adoption of electronic healthcare records

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Adoption of Electronic Healthcare Records. Alexander Flores Arin Halicki Tiangan Lian Damien Mar Chong Mahesh Seethraman. Introduction. State of US Healthcare Rising Costs Quality of Care Recent Legislation. Solution: What can EHR do for you?. Network Good. Benefits. Insurance - PowerPoint PPT Presentation

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Adoption of Electronic Healthcare RecordsAlexander FloresArin HalickiTiangan LianDamien Mar ChongMahesh Seethraman

Introduction State of US HealthcareRising CostsQuality of CareRecent Legislation

Solution: What can EHR do for you?Public good, Damien will talk about it later2Network GoodEHR is a Network good with its own delicate eco-system.HospitalsDoctorsBenefitsPatientsInsurance CompaniesGovernmentBenefitsMedical GroupsEHR(platform)EHR is a Network good (talk about what benfits they derive) describe as eco-system.PatientDoctors (can have flexibility, who afflilate with and how run practice)Hospitals (labs, billing, emergencies)Payers ( insurance companies, claims management)Government no benefit relatively new player but doesnt derive true value

Insurance companies authorize the different procedures, in that sense, they are more closely associated with the patients and doctors than they are with medical groups themselves

* Government supports the network/platform w/ subsidies - but the benefits derived from the network is questionable. (Govt. is the largest provider of medicare and medicaid, so they derive a big benefit from the network)

3EHR PlatformsInteroperability and Scalability Can Drive EHR SuccessDifferent versionsFormatsLanguageService offerings

Different pricing modelsSizeBundlesIncentives

EHR as a concept/platform provides benfefits to rest of network.

PlatformsDifferent versionsFormatsLanguage (CCHIT, HL7)Service offeringsDifferent pricing modelsSize Based - ScalabilityWide Variety of Schemes (Take Cost links/data from Wiki page)

4ProductsScalability / CostLanguage/ InteroperabilityEPIC Systems CorporationAmbulatory & InpatientSpecialties / Departments / AncillariesHealth Information Management (HIM)Medical Groups to Practices or Organizations of any SizeHealth Level Seven (HL7 )ANSI X12XML Allscripts-Misys Healthcare Solutions, Inc.Practice Mgmt SystemsElectronic PrescribingDocument ImagingPatient AccessIndividual Practices to Practices or Organizations of any size CCHIT CertifiedOpen Source Connect written in JavaCerner CorporationHospitals /Health SystemsPrivate Practice PharmacyEmployersHome CareServices & DevicesIndividual Practices to Practices or Organizations of any size The Digital Imaging and Communications in Medicine (DICOM)GE HealthcareHospitals /Health SystemsPrivate Practice PharmacyPeer VisionProcessing & PlanningServices & DevicesMedical Groups to Practices or Organizations of any Size

The Digital Imaging and Communications in Medicine (DICOM)Health Level Seven (HL7 )Integrating the Healthcare Enterprise (IHE)

Whats driving EHR adoption? Whats driving EHR adoption?American Recovery and Reinvestment Act of 20092011 2015 scaled payment incentives to hospitals and physiciansBy 2015 scaled reimbursement penalties from Medicare plus escalation

Reporting treatment outcomes and other metricsPhysician Quality Reporting Incentives (PQRI)State Reporting Requirements eg. CA DMHC/OPA/OSHPDPay for performance

Improved Quality error reductions

Cost reductionWe spend more than OECD nations in healthcare as a percent of GDP but with lesser doctors, professionals, hospitals etcPer capita we spend more and we are measured last in quality by Commonwealthfund.$80billion savings.

Top Motivating Factors for EHR Adoption (75% of Hospitals)Share patient-record info among healthcare practitioners and professionalsImprove clinical processes or workflow efficiencyReduce medical errors; improve patient safetyImprove quality of care

State and Pattern of HIT Adoption, RAND, 2005 Factors Influencing EHR Adoption System-level factorsRegional factorsHospital typeHospital-bed-sizeMedicare and MedicaidPhysician practice and size

By System-Level Factors

Importance of Network Externalities in the decision to adopt HIT.Network Externalities the value of technology investment for the provider depends on whether other providers have adopted this technology.

The majority of community hospitals belong to multi-hospital systems; thus, their adoption behavior is related to their systems adoption behavior.

MSA Metropolitan Service AreaEMR Electronic Medical RecordsCPOE Computerized Physician Order EntryPACS Picture Archiving Communications System (e.g., Radiology)9By Regional Factors

Key takeaway: Systems with up to 5 hospitals is likely to adopt HIT than systems with more than 5 hospitals.

Why? - The investment might become more difficult to coordinate as the hospital system gets larger.10By Hospital Type

Academic and Pediatrician hospitals why?Academics easy

Pediatrics Higher benefits of EMR and CPOE while caring for children (i.e., children are not as reliable a source of their medical histories, medications, etc., as adults)

Critical Access tiny size and rural location; offer limited range of services

Long-term small size; exempt from Medicare payment system which is a drive in increasing adoption of HIT11By Hospital-Bed-Size Category

12By Medicare

Hospitals with majority of patients claims paid by Medicare are less likely to adopt EMR.Why? Lower reimbursement rates of Medicare compared with other insurers explains, at least in part, its negative effect on hospital investment in HIT.13By Medicaid

Hospitals with a large share of Medicaid patients are generally considered disadvantaged and often receive grants and other financial help, which could be devoted to HIT investment.14By Practice and Size

Size effect is very important in the ambulatory clinics.

Practices with over 30 physicians are 3 times as likely to adopt an EMR system as is a solo practitioner.

Leaders in EMR adoption in ambulatory practice are multi-specialty clinics. They are larger organization and have financial resources; and there is greater organizational value to be derived in exchanging info among doctors in multi-specialty clinics.15Barriers to EHR Adoption Older RecordsCosts of conversionOwnershipOther challenges (Tech/Human)

Patient rights & PrivacyHIPAA regulationsDigital securityTheft of information

Significant investment needed to convert old paper records to ehrHow do we do it ? Scan them in ? Type em in anually ? What about human / machine errors that may be introduced during this processWhose responsibility is it to upload all this info from the past into an EhrWhose responsibility is it to payfor the capacity needed to store all the past information ?

HIPAA rights even if the patient is not part of your network.How can you provide 24x7 access, if you dont invest in infrastructureHow long do you have to keep the data if the patient is not part of your network ?

How do you ensure that the only authorized personnel view patients recordsHow do you validate authentication to a requestor, that the patient authorized it ?What legal consequences / preventive mechanisms does a hospital/clinic need to put in place ?What do you do when the info is available 24x7, with a higher probablity of theft due to hacking ?

Barriers to EHR AdoptionOther reasonsLack of support from medical staffResistance to change One system does not fit all needs Fragmentation & customizationROI impactState and Pattern of HIT Adoption, RAND, 2005 Why this lack of progress in ehr, even though it was proposed in the 60sTechnological back seat?Resistance to change, Customization costly process, exposes inefficiencies in the existing process, Hospitals have to change their routine retraining, reduction in productivity in the earlier stages of adoptionhttp://kids.nationalgeographic.com/staticfiles/NGS/Shared/StaticFiles/NGKids/Image/myths_NGK0607_ostrich_lg.jpgBarriers to EHR AdoptionInteroperabilitySynchronizationHardware

CostsWho pays for itStartup costsMaintenance costsHardware High fixed costsProcess change

18Many systems for EHR, billings, admissions, discharges, prescribing. For example, theres EPIC, Eclipsys, GE, AllScripts systems. And then on top of that someone might EPIC for billings but Eclipsys for EMR. Cannot communicate across other systems in other hospitals or clinics. So hospitals and doctors may hesitate to invest if their systems may not communicate with one another. Hardware compatibility, if moving systems.

There are many players and many health plan payers. How to get them to pay in?Big startup costs. $10,000s to $millions.Ongoing maintenance costs for small facilities might be high.High fixed costs. RecommendationsSingle payer system Create interoperability standardPublic-private ownership for patient informationFinancial incentives for EHR AdoptionLeasing of EHR solutions or SaaSPay for performanceFree/Subsidized basic SystemTrain new healthcare practioners about EHR.At Medical schools

Single payer system Federal govt subsidizes a basic systemViSTACreate interoperability standardCCHIT certification with HITSP standardGovernment oversightPublic-private partnership/RHIOsCalifornia eHealth CollaborativePublic-private ownership that addresses who owns the patient informationLeasing of EHR solutions Lower Setup costs.SaaS - NextGenProviding financial incentives to hospitals, clinics, etc..Go into academia and train new physicians about EHR.

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