STRENGTHENING THE BONDS OF HEALTHCARE NETWORKS

Natalia Hajnas & Michelle Busching Loyola Univeristy Chicago

HONR 204, Fall 2010

George K. Thiruvathukal, Course Professor

PART ONE: Establishing the Network of Study

…

Dr. C,

M.D.

Dr. A,

M.D.Dr. B

,

M.D.

…

Dr. E, M.D.

Dr. D, M.D.

The Practice We Observed

THE INDIVIDUAL PRACTICE AS A NETWORK WITHIN ITSELF

Visual: organic chemistry molecular model analogy

Molecule represents the “network within the greater healthcare network” Cyclopropane = the 3 family physicians Acetylene = the 2 OB/GYN physicians Connecting double bond = links the separate

specializations (family medicine & gynecologic oncology) Communication & referrals to the family doctors from

the OB/GYNs occurs on a daily basis

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Visual: poster (drawn network graph)

Colors

Distance matters

Thickness

What constitutes a relationship between 2 physicians? (in other words, how are the edges of the graph created?) Incoming and outgoing referrals o Recommending a patient go see a

particular physician (“unwritten referral”)

Our data: composed of records of outgoing referrals ….from the 2 OB/GYNs

Qualitative & Quantitative Additional edges – are there any

relationships between the referred physician’s? Qualitative

REASONS FOR REFERRALS

From our data (written referrals): Consultation Treatment Evaluation Pre-op testing Ultrasound Colposcopy Colonoscopy

EFFICIENCY OF REFERRALS

Folder where copies of all written referrals are kept to reference if need be

How could there be improvement in communication between physician’s offices? Referral system – works fine Effectiveness of sharing patients’ medical

records between medical offices – could be better….. HOW?

PART TWO: A proposal for change

(electronic medical records)

OUR PROPOSAL

Adoption of EMRs in all healthcare settings Specifically, to the practice we collected network

data from

FIRST HAND COMPARISON OF EMRS VS. PMRS

Survey distributed to medical offices within the same hospital as the practice of focus Originally 20 handed

out, then ~15 more because of poor return from the 1st distribution

Final sample size = 16 Overview of the

questions asked

56%

44%

Type of Medical Records Used

EMRs PMRs

RESULTS OF THE SURVEY

Average satisfaction: EMRs = 4.44, PMRs = 4 In general those surveyed were satisfied with

their current record keeping system despite what they wrote pros and cons of each.

0 physicians/ physician reps. who use PMRs have used EMRs in the past. All those who use EMRs, prefer EMRs to PMRs

(one respondent who currently uses PMRs prefers EMRs…)

RESULTS (CONT.)

Advantages A- Ease of use B- Organization C- Time efficient D- Thorough

documentation E- Nothing F- Accustomed to it G- Tangibility H- Legibility

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PMREMR

RESULTS (CONT.)

Disadvantages A- Space B- Time C- Poor organization D- Illegibility E- Nothing F- Everything G- System Failure H- Cost I- Poor

interoperability J- Error prone A B C D E F G H I J

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PMREMR

EMRS VS. PMRS

Decreased risk of clerical errors

Tangible Ability to integrate

information from other sources

Chart accessibility and retrieval

Accurate and legible Organized Security features

Pros of PMRs Pros of EMRs

EMRS VS. PMRS

Expenses of storage Unorganized Illegible Continuity of care

Increased amount of time spent charting

Inability to integrate information from other sources

Continuity of care System failures Initial costs

Cons of PMRs Cons of EMRs

Expense category Annual Cost Annual Cost Material costs:

New chart folders $465Superbills $710Fax ink and paper $600Printed paper and forms for charts $2,250Employee costs for nonproductive time:

Chart searching (2.25 hours/day as tracked by our manager at $10.50 per hour, average)

$6,136

Inputting superbill charges (20 hours/week at $11per hour) $11,440Lost Income:

Charges not posted (average of $100 per physician per month) $3,600Costs for storing paper records:

Storage facility used for our old records $1,524In-office space rental costs (165 sq. ft at $19 per sq. ft per year) $3,135

Total cost per year $29,860Cost per physician per year including costs for space

$9,953

Cost per physician per year excluding costs for space

$8,400

GOVERNMENT PUSH: INPUT FROM PRESIDENT OBAMA

http://www.youtube.com/watch?v=qEb6FrSuUJs&NR=1

GOVERNMENT PUSH: INCENTIVES FOR EMR ADOPTION

Start Year

2011 2012 2013 2014 2015 Total

2011 $18,000

$12,000

$8,000 $4,000 $2,000 $44,000

2012 $18,000

$12,000

$8,000 $4,000 $42,000

2013 $15,000

$12,000

$8,000 $35,000

2014 $12,000

$8,000 $20,000

• Medicare physicians who implement electronic medical records receive reimbursements • Penalties for those who do not do so begin in 2015

UNIVERSAL MEDICAL RECORDS

Our requirements: One record-keeping

program with: Medical history Scheduling system Billing system Prescription writing Referrals

Reliable system With back-up Supercomputer

VITL

Vermont Information Technology Leaders Non-for profit

Aids in the transition from PMR to EMR Health Information Exchange

EMRs can be exchanged between different healthcare entities throughout the entire state

Consolidate medical history to one location

ONE STEP FURTHER

Genealogies of Medical Records A thorough family

history of disease, health related traits, and responses to treatments and medications Used for research Could be used as a

diagnostic and treatment guide

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SOURCES http://pn.psychiatryonline.org/content/38/9/34.full http://www.edocscan.com/reducing-costs-for-scanning-medical-records http://en.wikipedia.org/wiki/Medical_records http://miwww.acog.org/departments/dept_notice.cfm?recno=47&bulletin=4882 http://www.compete-study.com/documents/

Measuring_the_Success_of_Electronic_Medical_Record_Implementation_Using_Electronic_and_Survey_Data.pdf

http://www.chcf.org/~/media/Files/PDF/E/PDF%20EMRLessonsSmallPhyscianPractices.pdf

http://www.youtube.com/watch?v=1Nv4Q5-Iij4&feature=related http://www.vitl.net/about-us http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839727/ http://www.openehr.org/specifications/spec_strategy.html http://www.e-mds.com/solutions/chart/chart.html http://www.hemidata.com/emr.html http://www.bcbs.com/blueresources/mcrg/2007/chap3/pay-for-performance/slide5.html http://www.aafp.org/online/en/home/publications/journals/fpm.html http://www.openclinical.org/emr.html Information packet from EMR seminar at Alexian Brothers Hospital in Elk Grove Village,

IL hosted by Conomikes Associates, Inc.