1. Health Insights, London CHELSEA FOOTBALL CLUB 11 JUNE 2014

2. Outline Introduction to HIMSS Analytics EMR Adoption Model What are the benefits of using the acute care EMRAM? What is next? The Continuity of Care Maturity Model

3. History of the Acute Care EMRAM The acute care EMRAM was developed in 2005 Why the structure? –It is the typical manner by which hospitals rollout enterprise clinical systems Are there any usual variations? –Academic Medical Centers often have CPOE live to enable education for the medical students and residents The first Stage 7 validation occurred in Q4 2008 –Three years after EMRAM introduction

4. Why Do We Do It? Thought leadership –Quality, Safety, Efficiency improvements To inform government policy –Numerous countries and regions use HIMSS Analytics to gather data for their policy formulation To reflect the market –Where is the market heading To “drive the market” Hospital Data sets: –>5,400 US and >700 Canada –>8,000 Europe –> 5,000 Asia-Pacific

5. Data from HIMSS Analytics ® Database © 2012 HIMSS Analytics 1.1% 3.1% 13.3% 24.2% 15.7% 27.7% 7.2% 3.2% 5.6% 4.0% 6.1% 12.3 % 46.3% 13.7% 6.6% 10.0% 2011 Q2 2014 Q1 N = 5439 N = 5449 Complete EMR, CCDA transactions; Data Analytics to Improve Care Physician documentation (structured templates), full CDSS, full R-PACS Closed Loop Medication Administration = Bar Code Enablement CPOE, or e-Prescribing, Clinical Decision Support (clinical protocols) Clinical documentation, CDSS (error checking) CDR, Controlled Medical Vocabulary, CDS, HIE capable Ancillaries - Lab, Rad, Pharmacy - All Installed All Three Ancillaries Not Installed

6. What Are the Benefits of Using the Acute Care EMRAM? SOME QUALITY, SAFETY & EFFICIENCY CORRELATIONS OF STAGE 7 HOSPITALS AND HEALTH SYSTEMS

7. First, A Look at How US Market Has Changed The shift to outpatient care has dramatically reduced the number of hospitals and hospital beds – by 2013: 150 beds Note: Sweden intends to reduce # hospitals by 20% in next decade Note: Estonia has >50% reduction in # hospitals in five years -25% -41%

8. EMR Adoption in the U.S. Market Trended 2006 – 2013 Data from HIMSS Analytics TM Database This is how long it takes to make “significant” national progress Stage20062007200820092010201120122014 Q1 Stage 70.00% 0.30%0.70%1.00%1.20%1.80%3.10% Stage 60.10%0.80%0.50%1.60%3.20%5.20%7.30%13.30% Stage 50.50%1.40%2.50%3.80%4.50%8.40%11.50%24.20% Stage 43.10%2.20%2.50%7.40%10.50%13.20%14.00%15.70% Stage 318.70%25.10%35.70%50.90%49.00%44.90%41.70%27.70% Stage 240.00%37.20%31.40%16.90%14.60%12.40%11.40%7.20% Stage 117.40%14.00%11.50%7.20%7.10%5.70%4.80%3.20% Stage 020.40%19.30%15.60%11.50%10.10%9.00%7.50%5.60% # of Hospitalsn = 4,237n = 5,073n = 5,166n = 5,235n = 5,281N=5,337N=5,310N= 5,458

9. Stage 7 Studies on a Macro Scale Correlations With Stage 7 Status

10. Source: HIMSS Analytics Representation of TJC Top Performing Hospitals by # Quality Metrics Excelling In, per EMRAM Stage 2.3% 6.5% 16.3% 18.1% 10.6% 12.9% 20.7% 39.8%

11. Representation of Hospitals with an "A" Leapfrog Hospital Safety Grade by EMRAM Stage Tipping Point

12. Value Based Purchasing (VBP) Clinical Scores

13. What About Cost Efficiency? Some Ground Breaking Research on the Effect of EMR Deployment

14. What We Found in Researching Hospitals that implemented EMR between 1996 and 2009 did NOT generally see a reduction in operating expense, EXCEPT: –Cost rise immediately during and following implementation and then fall back to previous levels However: –Hospitals in locations with IT intensive industry found cost reductions after three years –Hospitals in other locations found costs increased –The initial cost increases was smaller for those in IT intensive locations The Trillion Dollar Conundrum: Complementarities and Health Information Technology (NBER Working Paper No. 18281)18281 Used by permission – Avi Goldfarb

17. Efficiencies Adjusted for Case Mix Index = intensity Quality scores, publically available Readmission rate, publically available Labor input, publically available –Nursing specifically etc. ….

18. Hospital Cost Efficiencies BY EMRAM Stage Early DRAFT Not for Distribution Used by permission – Eric Ford

19. STATUS OF EMR ADOPTION

20. EMR ADOPTION IN TURKEY, EUROPE AND THE US... based on HIMSS Analytics EMR Adoption Model 1) Only public hospitals, of those 90% with >200 beds 2) Excl. Turkey; incl. Austria (42), Belgium (1), Denmark (16), Finland (3), France (17), Germany (383), Ireland (2), Italy (524), Netherlands (68), Norway (3), Poland (83), Portugal (29), Slovenia (2), Spain (220), Sweden (1), Switzerland (8), UK (25) 3) The EMRAM algorithm between Europe and the US differs in some degrees in order to reflect HIT implementation of that particular region EMR Adoption Model Scores, Means per Country (data from 4/13 – 5/14 (Turkey), 4/12 – 3/14 (Europe), 4/13 – 3/14 (US), no weighting etc. applied) Source: HIMSS Europe Database (05/2014) Turkey 1 (143) Europe 2 (1,427) Germany (383) Netherlands (68) USA 3 (5,449) EMRAM Score (Means)

21. EMR ADOPTION IN TURKEY, EUROPE AND THE US... based on HIMSS Analytics EMR Adoption Model 1) Excl. Turkey; incl. Austria (14), Belgium (1), Denmark (15), Finland (3), France (16), Germany (193), Italy (178), Netherlands (63), Norway (3), Poland (55), Portugal (13), Slovenia (1), Spain (79), Sweden (1), Switzerland (4), UK (20) 2) The EMRAM algorithm between Europe and the US differs in some degrees in order to reflect HIT implementation of that particular region EMR Adoption Model Scores, Means per Country (data from 4/13 – 5/14 (Turkey), 4/12 – 3/14 (Europe), 4/13 – 3/14 (US), no weighting etc. applied) Source: HIMSS Europe Database (05/2014) Turkey (134) Europe 1 (659) Germany (193) Netherlands (63) USA 2 (1,310) EMRAM Score (Means) Only public and non-profit hospitals with >199 beds

22. So, What is Expected at Stage 7? Very Good Analytics Use Analytics to Find Care Issues to Address Use Analytics to Prove that IT Tools are Enabling Improvements

23. Find Patients Who Could Benefit From BRCA1 and BRCA2 DNA Testing Major University devised rules to search for child bearing age patients who have relatives with estrogen driven CA’s Rule fired 1,355 times in October –Generated 22 referrals Rule fired 1,478 time in November –Generated ~140 referrals in November This tells us several things: –A profound finding –Hard to “sell” DNA testing

24. Predictive Alerting for Potential Readmissions 40 key variable are tracked to generate predictive score Alerts to physicians with advice on best practice – updated hourly !

25. Their Model is at 80% Accuracy

26. Using I.T. Tools to Improve Patient Engagement

27. Target Your Problems and Cohorts Rural north central health system attacked CHF readmission rate –Weight gain due to medication insufficiency or behavior factors, is a strong predictor of readmission Gave away blue-tooth enabled weight scales to targeted CHF patients –Reduced readmissions by -42% over 12 months

28. Target Your Problems and Cohorts Teenage obesity & Fit Bits.. Create competitive cohorts with PHR –-11% reduction in obesity in a year

29. Mature Organizations Have Created an e-Continuum of Care And Have Reduced Costs per Person per Year Introducing Introducing The Continuity of Care Maturity Model

30. Model Audiences Global applicability Primary Target Audiences: –Regional & National Health Authorities/ MoH –Integrated Delivery Networks (IDN) –Health Management Organizations (HMOs) / Accountable Care Organizations (ACOs) –(Private) care chains

32. THANK YOU John P Hoyt jhoyt@himss.org