Successfully Choosing Your EMR

Founder Medical Strategic Planning, Inc

Art Gasch

Health Summit West

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Self - Disclosure

No conflicts with EMR developers or EMR distributorsNo conflicts with EMR developers or EMR distributors

Author:Author: Successfully Choosing Your EMR: 15 Crucial Decisions

Architect:Architect: MSP EHR Selector website (www.ehrselector.com)

The book & website are mentioned in this presentation

It’s a law, not a suggestion – but what’s the right approach to adopt?

82% of practices and 92% of hospitals lack comprehensive EMR/EHR

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20% MDs Unhappy With EMR Deployed

Satisfied

“Not easy-to-use” & “workflow disruptions” are two major causes of EMR deployment failures

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Crucial Decision(s) Physicians Now Face

1. When to sail into action?

2. How to navigate EMR adoption?

3. Continue to wait in port for the reform storm to weaken and pass by?

Once the storm passes, the waters will become more calm & saferOnce the storm passes, the waters will become more calm & safer!!

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Steps & Considerations in Choosing Your EMR

3. Practice & Staff Readiness Assessment3. Practice & Staff Readiness Assessment

Widespread, successful EHR adoption is foundational for all healthcare reform

1. Form EMR Committee – Engage All Affected1. Form EMR Committee – Engage All Affected

2. Determine Current & Future Needs2. Determine Current & Future Needs

4. Carefully Evaluate EMR Alternatives4. Carefully Evaluate EMR Alternatives

5. A Web-based EMR Information Resource5. A Web-based EMR Information Resource

0. Understand Paradigm Change Faced0. Understand Paradigm Change Faced

Understand the Paradigm Change

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For 1For 1--10 primary care practices, it will be a 10 primary care practices, it will be a major paradigm change that requires computermajor paradigm change that requires computer

technology staff may not be familiar with!technology staff may not be familiar with!

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A more structured way to describe the encounter

“On my trip to TEPR I spent $1,079.48, mostly on the hotel and travel expenses.”

--- versus ---

What was the total for mileage and parking? – can’t be answered from the freeform description. How much detail is enough? How much longer does charting take?

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EMR – A New Paradigm, Not an Electronic Version of the Paper Record

If the clinical data is structured, it’s stored in a DBMS and screens

displayed are database reports, not images of physical pages. How

EMRs store & manage data is critical to their ability to document

various PQRI & HEDIS quality measures.

EMR Planning, Adoption, Deployment is a Process

PGPs required to submit more specific patient data to an increasing number of intermediaries

With little incentive to offset the costs and risks of capturing the data

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‘Tug-of-Wars’ Due to Misaligned Priorities

Primary Care MDThe CIOLegacy IT Vendor

CIO – ‘Create as few new EHR interfaces to legacy hospital systems as possible’

MDs - ’Saying “No” to EHRs that cripple office workflow & productivity’

Form the EMR Committee

Be Inclusive, not exclusive

Determine Current & Future

Needs & Risks

Keys to Avoiding RAC Audits

CMS and its RAC Bounty Hunters

Courtesy – Foley & Lardner

Don’t Rush (Plan & Deployment)

Process

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Commonly Overlooked Issues

Individualized EMR process based upon your practice readiness assessment

Security Mgmt

EMR 

Satisfaction

Ratings

Workflow

Anal.

Backup Power & 

Contingency

Planning

Staff EMR

Orientation

Readiness

Assessment

Office 

Renovations

Form EHR

Committee

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Key Activities May be overlooked or abbreviated in accelerated deployment approaches

Copyright 2009 ‐

All Rights Reserved by MSP

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Typical EMR Planning Timeline (with Selected EMR Milestones)

The EMR or EMR/PMS or EMR/PMS/Portal Planning Process Has MORE steps (takes longer) if an in‐office EMR deployment is the objective!

All Detailed Tasks by Role are NOT shown above

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EMR Adoption Must Be Quick for RECs to Succeed

Medical Strategic Planning I Professional Information Transforming North American Healthcare Markets

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Three REC Payment Milestones

SubscriptionSubscription DeploymentDeployment MU CertificationMU Certification

1/3rd

Second payment when 

EMR is deployed and 

provides CPOE and e‐RX 

and received e‐Lab results

1/3rd

REC gets paid for signing 

you up.  Focused on 

marketing first

1/3rd

Final payment when EP is 

certified as a Meaningful 

User of EMR technology

Math is simple ‐

anything that delays a payment milestone, puts REC at financial

risk. Expediting DEPLOYMENT is key to timely receipt of 2nd

payment.  

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License Grant: Vendor Example

Subject to the terms and conditions of this Agreement, Vendor grants Licensee a non-transferable, non-exclusive license to use the Software for its internal purposes.

Vs.

Subject to the terms and conditions of this Agreement, Vendor grants to Licensee a perpetual, non-exclusive license to use the Software for its business activities. Such business activities include, but are not limited to, the right of Licensee’s parents and their respective affiliates, subsidiaries, and joint venturers to access and use the Software. In addition, Licensee may serve as a service bureau for the foregoing entities.

If you were buying a house, would you use the seller’s attorney?

Courtesy Foley & Lardner

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Specifications

Most vendors warrant to the “documentation”

– EMR Vendor controls the documentation

– Can change at any time. Functionality “creep”Is specific functionality/interoperability required?

RFQ and response included or not?

Courtesy Foley & Lardner

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Legal Agreement Scope

How thoroughly are each of these points covered? Law firms with national heatlhcare practices, like Foley & Lardner or LeClairRyan can help. Figure $5-9K for EMR related legal work on RFQ and final contracting/licensing.

Courtesy Foley & Lardner

Practice & Staff Readiness

Assessment

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Practice & Staff Readiness Assessment

Carefully Evaluate EMR Alternatives

Picking an EMR is like buying a house or purchasing a car

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A Crucial Decision to Make

Did you let someone else do that for you, or did you want to do it yourself?

Whoever makes the choice, YOU will live with it everyday!

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www.ehrselector.com shows ‘functionally qualified’ EHR developers (that RECs didn’t present to you)

TEXT EXTTEXT

• Little consistency in EMR features from state to state, apart from MU

• Vendors qualified inconsistent from one state to another.

• Some EMR vendor products that meet MU criteria are overlooked in many states.

A A ‘‘functionallyfunctionally--qualifiedqualified’’ EMR product EMR product is one that has the same is one that has the same functionality as the common functionality as the common denominator of RECdenominator of REC--selected EHR selected EHR products.products.

…

575 more EMRs

in between (of both types)

Over 600 EHR Products Listed on 

www.EHRSelector.com

Website!

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A One-stop Portal for Diverse EHR Needs

www.ehrselector.comOffering Independent, Impartial:

• Lists of EMR Planning, Deployment & 

Security Consultants, Accountants, 

Lawyers, Chart Conversion/Scanning 

Services 

• EMR Educational Resources 

• Hardware Suppliers 

• Post‐Deployment System Support 

• EMR Product satisfaction scores (KLAS)

• EMR Selection Tracking, Tools & Reports 

for EMR Consultants/RECs

•

Ability to compare 687 features of key 

EMR products to your needs.

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Scroll down to see add’l. criteria

Compare Vendors 3 at a Time

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Keep Scrolling Through All 680 Criteria

See which vendors offer which features

Slide 33User Interface – A Crucial Issue

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Logically Organized Categories and CriteriaLogically organized criteria global, REC & user defined profiles simplify selection

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How Do I Get Patients Involved with my EMR?

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Both require careful planningIn-Office vs. Web-based EMR Deployment

Less External I-Net & Theft Exposure

I-Net essential for operation, redundant connectivity required

Browser-based operation & rapid deployment make this the REC

favorite for EP clients

Greater In-office skill set. Required & some hardware maintenance.

In-Office Appoach

Web-Based ASP Approach

Which is ‘right’ for your practice?

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Areas of Concern What you need to consider

Loss of Internet Connection Can be a power failure, or I-Net provider failure, so your contingency plan must cover all of these.

EMR Responsiveness Internet can be slow, and add 1 (or more) seconds to menu responses.

Non-control of EMR upgrades In the ASP model, every client migrates to new versions at same time at the will of the EMR developer. Can create a training issue.

Workflow Customization Issues ASP apps may not be as user-customizable as in-office EMRs.

PMS Integration Challenges Can be more challenging to integrate Web-EMR with in-office PMS, or even impossible.

Browser IssuesWith 4 major brands, and several versions/brand, and numerous options, and different renderings of sites, browser management is not trivial to get and keep right.

Increased Security RisksEvery ASP user is ‘facing’ the I-net, and any user breach can compromise entire network. ASP EMR are also better targets for hackers than any individual office is.

Lack of Control of Backup Strategy and on-site access to patient files

How long does it take an ASP to restore backup if patient files are lost or breached, or ASP and EMR are two different organizations

Special Licensing considerations to be addressed

Some issues don’t exist with in-office deployments, but require special terms for web-based deployments.

User Interface Constraints Speech recognition is more challenging in I-net based EMRs. Many practices are used to transcription, and like speech recognition EMRs.

Issues With I-Net Based SaaS ASP EMRs

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2010 EHR Book Library

Learning Resource Category

Resource Supplier & Website Resource Name/Title Contact or Author &

WebsiteContact Email & Phone

Books

Wiley-Blackwell Customer Care 10475 Crosspoint Blvd Indianapolis, IN 46256

Successfully Choosing the Right EMR – 15 Crucial Decisions Released April 2010ISBN 978-1-4443-3214-8

Arthur Gasch & Betty Gasch, RN, BSN

877-762-2974 Voice 800-605-2665 FaxOr Amazon

Books MGMA Press or Amazon

Electronic Health Records, 2nd Edition, Transforming Your Medical PracticeReleased 2010ISBN 978-1-56829-343-1

Margret Amatayakul2313 W. Weathersfield Schaumburg, IL 60193

877-ASK MGMA

Books

AHIMA 233 N. Michigan Ave., Suite 2150 Chicago, IL 60601

How to Evaluate Electronic Health Record (EHR) Systems ~$129 - Released 2008

Patricia Trites and Dr. Reed Gelzer

312-233-1100 Rita Scichilone

Books Prentice Hall PTR EMR Complete: A Worktext, January, 2010 Daniel Limmer Amazon or Borders

Online

Books Elsevier Health Sciences

The Electronic Health Record for the Physician's OfficeReleased 2010ISBN 978-1-43770-0-282

Any DeVore Amazon or Borders Online

Just released (2010) books provide excellent introduction to EMR issues that transcend MU. They can prepare staff for college courses or may be all that is needed, depending on baseline EMR knowledge in clinical staff. Your Practice Readiness Assessment will show you.

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Upgrade Time…

is not Your Time

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Do any of the ASP EMRs offered to you include a user-customizable workflow engines?

(These offer users the ability to make their workflow specific for each user, and for specific types of patient encounters, without requiring EMR vendor assistance or charges).

If user workflow modification isn’t built-in, it can’t be added on. An example of an EMR with workflow management is EncounterProOpen Source EMR.

Workflow and Application Customization

The number of keystrokes required to accomplish any task and the entire patient encounter is critical. This is something that no REC can evaluate for you because they don’t know your workflow!

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User-Accessible Workflow Customization

A few of the 13 criteria for user-customizable workflow functions

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Getting EMR Integration Right

HIE Integration

RHIOsWeb Portal

Basic EMR

Patient Kiosk

IntegratedPMS

If EMR is on web, and PMS is in your office, their integration can be more challenging

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Getting EMR Integration Right

The EHR Selector A Consultant’s Management Tool

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MSP’s EHR Selector is Easy

TEXT EXTTEXT

Simple to find www.ehrselector.com

Convenient cascading selection categories

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EMR Selection is About Getting Details Right!

48Feb. 2, 2010 48

9 of 35 Rx Criteria For ‘MU’ requires only 3

2 not req’d by MU can result in patient death

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Assert 144 Criteria in ONE Global (AGA) Profile

Criteria picked by AGA physicians who have already adopted EHR and found them to be important.

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Built-In ‘Help’ Systems Clarifies Questions or Raises Important Considerations

Help may be brief Help may be brief or extensive, but or extensive, but is generally concise is generally concise and relevant.and relevant.

Help is a Help is a click away!click away!

A Glossary of Terms A Glossary of Terms is also availableis also available

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Glossary Provides Basic Info w/Hot-Link to More Info

From Help Screen

Hot Link to background info on the Internet

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After Assertion, Simply Submit

TEXT EXTTEXT

Attach functional criteria listed to your RFQ to document needs

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Searching by Keyword Quickly Locates Features

Which can then be quickly asserted with a single click!

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Developers’ KLAS Ratings

MSP EMR Selector includes embedded

KLAS ratings

MSP EMR Selector includes embedded

KLAS ratings

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Web-based EHR Selector Comparison Matrix

MSP Competitor A Competitor B Competitor C Competitor D

Uses 3rd-Party Vetted Information Yes No No No No

Partners w/Major MD Organizations 6 No No Some Yes

KLAS Research EMR Ratings Yes No No No No

2010 Meaningful Use Flags Yes ?? ?? ?? No

Sells EHR Products No Yes No No No

Exhibitor Fees Fund EHR Selector Company No No No Yes Yes

Provides EHR Consulting No No No Yes ???

Solicits EHR Commissions or Finder’s Fees ? No Yes ??? ??? ???

Direct Match & Vendor Feature Magnifier Yes No No No No

REC/Consultants Mode Yes No No No No

Look For - No conflicts of interest – truly impartial, partially-vetted, developer-neutral data!

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Thanks for your interest.

Leave me a business card if you would like a copy of the presentation.

Questions & Answers

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Medical Strategic Planning, Inc. Arthur Gasch – Founder, Board of Directors 5 Shelbern Dr. - Lincroft, NJ 07738 art.gasch@medsp.com Ph: 732-219-5090 Fax: 732-219-5066 Wm. F. Andrew – VP EHR Business Unit Online: http://www.medsp.com and bill@medsp.com http://www.ehrselector.com

Selected MSP EHR Partners/Associates:Carolyn Samuels, M.D. – Creator of EHR Selector, Managing Member CSMed, LLCRobt. Bruegel, Ph.D. – Associate for Andrew & Associates EHR BenchmarkDavid Ginsberg – Founder, Privaplan, Inc.

Selected EHR Cooperating Organizations:ACC – College of Cardiology AGA – Gastroenterological AssociationAHQA – Health Quality Association HIMSS – Hlth Info Mgmt & Sys. Society

MSP Contact Information