EHR—Electronic Health Records

Why Should I Be Worried?

EHR—What Should I Know?
What is the most important point?
 None of the EHR vendors currently meet the
Federal requirements for an EHR because one of
the primary requirements is an EHR must be
interoperable with other EHRs.
 Do you have specialists who can tell you what to
do?

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EHR—What Should I Know?
What is the elephant in the room?
 Non-interoperable EHRs will further impede access by
creating proprietary information silos
 To be of any value, EMRs must be interoperable &
interconnected to EHRs, both ambulatory and clinical
 EHRs must be interoperable & interconnected
 Without a web of EHRs, there are no Regional Health
Information Organizations (RHIOs)
 The RHIOs all have different architectures
 Without RHIOs there is no National Health Information
Network (NHIN)

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EHR—What Should I Know?
What is the Network Effect of
Networked EHRs?
The network of EHRs could act as a value multiplier.
Without a network the value multiplier is zero.

 One EHR is worth nothing

 Two EHRs connected to each other are worth something
 A network of EHRs is very valuable.

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EHR—What Should I Know?
What is the elephant in the room?
 What does this mean—EHRs must be
interoperable & interconnected?
– Know before you buy—what connects to what?
– If EHRs aren’t connected, doctors will need electronic
and paper files

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EHR—Exponential Problems
What must be connected? An N x M
connection must work for:
 Hospitals connecting to:
– Doctors
– Hospitals
– RHIOs
– Labs
– Pharmacies
– Imaging
– Electronic Health Records (1 x N)
 EHR to EHR
– Continuity of Care Record (CCR)

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EHR—Fail Safe Points
What are the EHR Fail Safe Points
(FSPs)?
 EHR is healthcare’s Y2K time bomb.
 There a is concurrent national rollout of EHR;
standards not available until 2010.
 The costs are very high, so are the penalties
 1/3rd to 2/3rd of EHRs implemented have failed
 There may not be time to earn the incentives
 Nobody knows which applications will qualify for
certification
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EHR—Fail Safe Points
What are the other EHR FSPs?
 There aren’t nearly enough resources to do the work
– EHR vendors can’t staff for a national rollout
– Healthcare IT resources to support providers are 50% below
the number required
 Healthcare providers in-house IT department has:
– No experience with EHR
– Never built one
– Never bought one
– Never installed one

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EHR—Ambulatory Practices
I think it is advantageous for them to wait. Within
12-18 months they will likely have the
opportunity to acquire a plug-and-play EHR in-
house or SaaS.
 Project management
 Selection
 Implementation
 Adapting workflows
 Training
 Support

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Electronic Health Record
(EHR)
The need for change is real and
mandated
In the US there are more than 20,000 healthcare transactions
each minute.

In Canada, in the absence of a comprehensive EHR system,

for every 1,000:
 Hospital admissions, 75 people will suffer an adverse drug
event;
 Patients with an ambulatory encounter, 20 will suffer a
serious drug event;
 Laboratory tests performed, up to 150 will be unnecessary;
 Emergency room visits, 320 patients will have an 10
EHR is Wide Open
New England Journal of Medicine (NEJM)
received responses from 63.1% of
hospitals surveyed:

 Only 1.5% of U.S. hospitals have a comprehensive

electronic-records system (i.e., present in all clinical units),
 7.6% have a basic system (i.e., present in at least one
clinical unit).
 Computerized provider-order entry for medications has
been implemented in only 17% of hospitals.
 Respondents cited capital and maintenance
costs as the primary barriers to implementation
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EHR—Meaningful Use?
From HHS: Must Zoom to read

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EHR—Snail Paced Adoption

NEJM

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EHR Barriers—Magnitude of
staffing barrier is grossly
underestimated
Barriers to Electronic-Records Adoption
(NEMJ)

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EHR Facilitators—will not have the
desired impact
Facilitators of Electronic-Records Adoption
(NEMJ)

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EHR Costs—to pass the
interoperability test are
understated
The Cost of Change
Canada budgeted US $450 per person to implement EHR.

The US stimulus package allocates $20 billion for EHR, roughly US

$60 per individual. How large is the shortfall, and what or who
will make up the difference?

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EHR—if it doesn’t connect, it
doesn’t work
Just because EHR’s have been
implemented, doesn’t mean they’re
of any value.
“I've witnessed more serious errors with the EHR than in my
previous 25 years as a physician. These are the errors in thinking
and decision making: cases where the physician was so distracted
by the order tree that she forgot an important order; cases where
the fragmented, disordered thinking was imposed by the EHR.”
Christine A. Sinsky, MD

"...our system for delivering medical care is clearly in crisis...At the heart
of the problem is the fragmented nature of the way health information is
created and collected,"
Bill Gates

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Most EHRs don’t operate beyond the walls of the
EHR—if this was reality TV,
there’d be no winners
Foundational Elements of National
EHR:
 Completing the baseline EHR info-structure for 100 percent
of the population
 Seamless communication across the continuum of care and
into community based settings. (The availability of
electronic medical records, for example, would integrate
primary care physicians and specialists into community
care facilities)
 Extending order entry functionality and other decision-
support elements in acute care settings to support delivery
of high quality care
 Empowering patients to manage their own care by creating
patient portals with self-care tools and basic personal 18
health information
EHR Enablers—who’s watching
the business processes?

System Enablers of EHR

The final components of EHR are the system enablers
which leverage the benefits of the investment:

 Redesigning the key business processes, along with

change management efforts, education and training
 Establishing common data, integration, and communication
standards
 Applying appropriate legislative frameworks for privacy
and patient consent

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EHR Readiness Methodology

EHR
Readiness
Methodology
has a 6 phase
scorecard.
Enterprise Readiness
Assessment
The Enterprise Readiness Assessment
identifies gaps in:

 Change Management Readiness

 Technology Readiness
 Risk Management
 Standards Readiness
EHR Implementation
Playbook
The Implementation Playbook defines a program or
set of projects the enterprise needs to execute in
order to implement EHR. Potential projects may
include:
 Requirements
 SW selection
 Change Management
 Integration
 Policy, Procedure or Process
 Training
Enterprise Risk Assessment

The Enterprise Risk Assessment identifies

potential fatal EHR implementation risks:

 Interoperability
 Meaningful Use
 Certifiability
EHR Cost Benefit/Funding
Analysis
The Cost Benefit Analysis
identifies:

 The cost of implementation and the

level of funding necessary to
successfully implement EHR
 Funding sources such as grants or
federal government loans
 The short term costs and the long
term benefits
 ROI development and monitoring
EHR Implementation
Management
Implementation Management oversees
projects to successfully implement each
EHR project managing:

 Project task management

 Budget, Schedule, & ROI
 Issues tracking and resolution
 Staffing and skill requirements
 Project accountability and visibility
Healthcare Consulting
Strengths include:
 Partners averaging 25+ years of Big 4 consulting
experience
 Functional expertise that includes all aspects of healthcare
consulting
 Healthcare PMO expertise
 Federal Healthcare sector expertise

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