overview of the medical records marketplace c. peter waegemann ceo, medical records institute
TRANSCRIPT
Overview of the Medical Records
Marketplace
C. Peter WaegemannCEO, Medical Records
Institute
What I’ll be Talking About...
1.Defining EHRs and EMRs
2.Identifying Markets3.Analyzing Domain
Issues4.International
Perspective
History of Computer-based Patient Record Systems
1960s First Attempts1970s and 80s Progress slowed1991 IOM Study1995-98 Failures and Decline
of Interest1999 Focus on Personal
Web-based RecordsSince 2002 Back to the Top of
the List
Health IT Product Categories per Year (US)
• Financial Solutions $ 800 million• Administrative Solutions $ 200 million• Imaging Solutions $7,000 million• Clinical Solutions $26,000 mill.• Other Non-Provider Solutions?
– Public Health – Bio-terrorism, etc.
• NHIN (?) ?
What Is an Electronic Health Record?
• CPR - Computer-based Patient Record • CMR – Computerized Medical Record • PMRI – Patient Medical Record
Information• ICRS – Integrated Care Record Services• PCR – Patient-carried (Card-based)
Patient Record• PHR – Personal Health Record • EMR – Electronic Medical Record• DMR – Digital Medical Record • EPR – Electronic Patient Record • EHR – Electronic Health Record
EHR Structure: Loosely Connected or Unconnected Data Islands
Prenatal Record Family Record
Pediatric Record
Potentially multiple providers/records
Primary Care Record
Specialty Provider Record
Personal Health Record
Hospital Record
Wellness Health Information
Pharmacy/Medication Records
Employer/Other Health Records
Payer/Financial Health History Information
Many other Health History Repositories
Emergency Care Record
LegendEMRS
How many EMRs are in an EHR?
Seven Domains1.Integrated Healthcare Delivery
Organizations2.Hospitals
• Teaching Hospitals (500+)• Hospitals (5500)
3.Ambulatory Care Providers (600,000)• By Medical Specialty (165+ Subspecialties)
4.Personal (Consumer Health Records) 5.Home Healthcare6.Long-term Care (37,000)7.Specialty Systems (Dental, Alternative
Care, Sports Medicine, etc.)
Integrated Delivery Servicesand Hospitals
• Focus on Enterprise-wide Interoperability
• Competition-driven• Patient Safety Driven• User Considerations
– Industry– Standards– User Acceptance
Ambulatory Care Providers
• 75% of Physicians in Small Practices
• Many Specialties• 318 Vendors• Prices Range from $200 to
$60,000 per Physician
EMR Benefits in Ambulatory Field
Pressure to
Implement an EMR
Pressure to
Implement an EMR
Potential Benefits
1.1. More moneyMore money
2.2. Better competitivenessBetter competitiveness
3.3. Remote workingRemote working
4.4. Workflow benefitsWorkflow benefits
5.5. Better decision supportBetter decision support
6.6. Easier reportingEasier reporting
7.7. Be better informed about Be better informed about patientspatients
8.8. Attract more patientsAttract more patients
1.1. More moneyMore money
2.2. Better competitivenessBetter competitiveness
3.3. Remote workingRemote working
4.4. Workflow benefitsWorkflow benefits
5.5. Better decision supportBetter decision support
6.6. Easier reportingEasier reporting
7.7. Be better informed about Be better informed about patientspatients
8.8. Attract more patientsAttract more patients
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
Savings from Transcription
Patient Information
Capture
System Efficiency
Better Coding(not guaranteed)
Back-end Speech
Recognition
Front-end Speech
Recognition
Speech Recognition
• Automated coding
• Higher Revenues from ‘Lost’
Charges and Better Coding
• Success Varies
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
Patient AttractionConnectivity with Medical
Community
• Email• Refills• Trust• Technology
Attraction
• Email• Refills• Trust• Technology
Attraction
• Referrals• Reports• Labs• Hospital Communication• CCR
• Referrals• Reports• Labs• Hospital Communication• CCR
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
Remote Computing and Remote Documentation
• Working at home or anywhere
• Arranging your time accordingly
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
Workflow Benefits
• No waiting or searching for charts (for example, think of phone calls)
• Easier refills• Easier results management • Signatures• Immediate availability of patient data• Point-of-care documentation• Better time management
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
Computer and Internet Support for Decision Making
• Formularies• Diagnostic information• Information about medications• Other decision support info
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
• Query system by condition or medication
• Follow-up and reminders
• Ad hoc reports
• Other reports
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
• Receive patient information electronically
• Integrate and create CCR
• All insurance information
• Health status from other providers
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
1. More money
2. Better competitiveness
3. Remote working
4. Workflow benefits
5. Better decision support
6. Easier reporting
7. Be better informed about patients
8. Attract more patients
Communication by email
Less waiting time
Computer-generated patient education
Guidance to websites
Web portals
Issues
• Funding and Benefits– Change in Care Work Flow– Information Capture
• Complexity of Decision Making• Hurdles of RHIOs• CCHIT• Lack of Guidance
Workflow Issues and Functionality
Data Collection Verification
Documentation
Order Entry
Communication
Practice Management
Reference Management
Confidentiality Security
Analyzability
Interoperability
Paperlessness
Decision Support
Disease Management
Personal/Consumer Health Record Marketplace
2000/2001
104 PHR Vendors
13 million PHRs
2006
16 PHR Vendors
1 million PHRs
2007/8
24 PHR Vendors
3 million PHRs
Issues
• Hype about PHR Market• Business Models• New Industries• Major Hurdles
– Assembling Paper Copies– Authentication– Lack of Standards– Consumer Awareness
Disappointing
• Home Healthcare Market• Long-term Care Market• Specialty Systems (Dental,
Alternative Care, Sports Medicine, etc.)
Outlook: US
• Will Regional and National Projects Accelerate or Slow Implementations?
• When will the Hospital Market Change to an Open System?
• When will the LTC and HH Markets be Integrated?
• When will the Consumer PHR Market take off?And Who will be the Players?
International HIT Market
• US Is The Largest HIT Market• Germany Is The Second
Largest– Close To US In Export Focusing
On Different Regions
• UK • Scandinavian Markets• Asian Markets
What is Success?
