May 29, 2013 Rome, Italy Electronic Medical Record Adoption...

Sotto l’Alto Patronato del Capo dello Stato ,Presidenza della Repubblica Italiana

FORUM PA and HIMSS present

e-Health ConferenceMay 29, 2013Rome, Italy

PATRONAGES SPONSORS SUPPORTING PARTNER MEDIA PARTNER

Electronic Medical Record Adoption Rates:

Italy, Europe, United States, Middle East, Asia Comparisons

John P. HoytExecutive Vice President HIMSS Analytics

e-Health ConferenceMay 29, 2013Rome, Italy

Learning Objectives

• Understand the HIMSS Analytics EMR Adoption Model (EMRAM)

• Compare Italy to other leading nations in EMRAM

• Understand some of the benefits of advanced EMR adoption

Stage Short Description Europe

Stage 7 Complete EMR; CCD to share data; Data warehousing for quality assurance, and business intelligence; Data continuity with ED 0.1%

Stage 6 Physician documentation with CDSS, Closed loop medication administration 1.4%

Stage 5 Radiology PACS, filmless 14.9%

Stage 4 CPOE (i.e. ePrescribing); CDS based on clinical protocols 2.8%

Stage 3 Nursing/clinical documentation PACS available outside Radiology 4.0%

Stage 2 Clinical Data Repository (CDR) Clinical Decision Support (CDS) for basic conflict checking 27.2%

Stage 1 Ancillaries – Lab, Radiology, Pharmacy – All Installed OR processing LIS, RIS, PHIS data output online from external service providers 18.8%

Stage 0 All Three Ancillaries (LIS, RIS, PHIS) Not Installed OR Not processing Lab, Radiology, Pharmacy data output online from external service providers 30.7%

Institutions with valid EMRAM score (based on data from last 24 months, status as of Q1/2013) 1,354

HIMSS Analytics European EMR Adoption Model

e-Health ConferenceMay 29, 2013Rome, Italy

Why Does HIMSS Analytics Collect IT Adoption Data?

• Thought Leadership• Research on maturity vs. QSAE (quality,

safety, efficiency)• Predict where the market is going• Serve vendors, consultants• Inform government policy decisions

e-Health ConferenceMay 29, 2013Rome, Italy

Why Does HIMSS Analytics Collect IT Adoption Data?

• “Push the Market”• Participating Hospitals Practices receive:

• Their EMR Adoption Model Score • Access to the HIMSS Analytics Benchmarking

tool consisting of peer comparison reports assists in: • IS strategy development• Identifying opportunity for investment• Improving competitiveness

Data from HIMSS Analytics® Database ©

Cross Regional EMRAM Score Distribution, 1st Q, 2013

Stage Asia Pacific Middle East United States Canada Europe

Stage 7 0.2% 0.0% 1.9% 0.0% 0.1%

Stage 6 2.2% 7.1% 9.1% 0.5% 1.4%

Stage 5 5.3% 14.2% 16.3% 0.3% 14.9%

Stage 4 3.0% 5.3% 14.4% 2.2% 2.8%

Stage 3 0.4% 19.5% 36.3% 33.6% 4.0%

Stage 2 26.0% 19.5% 10.1% 26.9% 27.2%

Stage 1 6.1% 13.3% 4.2% 14.8% 18.8%

Stage 0 56.9% 21.2% 7.8% 21.7% 30.7%

N = 508 N = 113 N = 5,441 N = 640 N = 1,354

Data from HIMSS Analytics® Database ©

Cross Country EMRAM Score Distribution 1st Q, 2013

Stage United States Canada Germany Poland Portugal Spain Netherlands Italy

Stage 7 1.9% 0.0% 0.3% 0.0% 0.0% 0.5% 0.0% 0.0%

Stage 6 9.1% 0.5% 0.0% 0.0% 0.0% 4.3% 3.8% 0.6%

Stage 5 16.3% 0.3% 8.3% 0.0% 26.1% 40.9% 34.6% 6.6%

Stage 4 14.4% 2.2% 1.9% 0.7% 4.3% 6.7% 3.8% 1.8%

Stage 3 36.3% 33.6% 8.3% 0.0% 21.7% 1.9% 1.9% 3.4%

Stage 2 10.1% 26.9% 34.9% 10.3% 4.3% 18.8% 55.8% 26.7%

Stage 1 4.2% 14.8% 0.6% 13.0% 4.3% 9.6% 0.0% 41.4%

Stage 0 7.8% 21.7% 45.7% 76.0% 39.1% 17.3% 0.0% 19.5%

N = 5,441 N = 640 N = 324 N = 146 N = 23 N = 208 N = 52 N = 498

Data from HIMSS Analytics® Database ©

Cross Country EMRAM Score Distribution 1st Q, 2013

Stage United States Australia Malaysia Singapore United Arab

EmiratesSaudi Arabia Italy

Stage 7 1.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Stage 6 9.1% 0.0% 0.5% 57.1% 12.8% 3.0% 0.6%

Stage 5 16.3% 3.7% 4.7% 14.3% 14.9% 13.6% 6.6%

Stage 4 14.4% 0.9% 2.8% 14.3% 4.3% 6.1% 1.8%

Stage 3 36.3% 0.5% 0.5% 0.0% 6.4% 28.8% 3.4%

Stage 2 10.1% 51.6% 1.9% 14.3% 25.5% 15.2% 26.7%

Stage 1 4.2% 4.6% 1.4% 0.0% 21.3% 7.6% 41.4%

Stage 0 7.8% 38.7% 88.2% 0.0% 14.9% 25.8% 19.5%

N = 5,441 N = 217 N = 212 N = 7 N = 47 N = 66 N = 498

COUNTRY COMPARISON - NURSING DOCUMENTATION

COUNTRY COMPARISON - eMAR

COUNTRY COMPARISON -ePRESCRIBING

COUNTRY COMPARISON - CPOE

COUNTRY COMPARISON - PHYSICIAN DOCUMENTATION

COUNTRY COMPARISON - PHARMACY BAR CODING

COUNTRY COMPARISON – DATA WAREHOUSING - CLINICAL

CLOSED LOOP MEDICATION ADMINISTRATION

Big Challenge Outside U.S.A.

e-Health ConferenceMay 29, 2013Rome, Italy

1. Physician enters the medication order directly –allows for CDSS interaction

2. Pharmacist verifies the order3. Pharmacist dispenses a bar coded unit dose

medication or prepared compound4. Positive patient ID – barcode on wristband or

RFID5. Positive medication ID with bar code on the unit

dose medication6. Verification of the “five rights”

The Closed Loop Medication Administration Process

CLOSED LOOP MEDICATION ADMINISTRATION

18

CPOE

2 Medication orders that pass CDSS flow to Pharmacy

3 Pharmacy validates order and dispenses medication to ADM or floor

ADM

Nurse retrieves medication from ADM and takes it to patient

4, 5, 6 Nurse scans patient ID and medication for “five rights”CDSS

POCAdministration

EMAR

eMAR is updated and available for review

Pharmacy

1

AND WHAT VALUE IS DERIVED?

• 60% of errors from prescribing & transcribing1

• 26% of errors from administration1

• 14% of errors from dispensing1

1 D W Bates, D J Cullen, N Laird, et al., “Incidence of Adverse Drug Events and Potential Adverse Drug Events: Implications for Prevention”, JAMA, 247 (1995), pp. 29-34

e-Health ConferenceMay 29, 2013Rome, Italy

Other Citations• With bedside scanning rates of 87%+, an academic medical center in

the U.S. decreased their medication errors from 1.2 to 0.3 errors per 1,000 patient days, a 75% reduction1.

• With the implementation of CPOE, pharmacist verification and CLMA, order-to-administration times of IV antibiotics experienced a reduction of 1.18 hours (p < 0.0001) per order2.

• CPOE, electronic dispensing and barcode patient identification reduced prescribing errors by 47% and MAEs by 37%, and increased time spent on medication-related tasks.3

1 http://www.healthleadersmedia.com/content/QUA-251798/Hospital-Nearly-Doubles-Medication-Scanning-Rates

2 http://www.ajhp.org/content/69/16/1423.abstract?sid=f86b4fb8-8a05-4d36-84b5-a87d0d7fedf0

3 http://qualitysafety.bmj.com/content/16/4/279.short

21

CLOSED LOOP MEDICATION ADMINISTRATION - A KEY ELEMENT OF PATIENT SAFETY IMPROVEMENT

Source: Effect of Bar-Code Technology on the Safety of Medication Administration; Poon, Keohane, Bates, Lipsitz, et al, New England Journal of Medicine, 2010;362:1698-707, May 6, 2010

e-Health ConferenceMay 29, 2013Rome, Italy

Summarization• Use technology to create a culture of performance excellence• Design performance improvement goals into the

implementation – Define the problems you are trying to solve• Standardize care using “best practices” built into documentation

and order sets for specific high risk diagnoses• “Management by walking around”

• Get out onto the wards to see systems in use, listen to users

• Encourage, encourage, encourage• Measure before & after

• This is your only chance to measure the effects of system implementation

John P HoytExecutive Vice PresidentHIMSS Analytics

jhoyt@himss.org