $34b in America’s Annual healthcare higher efficiency and safety • Network effect: Hospitals->Hospitals, HCP->HCP

3. Case Study Canadian Medical Assessment (CMA) 20 Cases in primary care Objectives: ID & capture best practices in EMR Paterson, Grace I. et. Al. Cross-Canada EMR Case Studies: Analysis of Physicians’ Perspectives on Benefits and Barriers (2011). Electronic Journal of Health Informatics. Vol 6(4):e34.

4. Three primary research questions 1. How are EMRs implemented? 2. How are EMRs used in clinical practice? 3. How can EMR adoption be increased and sustained?

5. Tools Used EMR System and Use Assessment Survey Interview guide for site visits Transcription codes Observation guide Case study report template

6. EMR System and Use Assessment Survey ★   ★ ★ ★  ★ ★  ★   ★ ★    http://www.cma.ca/EMRCaseStudies.

7. Themes in EMR CS Clinic culture and leadership Motivation EMR capabilities and use Technical issues Scanning Workflow and process change-organization impact Implementation strategy Patient safety Key success factors and lessons learned Facilitators of EMR adoption Quality of care Costs versus benefits Efficiency Lessons learned Future plans Benefits of EMR Barriers to EMR adoption

8. “Benefits of EMR” The benefits of EMR system functions from the interviews

9. “Benefits of EMR” Intrinsic: peace of mind, provisions of better care and patient satisfaction Practice: Reduced physician turnover, saved space, improved morale, practice audit, creation of data Financial: As a whole, generally reduce cost

10. Addressing: attitude, misconceptions, lost productivity, lack of interoperability, outdated and restricted legislations “Barriers to EMR Adoption” Fear of change/mistakes Need to scan documents and possibility of introducing errors from this and/or data entry Lack of speed and reliability Need for expert IT support Start up delays due to need to populate Changes to office configuration Lost productivity Insufficient interoperability- “electronic island” Outdated/restrictive legislation Fee-for-service reimbursement model

11. Discussion Picture #1 Picture #2

12. Conclusion of findings • Social Benefits>Barriers • EMR in medical schools • Reengineer practice and master EMR use

13. Conceptual Model toward a Competitive Advantage Richards, Rhonda J., Prybutol, Victor R., and Ryan, Sherry D. Electronic Medical Records: Tools for Competitive Advantage (2012). International Journal of Quality and Service Sciences. Vol 4 No. 2, pp. 120-136.

14. Triggers toward EMR Political strainsHealthcare as a Right (American Recovery and Reinvestment Act of 2009) Presidential Initiatives for EMR implementation, 2014 Financial incentives, 2011 Financial penalties to HCP, 2014 Keep updated systems Economic strainsRising HC cost Increased HC demand Customers seek increase in quantity and efficiency Legal StrainsHIPAA rules Office of the National Coordinator for Health Information technology Health Information Standards Committee Privacy Laws Security Laws

15. IT Strategy via EMR Network and Integration (for alignment w/ 3rdpt)Sharing information to other HCP, payers, and patients Standards and RegulationInteroperability Support Existing technologies National Health Information Network Emerging technologyintegrate emerging technologies adoption Review of emerging technologies Early adoption

16. Strategic Alignment IT linkage with PhysiciansDM, user, admin, purchaser Commitment to adoption/use Bear cost while insurance companies, patients, and government associations IT linkage with Clinical AdministrationStreamlined Scheduling Integration of Billing National Health Information Network Share clinical data Avoid Duplications Trained in Technology Physicians linkage to clinical administrationPhysician play role in scheduling, doc, bill, referral, Rx services, storage and data mining for competitive use of information Implementation vs. need financial benefit

17. Outcomes leading to competitive advantage PatientIS interface with users; web apps: apt., registration, Rx services and surveys. Decreased ADR, Antibiotics, hospital stay, and cost Enhanced satisfaction Quality care from database of health informationand DSS->ADR->FDA->Drug safety monitoring Global health risk via demographic data Clinicalcomputerized patient records, document management systems, data warehouses, distribution networks, and telematics. Allow for speed, reduced errors, and cost savings. Integration of Dx, treatment codes->faster collections Physician Efficiency Access to data, automated Rx, more support

18. Competitive Advantage Firms compete on the basis of unique resources High Quality Care Satisfaction Outcome Measurement and Monitoring (MU) Affordable Healthcare

19. PACIS NEXTGEN REGION V North- User Group Meeting • Contract Modules • Integrated PIR • Patient Portal • Clinical Viewer • Patient Keeper • PACIS.com

20. Risks and Disadvantages of EMR integration Information transparency Wealth of information Privacy-> inadequate quality of care Rising cost of EMR

21. Privacy Do privacy protection laws inhibit technology diffusion of EMR? Ex: RFID privacy bill in 2004 in Utah House of Representatives, designed to prevent matching RFID data with consumer’s personal information Miller, Amalia R. And Tucker, Catherine. Privacy Protection and Technology Diffusion: The Case of Electronic Medical Records (February 2009). NET Institute Working Paper No. 07-16.

22. Privacy Accomplished by: Issues with data security Issues with confidentiality Reduction in medical identity theft

23. Privacy laws can increase network costs or network benefits from EMR adoption. They can improve patient compliance: “69% of survey respondents state that they are very concerned or somewhat concerned that an EMR system could lead to ‘more sharing of your medical information without your knowledge’” They can also impose addition network costs: “It is more expensive to design a system that has the additional flexibility to limit the flow of information by the type of detail in a patient medical record and by the type of external destination, irrespective of how many patients refuse to have their records shared.” Privacy Reduction in medical identity theft

24. adopt*ijt=f(NetworkNetBenefitsEMRijt,StandAloneNetBenetfitsEMRit|PrivacyLawit)adopt*ijt=f(NetworkNetBenefitsEMRijt,StandAloneNetBenetfitsEMRit|PrivacyLawit) Conceptual Model of Hospital EMR Adoption

25. Conceptual Model of Hospital EMR Adoption ICU: Information they collect is only used at the time and not useful when it is transferred

26. Network effect Contingent on: • Willingness of patient to provide health information and have information transferred electronically across HCP • Other HCP can exchange health information

27. Tables/Data in Study of Privacy Laws on EMR adoption

28. EMR adoption: “… state privacy protection of hospital medical information is inhibiting EMR adoption by around 11% per three-year period, or 24% overall in states with such laws.” Privacy and EMR Adoption/ Network Effects “In states without hospital privacy legislation, EMR adoption by one hospital increases the probability of a neighboring hospital adoption by 7% overall using cross-sectional data and by 2% every there years using panel data” Network effect: No measureable network effect in states with privacy protection legislation.

29. T/F From the Case Study, in states with privacy protection laws the EMR adoption rate is negative?

30. MC Political Economic Private Legal None of the above Which of the answers below is NOT a trigger from the conceptual model of implementing EMR?

31. MC Without With With little None of the above In states _________ privacy protection laws, there was no measurable effect on network effect according to the case study.

32. THANK YOU!!!