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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
TH
E B
IGG
ER
PIC
TU
RE
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
A B C D E F G H0
1
2
3
4
5
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7
8
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
0
1
2
3
4
5
6
7
8
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
ELEC
TR
ON
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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.