Successfully Choosing Your EMR

Successfully Choosing Your EMR

Founder

Medical Strategic Planning, Inc

Art Gasch

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Self - Disclosure

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No conflicts with EMR developers or EMR distributors

No conflicts with EMR developers or EMR distributors

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Author:

Author:

Successfully Choosing Your EMR: 15 Crucial Decisions

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Architect: MSP EHR Selector website (

Architect:

www.ehrselector.com

)

The book & website are mentioned in this presentation

It’s a law, not a suggestion – but what’s

the right approach to adopt?

82% of practices and 92% of hospitals

lack comprehensive EMR/EHR

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20% MDs Unhappy With EMR Deployed

Satisfied

“Not easy-to-use” & “workflow disruptions” are

two major causes of EMR deployment failures

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Crucial Decision(s) Physicians Now Face

1. When to sail into action?

2. How to navigate EMR adoption?

3. Continue to wait in port for the reform storm to weaken and pass by?

Once the storm passes, the waters will become more calm & safer

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Steps & Considerations in Choosing Your EMR

3. Practice & Staff Readiness Assessment

3. Practice & Staff Readiness Assessment

Widespread, successful EHR adoption is foundational for all healthcare reform

1. Form EMR Committee – Engage All Affected

1. Form EMR Committee – Engage All Affected

2. Determine Current & Future Needs

2. Determine Current & Future Needs

4. Carefully Evaluate EMR Alternatives

4. Carefully Evaluate EMR Alternatives

5. A Web-based EMR Information Resource

5. A Web-based EMR Information Resource

0. Understand Paradigm Change Faced

0. Understand Paradigm Change Faced

Understand the

Paradigm Change

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For 1

For 1

-

-

10 primary care practices, it will be a

10 primary care practices, it will be a

major paradigm change that requires computer

major paradigm change that requires computer

technology staff may not be familiar with!

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A more structured way to describe the encounter

“On my trip to TEPR I spent $1,079.48, mostly on the hotel and travel expenses.”

versus

---What was the total for mileage and parking? – can’t be answered from the freeform

description. How much detail is enough? How much longer does charting take?

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EMR – A New Paradigm,

Not an Electronic Version of the Paper Record

If the clinical data is

structured, it’s stored in

a DBMS and screens

displayed are database

reports, not images of

physical pages. How

EMRs store & manage

data is critical to their

ability to document

various PQRI & HEDIS

quality measures.

PGPs required to submit more specific patient data

to an increasing number of intermediaries

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‘Tug-of-Wars’ Due to Misaligned Priorities

Primary Care MD

The CIO

Legacy IT

Vendor

CIO – ‘Create as few new EHR

interfaces to legacy hospital

systems as possible’

MDs - ’Saying “No” to EHRs

that cripple office workflow

& productivity’

Form the

EMR Committee

Determine Current

& Future

Keys to Avoiding RAC Audits

CMS and its RAC Bounty Hunters

Don’t Rush

(Plan & Deployment)

Process

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Commonly Overlooked Issues

Individualized EMR process based upon your practice readiness assessment

Security

Mgmt

EMR

Satisfaction

Ratings

Workflow

Anal.

Backup

Power

&

Contingency

Planning

Staff

EMR

Orientation

Readiness

Assessment

Office

Renovations

Form

EHR

Committee

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Key Activities May be overlooked or abbreviated in

accelerated deployment approaches

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Typical EMR Planning Timeline (with Selected EMR Milestones)

The

EMR

or

EMR/PMS

or

EMR/PMS/Portal

Planning

Process

Has MORE steps (takes longer) if an in‐office EMR deployment is the objective!

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EMR Adoption Must Be Quick for RECs to Succeed

Medical Strategic Planning I Professional Information Transforming

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Three REC Payment Milestones

Subscription

Subscription

Deployment

_Deployment

MU Certification

_{MU Certification}

1/3

Second

payment

when

EMR

is

deployed

and

provides

CPOE

and

e

‐

RX

and

received

e

‐

Lab

results

1/3

REC

gets

paid

for

signing

you

up.

Focused

on

marketing

first

1/3

Final

payment

when

EP

is

certified

as

a

Meaningful

User

of

EMR

technology

Math

is

simple

 ‐

anything

that

delays

a

payment

milestone,

puts

REC

at

financial

risk.

Expediting

DEPLOYMENT

is

key

to

timely

receipt

of

2

_payment.

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License Grant: Vendor Example

Subject to the terms and conditions of this Agreement, Vendor grants

Licensee

a

non-transferable

, non-exclusive license to use the Software for

its

internal purposes

.

Vs.

Subject to the terms and conditions of this Agreement, Vendor grants to

Licensee a perpetual, non-exclusive license to use the Software for its

business activities. Such business activities include, but are not limited to,

the right of Licensee’s parents and their respective affiliates, subsidiaries,

and joint venturers to access and use the Software. In addition, Licensee

may serve as a service bureau for the foregoing entities

.

If you were buying a house, would you use the seller’s attorney?

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Specifications

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Most vendors warrant to the “documentation”

–

EMR Vendor controls the documentation

–

Can change at any time. Functionality “creep”

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Is specific functionality/interoperability required?

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RFQ and response included or not?

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Legal Agreement Scope

How thoroughly are each of these points covered? Law firms with national

heatlhcare practices, like Foley & Lardner or LeClairRyan can help. Figure

$5-9K for EMR related legal work on RFQ and final contracting/licensing.

Practice & Staff

Readiness

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Carefully Evaluate

EMR Alternatives

Picking an EMR is like buying a house or

purchasing a car

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A Crucial Decision to Make

Did you let someone else do that for you, or

did you want to do it yourself?

Whoever makes the choice, YOU will live with

it everyday!

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www.ehrselector.com

shows ‘functionally qualified’

EHR developers (that RECs didn’t present to you)

TEXT

TEXT

EXT

•

Little consistency in EMR features

from state to state, apart from MU

•

Vendors qualified inconsistent from

one state to another.

•

Some EMR vendor products that

meet MU criteria are overlooked in

many states.

A

A

‘

‘

functionally

functionally

-

-

qualified

qualified

’

’

EMR product

EMR product

is one that has the same

is one that has the same

functionality as the common

functionality as the common

denominator of REC

denominator of REC

-

-

selected EHR

selected EHR

products.

products.

…

575

more

EMRs

in

between

(of

both

types)

Over

600

EHR

Products

Listed

on

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A One-stop Portal for Diverse EHR Needs

www.ehrselector.com

Offering

Independent,

Impartial:

• Lists

of

EMR

Planning,

Deployment

&

Security

Consultants,

Accountants,

Lawyers,

Chart

Conversion/Scanning

Services

• EMR

Educational

Resources

• Hardware

Suppliers

• Post

‐

Deployment

System

Support

• EMR

Product

satisfaction

scores

(KLAS)

• EMR

Selection

Tracking,

Tools

&

Reports

for

EMR

Consultants/RECs

•

Ability

to

compare

687

features

of

key

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Scroll down to

see add’l. criteria

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Keep Scrolling Through All 680 Criteria

See which vendors

offer which features

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Logically Organized Categories and Criteria

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Both require careful planning

In-Office vs. Web-based EMR Deployment

Less External I-Net &

Theft Exposure

I-Net essential for

operation, redundant

connectivity required

Browser-based operation

& rapid deployment

make this the REC

favorite for EP clients

Greater In-office skill set.

Required & some

hardware maintenance.

In-Office

Appoach

Web-Based

ASP Approach

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Areas of Concern

What you need to consider

Loss of Internet Connection Can be a power failure, or I-Net provider failure, so your contingency plan must

cover all of these.

EMR Responsiveness Internet can be slow, and add 1 (or more) seconds to menu responses.

Non-control of EMR upgrades In the ASP model, every client migrates to new versions at same time at the will

of the EMR developer. Can create a training issue.

Workflow Customization Issues ASP apps may not be as user-customizable as in-office EMRs.

PMS Integration Challenges Can be more challenging to integrate Web-EMR with in-office PMS, or even

impossible.

Browser Issues

With 4 major brands, and several versions/brand, and numerous options, and different renderings of sites, browser management is not trivial to get and keep right.

Increased Security Risks

Every ASP user is ‘facing’ the I-net, and any user breach can compromise entire network. ASP EMR are also better targets for hackers than any individual office is.

Lack of Control of Backup Strategy and on-site access to patient files

How long does it take an ASP to restore backup if patient files are lost or breached, or ASP and EMR are two different organizations

Special Licensing considerations to be addressed

Some issues don’t exist with in-office deployments, but require special terms for web-based deployments.

User Interface Constraints Speech recognition is more challenging in I-net based EMRs. Many practices

are used to transcription, and like speech recognition EMRs.

Issues With I-Net Based SaaS ASP EMRs

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2010 EHR Book Library

Learning Resource Category

Resource Supplier &

Website Resource Name/Title

Contact or Author & Website

Contact Email & Phone Books Wiley-Blackwell Customer Care 10475 Crosspoint Blvd Indianapolis, IN 46256

Successfully Choosing the Right EMR – 15 Crucial Decisions

Released April 2010 ISBN 978-1-4443-3214-8

Arthur Gasch & Betty Gasch, RN, BSN

877-762-2974 Voice

800-605-2665 Fax Or Amazon

Books MGMA Press or Amazon

Electronic Health Records, 2nd _Edition, Transforming Your Medical Practice Released 2010 ISBN 978-1-56829-343-1 Margret Amatayakul 2313 W. Weathersfield Schaumburg, IL 60193 877-ASK MGMA Books AHIMA 233 N. Michigan Ave., Suite 2150 Chicago, IL 60601

How to Evaluate Electronic Health Record (EHR) Systems

~$129 - Released 2008

Patricia Trites and Dr. Reed Gelzer

312-233-1100 Rita Scichilone

Books Prentice Hall PTR EMR Complete: A Worktext,

January, 2010 Daniel Limmer

Amazon or Borders Online

Books Elsevier Health Sciences

The Electronic Health Record for the Physician's Office

Released 2010

ISBN 978-1-43770-0-282

Any DeVore Amazon or Borders Online

Just released (2010) books provide excellent introduction to EMR issues that transcend MU. They can prepare staff for college courses or may be all that is needed, depending on baseline EMR knowledge in clinical staff. Your Practice Readiness Assessment will show you.

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Upgrade Time…

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Do any of the ASP EMRs offered to you include a user-customizable

workflow engines?

(These offer users the ability to make their workflow specific for each

user, and for specific types of patient encounters, without requiring

EMR vendor assistance or charges).

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If user workflow modification isn’t built-in, it can’t be added on. An

example of an EMR with workflow management is EncounterPro

Open Source EMR.

Workflow and Application Customization

The number of keystrokes required to accomplish any task and the

entire patient encounter is critical. This is something that no REC can

evaluate for you because they don’t know your workflow!

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User-Accessible Workflow Customization

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Getting EMR Integration Right

HIE

Integration

RHIOs

Web

Portal

Basic

EMR

Patient

Kiosk

Integrated

PMS

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The EHR Selector

A Consultant’s

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MSP’s EHR Selector is Easy

TEXT

TEXT

EXT

Simple to find www.ehrselector.com

Convenient cascading

selection categories

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EMR Selection is About Getting Details Right!

48

Feb. 2, 2010

48

9 of 35 Rx Criteria

For ‘MU’ requires only

3

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Assert 144 Criteria in ONE Global (AGA) Profile

Criteria picked by AGA

physicians who have

already adopted EHR

and found them to be

important.

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Built-In ‘Help’ Systems Clarifies Questions or

Raises Important Considerations

Help may be brief

Help may be brief

or extensive, but

or extensive, but

is generally concise

is generally concise

and relevant.

and relevant.

Help is a

Help is a

click away!

click away!

A Glossary of Terms

A Glossary of Terms

is also available

is also available

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Glossary Provides Basic Info w/Hot-Link to More Info

From Help Screen Hot Link to background info on the Internet

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After Assertion, Simply Submit

TEXT

TEXT

EXT

Attach functional criteria listed to your RFQ to document needs

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Searching by Keyword Quickly Locates Features

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Developers’ KLAS Ratings

MSP EMR Selector

includes embedded

KLAS ratings

MSP EMR Selector

includes embedded

KLAS ratings

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Web-based EHR Selector Comparison Matrix

MSP Competitor A Competitor B Competitor C Competitor D

Uses 3rd_{-Party Vetted}

Information Yes No No No No

Partners w/Major MD

Organizations 6 No No Some Yes

KLAS Research

EMR Ratings Yes No No No No

2010 Meaningful

Use Flags Yes ?? ?? ?? No

Sells EHR Products No Yes No No No

Exhibitor Fees Fund EHR

Selector Company No No No Yes Yes

Provides EHR Consulting No No No Yes ???

Solicits EHR Commissions

or Finder’s Fees ? No Yes ??? ??? ???

Direct Match & Vendor

Feature Magnifier Yes No No No No

REC/Consultants Mode Yes No No No No

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Thanks for your interest.

Leave me a business card if you would like a copy of the presentation.

Questions & Answers

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Medical Strategic Planning, Inc.

Arthur Gasch –

Founder, Board of Directors

5 Shelbern Dr. - Lincroft, NJ 07738

[email protected]

Ph:

732-219-5090

Fax:

732-219-5066

Wm. F. Andrew

–

VP EHR Business Unit

Online:

http://www.medsp.com

and

[email protected]

http://www.ehrselector.com

Selected MSP EHR Partners/Associates:

Carolyn Samuels, M.D. – Creator of EHR Selector, Managing Member CSMed, LLC

Robt. Bruegel, Ph.D. – Associate for Andrew & Associates EHR Benchmark David Ginsberg – Founder, Privaplan, Inc.

Selected EHR Cooperating Organizations:

ACC – College of Cardiology AGA – Gastroenterological Association

AHQA – Health Quality Association HIMSS – Hlth Info Mgmt & Sys. Society