Electronic Medical Records:

Retrieval and Underwriting

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Texas Medical Dictionary

Artery.............................. The study of paintings

Bacteria.......................... Back door to the cafeteria 

Barium............................. What doctors do when patients die 

Benign............................ What you be, after you be eight 

Caesarean Section......... A neighborhood in Rome  

Cat scan......................... Searching for Kitty 

Cauterize........................ Made eye contact with her 

Colic................................. A sheep dog 

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Texas Medical Dictionary

Coma.............................. A punctuation mark 

Dilate............................... To live long 

Enema............................. Not a friend 

Fester.............................. Quicker than someone else 

Fibula............................... A small lie

Impotent..........................Distinguished, well know 

Labor Pain....................... Getting hurt at work 

Medical Staff.................... A Doctor's cane 

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Texas Medical Dictionary

Morbid..............................A higher offer

Nitrates.............................Cheaper than day rates 

Node................................ I knew it 

Outpatient....................... A person who has fainted 

Pelvis.............................. Second cousin to Elvis 

Post Operative............... A letter carrier 

Recovery Room............. Place to do upholstery

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Texas Medical Dictionary

Rectum...........................Dern near killed him 

Secretion........................Hiding something 

Seizure.......................... Roman emperor 

Tablet............................ A small table 

Terminal Illness............. Getting sick at the airport 

Tumor........................... One plus one more 

Urine............................. Opposite of you're out

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Sources

ACORD

MIB

PilotFish

Copy Services

Buyers Guide White Paper

Masters candidates in hospital administration Baylor University

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Today’s Presentation

Introduction to EMR / EHR - glossary of terms

Who’s driving HER adoption? What’s Law Got To Do With It? Healthcare Business - $$$ (who makes / saves money?) Government’s role Vendors

How will it affect me? Life insurance underwriting?

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Glossary

ARRA – American Recovery and Reinvestment Act. Among many other initiatives, the law provides incentive payments for healthcare providers that use EMRs. Incentive payments begin in 2011 and will gradually decrease until 2014 – after which, providers not using EMRs will be penalized.

EMR – Electronic Medical Records. Computerized system that stores notes, prescriptions, and other medical information for a patient in an electronic format rather than on paper. EMRs make searching for, retrieving, and sharing patient data more user-friendly and efficient. A federal mandate, called the Health Information Technology for Economic and Clinical Health Act (HITECH) and introduced in 2009, requires all medical practices and hospitals to adopt the EMR system by 2014.

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Glossary

EHR – Electronic Health Record. Electronic Health Record attempts to promote a more holistic view of patient records where continuum of care is the key aspect, allowing access to medical information by multiple stakeholders. Many healthcare systems possess pieces of the Electronic Health Record such as computerized physician order entry or electronic medical records within one point of care. However, only 1.5% of hospitals in the United States actually utilize a fully integrated Electronic Health Record

CCR – Continuity of Care Record. A new document standard being developed for EMR software vendors to allow patient data to be easily moved from on eMR vendor in the same format.

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Glossary

CCDIT – Certification Commission for Healthcare Information Technology. The organization that certifies healthcare IT products, including the certification to qualify EMR software for government incentive payments.

CDR – Clinical Data Repository. A database that consolidates data from a variety of healthcare providers to present a single health record for a patient.

REC – Regional Extension Center. Government funded system that offers technical assistance, guidance, and information on best practices to support and accelerate health care providers’ efforts to become meaningful users of EMR.

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The Drivers

Healthcare providers - improved healthcare - thorough, fast access to patient records Studies

» John Hopkins University study published in 2009 reviewed 41 hospitals. Those using EMR

15% lower death rate 16% fewer complications Lower operating costs

» Arizona State University study in 2010 found that hospitals using latest EMR technology reduced emergency room wait by 22% compared to old or no EMR

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The Drivers

Minimize dangerous errors / drug interactions – handwriting» Automatically alerts doctors of patient allergies or

dangerous drug interactions» National Academy of Sciences’ Institute of Medicine

determined sloppy handwriting led to 7,000 deaths every year in the United States.

More focus on patients, less on paperwork Automatic wellness reminders supports scheduling

important tests, exams – treatments screenings and immunizations

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The Drivers

Data mining – patient notification of drug recall, warnings, etc .

Software assisted diagnosis and treatment suggestions Improved customer service when patients call with

questions. Records are immediately available. Case study in a large practice in the Midwest reduced their patient responses from fifteen to five minutes.

Differential diagnosis Association of disease and treatment

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The Drivers

Sharing of data» Communicating with other organizations doctors,

hospitals, labs, physical therapists, pharmacists, etc. » Referrals – efficiently generate referral

letterandattach patient records» Prescriptions – electronic or autofax prescriptions to

pharmacist» Printing of EMR for chart requests (paving the

cowpath)» EDI – sharing of actual electronic data

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The Drivers

Summary» Better care» Safer environment for patients» More efficiency

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The Drivers

Reduce cost Increased efficiency Less wasted time searching for missing charts Lower operation costs Better quality of care Data mining Predictive diagnosis Scoring

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The Drivers

Government regulations American Recovery and Reinvestment Act (ARRA) of

2009» $45 billion to fund EMR adoption» Initial payments begin in 2011

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The Drivers

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The Drivers

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The Drivers

» Penalties beginning 2015 - doctors and hospitals alike without meaningful use by 2015 will receive decreased Medicaid and Medicare reimbursements

1% in 2015 2% in 2016 3% in 2017 3% - 5% thereafter

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The Drivers

Vendors 210 different providers of EMR solutions

» McKesson» General Electric» Cerner» Epic» Allscripts/Eclipsys

Large vendors Certification – integration and connectivity standards Security

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Obstacles

The New England Journal of Medicine has identified five major perceived barriers to adoption of Electronic Health Records: inadequate capital for purchase, unclear return on equity, maintenance costs, physicians’ resistance, and inadequate IT staff.

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Obstacles

Cost Only 20% of doctors and 10% of hospitals are currently

using EMR. Short term increased cost

» Systems» Software

Lost efficiencies due to training and learning curve Training – doctors, nurses, technicians and aids have not been trained in these systems. Costs associated with training cannot be overlooked.

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Obstacles

Inadequate technical staff – many times contractors must be hired to support installations.

Conversion of existing paper documents Long term yet to be determined CCHIT – Certification Commission for Healthcare

Information Technology

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Obstacles

Physician resistance With the advent of the Electronic Health Record,

physicians are being asked to completely change the way that they practice medicine.

New EHR systems are forcing physicians to use a computer throughout the entire continuum of care forcing the alteration of many habitual processes.

Data must be input into the system rather than through verbal documentation.

Each particular EHR vendor has its own unique terminology for navigation, making the learning curve even steeper.

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Obstacles

Security Privacy leaks and data breaches Access to large quantities of patient history information Data could be mined Strict access policies must be written and strictly

enforced including password protection, copying of records to external media or portable storage device

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Effects on Record Retrieval and Underwriting

Sharing of EMR data Current model requires printing to paper or other

electronic image format (pdf, tif, jpg) and sending via mail, fax or other electronic means

Data format standards » Health Level 7 (HL7) is an international community of

healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information.

Headquartered in Ann Arbor, MI Archaic standards

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Effects on Record Retrieval and Underwriting

» Clinical Data Repository – new document standard being developed for EMR software vendors to allow patient data to be easily moved from one EMR vendor to another in the same format

New XML standard CCR – needs work, cooperation Build once compliant with HL7 or CCR standard,

integrate with many across vendor systems and healthcare providers

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Conclusion

Great but how can we benefit without all the downside?

Some of these benefits include: immediate computerized decision support, improved patient continuum of care, and elimination of paper charts. However, these benefits may pale in comparison to the overall cost of implementing and maintaining the system. Installation costs of the actual system, training costs, and opportunity costs such as lost productivity from staff and clinicians make up significant costs of implementation.

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