1. Welcome

2. EMR, EHR, PHR, CCR… WHAT?? Electronic Medical Record Electronic Medical Record Electronic record with full interoperability within an Electronic record with full interoperability within an enterprise (hospital, clinic, practice) Electronic health record Electronic health record Refers to the entire Medical System and Interface. Refers to the entire Medical System and Interface. Personal Health Record Personal Health Record A medical record held or accessed by the patient. A medical record held or accessed by the patient. Continuity of Care Record Continuity of Care Record The standard is a comprehensive clinical content standard including patient demographics, encounters, diagnoses, medications, allergies and immunizations The standard is a comprehensive clinical content standard including patient demographics, encounters, diagnoses, medications, allergies and immunizations

3. Why implement an EMR Produce readable records Produce readable records Eliminate Chart Hunting Eliminate Chart Hunting Equivalent of one FTE for most practices Equivalent of one FTE for most practices Allow access at multiple office locations Allow access at multiple office locations Eliminate transcription fees Eliminate transcription fees Provide coding compliance Provide coding compliance Open another patient exam room Open another patient exam room Possibly reduce malpractice premiums Possibly reduce malpractice premiums Provide offsite accessibility for on call staff/Drs Provide offsite accessibility for on call staff/Drs Qualify for ARRA Funds Qualify for ARRA Funds Qualify for CMS Bonus payments Qualify for CMS Bonus payments

5. Advantages of EMR Everything comes to the point of care. Everything comes to the point of care. The chart becomes a dynamic tool beyond just a record of patient encounters. The chart becomes a dynamic tool beyond just a record of patient encounters. The data becomes The data becomes Legible Legible Easy to retrieve Easy to retrieve Searchable Searchable Reportable and measurable Reportable and measurable

7. Advantages of EMR Coding and billing can be combined with clinical documentation to more efficiently capture the information with faster turn around time for reimbursement. Coding and billing can be combined with clinical documentation to more efficiently capture the information with faster turn around time for reimbursement. Additional software can manage all communication with the patient, including phone calls and patient portal. Additional software can manage all communication with the patient, including phone calls and patient portal. Insurance formularies combined with eligibility checking equals more revenue. Insurance formularies combined with eligibility checking equals more revenue.

8. Advantages of EMR No more chart misplacement. No more chart misplacement. Data can be accessed from anywhere with internet access. Data can be accessed from anywhere with internet access. Prescription information becomes more manageable. Prescription information becomes more manageable. Multiple staff may access a record but not everyone can make changes to it. Multiple staff may access a record but not everyone can make changes to it. Access to information can be determined by job function. Access to information can be determined by job function.

9. Is it time for your practice? Do you have more than one office? Do you have more than one office? Are you starting a new practice or opening a new office? Are you starting a new practice or opening a new office? Have you run out of space for charts? Have you run out of space for charts? Do you spend too much time spent searching for charts? Do you spend too much time spent searching for charts? Have you been concerned about the need for readable charts - for legal or practical reasons? Have you been concerned about the need for readable charts - for legal or practical reasons? Do you carry your charts in a suitcase with wheels? Do you carry your charts in a suitcase with wheels?

11. When you are ready to consider EMR Form an EMR committee - include Dr, medical assistants/PA’s, billing staff, front desk staff Form an EMR committee - include Dr, medical assistants/PA’s, billing staff, front desk staff Document all current office practices and rational Document all current office practices and rational Evaluate each process for inclusion in the EMR Evaluate each process for inclusion in the EMR Make a wish list of needs for your practice by department Make a wish list of needs for your practice by department Involve staff – prepare them for change Involve staff – prepare them for change Determine whether a full overhaul or a phased in transition is best for your office Determine whether a full overhaul or a phased in transition is best for your office

12. Practice Assessment Document your practice profile Document your practice profile Single Specialty/Multi Specialty Single Specialty/Multi Specialty Number of office locations Number of office locations Number of Physicians, Nurses, Technicians Number of Physicians, Nurses, Technicians Number of front office, back office, and administrative staff and job functions? Number of front office, back office, and administrative staff and job functions? Estimated number of medical records? Estimated number of medical records? Number of active patients? Number of active patients? Number and names of the lab(s) the practice uses Number and names of the lab(s) the practice uses Number and names of hospitals the practice uses Number and names of hospitals the practice uses Any medical devices Any medical devices

13. Practice Assessment Document your practice profile Document your practice profile Single Specialty/Multi Specialty Single Specialty/Multi Specialty Number of office locations Number of office locations Number of Physicians, Nurses, Technicians Number of Physicians, Nurses, Technicians Number of front office, back office, and administrative staff and job functions? Number of front office, back office, and administrative staff and job functions? Estimated number of medical records? Estimated number of medical records? Number of active patients? Number of active patients? Number and names of the lab(s) the practice uses Number and names of the lab(s) the practice uses Number and names of hospitals the practice uses Number and names of hospitals the practice uses

14. EMR Essential Characteristics Data entry must be easy Data entry must be easy Clinical data entry should be similar to current formats Clinical data entry should be similar to current formats The well designed EMR should enhance patient flow The well designed EMR should enhance patient flow Whenever possible processes should be automated through electronic interfaces Whenever possible processes should be automated through electronic interfaces

15. EMR Essential Characteristics Ability to modify previously entered data with audit trails to identify the revisions Ability to modify previously entered data with audit trails to identify the revisions Search access should be fast, efficient and accurate Search access should be fast, efficient and accurate Ideal EMR interfaces with ANY practice management system Ideal EMR interfaces with ANY practice management system

16. EMR Essential Characteristics Patient education tools can be integrated and services reportable for more measurable results Patient education tools can be integrated and services reportable for more measurable results Documentation can be enhanced for accurate billing of all services provided Documentation can be enhanced for accurate billing of all services provided Reporting capabilities can be improved for better utilization review and clinical profiles Reporting capabilities can be improved for better utilization review and clinical profiles

17. The Search Ask if the Practice Management System can interface with an EMR Ask if the Practice Management System can interface with an EMR Pro’s – don’t have to implement a new cash flow system and workflow system. Pro’s – don’t have to implement a new cash flow system and workflow system. Con’s – ‘interfacing’ can put your practice in a position of interacting with two vendors with two different agendas, fees, etc Con’s – ‘interfacing’ can put your practice in a position of interacting with two vendors with two different agendas, fees, etc

18. Ask Does Your EMR have a 2-way HL7 interface? Does Your EMR have a 2-way HL7 interface? What is the infrastructure Microsoft, Oracle or IBM db2? What is the infrastructure Microsoft, Oracle or IBM db2? Does it interface with our existing PMS? Does it interface with our existing PMS? What is the disaster recovery plan? What is the disaster recovery plan? How many modules are there? How many modules are there? Are the formats customizable? Are the formats customizable?

19. Types of EMRs

20. ASP ASP = Application Service provider Internet based Internet based Data located off site Data located off site Should be available form anywhere Should be available form anywhere Access thru login only Access thru login only

21. ASP PROS Available from any internet connection Available from any internet connection No onsite servers No onsite servers No backup required No backup required No hardware maintenance No hardware maintenance No onsite data center No onsite data center No software to install No software to install No software to maintain No software to maintain No software upgrade to install No software upgrade to install Real time updates Real time updates

22. ASP CONS Must have internet to access patient chart Must have internet to access patient chart Data not in your hands Data not in your hands May have slower access May have slower access Usually no software ownership Usually no software ownership

23. CLINET SERVER Office based Office based Data located on site Data located on site May or may not be available form anywhere May or may not be available form anywhere May operate faster May operate faster

24. Client Server PROS May have access via web May have access via web No reliance on internet No reliance on internet All data is onsite All data is onsite

25. CLIENT SERVER CONS Available from any internet connection Available from any internet connection onsite servers required onsite servers required Backup required Backup required Hardware maintenance Hardware maintenance Onsite data center Onsite data center Software to install Software to install Software to maintain Software to maintain Software upgrade to install Software upgrade to install Updates with next Release Updates with next Release

26. Starting The Process

27. When you are ready to consider EMR Form an EMR committee - include Dr, medical assistants/PA’s, billing staff, front desk staff Form an EMR committee - include Dr, medical assistants/PA’s, billing staff, front desk staff Document all current office practices and rational if needed Document all current office practices and rational if needed Evaluate each process for inclusion in the EMR Evaluate each process for inclusion in the EMR Make a wish list of needs for your practice by department Make a wish list of needs for your practice by department Involve staff – prepare them for change Involve staff – prepare them for change Determine whether a full overhaul or a phased in transition is best for your office Determine whether a full overhaul or a phased in transition is best for your office

28. Selection process Ideally review 3 to 5 different products with demonstration documentation by each company Ideally review 3 to 5 different products with demonstration documentation by each company Then narrow down to top 2 or 3 for onsite demo’s Then narrow down to top 2 or 3 for onsite demo’s Ask for recommendations or trial period. Ask for recommendations or trial period.

29. Practice Assessment Document your practice profile Document your practice profile Single Specialty/Multi Specialty Single Specialty/Multi Specialty Number of office locations Number of office locations Number of Physicians, Nurses, Technicians Number of Physicians, Nurses, Technicians Number of front office, back office, and administrative staff and job functions? Number of front office, back office, and administrative staff and job functions? Estimated number of medical records? Estimated number of medical records? Number of active patients? Number of active patients? Number and names of the lab(s) the practice uses Number and names of the lab(s) the practice uses Number and names of hospitals the practice uses Number and names of hospitals the practice uses

30. EMR Essential Characteristics Ask if the Practice Management System can interface with an EMR Ask if the Practice Management System can interface with an EMR Pro’s – don’t have to implement a new cash flow system and workflow system. Pro’s – don’t have to implement a new cash flow system and workflow system. Con’s – ‘interfacing’ can put your practice in a position of interacting with two vendors with two different agendas, fees, etc Con’s – ‘interfacing’ can put your practice in a position of interacting with two vendors with two different agendas, fees, etc

31. Ask Does Your EMR have a 2-way HL7 interface? Does Your EMR have a 2-way HL7 interface? What other interface type are available? What other interface type are available? What is the database infrastructure Microsoft, Oracle or IBM db2? What is the database infrastructure Microsoft, Oracle or IBM db2? What operating system does it run on? What operating system does it run on? Does it interface with our existing PMS? Does it interface with our existing PMS? What is the disaster recovery plan? What is the disaster recovery plan? How many modules are there? How many modules are there? Are the formats customizable? Are the formats customizable?

32. EMR Essential Characteristics Data entry must be easy Data entry must be easy Clinical data entry should be similar to current formats Clinical data entry should be similar to current formats The well designed EMR should enhance patient flow The well designed EMR should enhance patient flow Whenever possible processes should be automated through electronic interfaces Whenever possible processes should be automated through electronic interfaces

33. EMR Essential Characteristics Patient education tools can be integrated and services reportable for more measurable results Patient education tools can be integrated and services reportable for more measurable results Documentation can be enhanced for accurate billing of all services provided Documentation can be enhanced for accurate billing of all services provided Reporting capabilities can be improved for better utilization review and clinical profiles Reporting capabilities can be improved for better utilization review and clinical profiles Ability to modify previously entered data with audit trails to identify the revisions Ability to modify previously entered data with audit trails to identify the revisions

34. Attributes of EMRs for Physician Practices Physician and practice workforce must be an integral part of identifying practice workflows, processes, and action triggers, and of specifying business requirements that will underpin the EHR Physician and practice workforce must be an integral part of identifying practice workflows, processes, and action triggers, and of specifying business requirements that will underpin the EHR The EMR must integrate administrative and clinical business requirements The EMR must integrate administrative and clinical business requirements

35. Possible Components Patient Demographics Patient Demographics Insurance eligibility checking. Insurance eligibility checking. E-prescribe with clinical and interaction check. E-prescribe with clinical and interaction check. Electronic Medical Records Electronic Medical Records Scheduling Scheduling Billing-electronic or drop to paper Billing-electronic or drop to paper Sales & Inventory Sales & Inventory Custom Reporting Custom Reporting

36. Incentives

37. HITECH Act On February 17th, President Obama signed the 2009 American Recovery and Reinvestment Act, allocating $19.2 billion for health information technology. The provision of the legislation known as the HITECH Act will be distributed as follows: $17.2 billion incentive payments for EHR use. $17.2 billion incentive payments for EHR use. $2 billion is available for grants and loans for health information $2 billion is available for grants and loans for health information technology advancement. When coupled with existing measures, these funds represent significant income opportunities for existing EHR users and to assist new users with adoption related costs.

38. HITECH Act

39. CMS Incentives 2 ½ % bonus payment for E-prescribing. 2 ½ % bonus payment for E-prescribing. 2 ½ % bonus for PQRI reporting. 2 ½ % bonus for PQRI reporting.

40. Other Incentives Malpractice reduction. Malpractice reduction. 5%-15% Reduction for using robust EMR Technology Grants Technology Grants Lab subsidies Lab subsidies Billing Company subsidies Billing Company subsidies Radiology Center Subsidies Radiology Center Subsidies Hospital Subsidies. Hospital Subsidies.

41. The Installation

42. Key points of EMR selection Be very clear about practice objectives in implementation Be very clear about practice objectives in implementation Assign an individual to work with EMR vendor on customization who: Assign an individual to work with EMR vendor on customization who: understands and embraces the technology understands and embraces the technology has time in their schedule to work w/vendor has time in their schedule to work w/vendor Set realistic timelines of implementation Set realistic timelines of implementation Keep staff updated on project/timeline Keep staff updated on project/timeline Allay staff fear of losing jobs- ask staff to identify other tasks getting least attention currently Allay staff fear of losing jobs- ask staff to identify other tasks getting least attention currently

43. Transition Considerations Big Bang Big Bang On one day, pull the switch and everything goes electronic On one day, pull the switch and everything goes electronic Modular Modular Adopt one module at a time (e.g.. ePrescribing), then transcription, then interfaces with Practice Management System, Lab, Hospital, Pharmacy … Adopt one module at a time (e.g.. ePrescribing), then transcription, then interfaces with Practice Management System, Lab, Hospital, Pharmacy …

44. Build Detailed Timeline Project Team and Plan Project Team and Plan Communication w/ vendors & staff Communication w/ vendors & staff Map Critical Practice Workflows (where are current bottlenecks) and remap with EMR Map Critical Practice Workflows (where are current bottlenecks) and remap with EMR Plan for Existing Data Plan for Existing Data Training Training System Testing System Testing Contingency Planning Contingency Planning Go-Live Planning Go-Live Planning

45. Transition Considerations Big Bang Big Bang More disruptive on front end, less on back end More disruptive on front end, less on back end Full team commitment Full team commitment More difficult to measure ROI More difficult to measure ROI Best for new practices Best for new practices Modular Modular Less disruptive Less disruptive Slower to experience full benefit Slower to experience full benefit Adaptable to resistant physicians Adaptable to resistant physicians Easier to measure ROI Easier to measure ROI

46. Wrap up It is not a matter of “if”, it’s a matter of when It is not a matter of “if”, it’s a matter of when Exception: retiring from practice in next 5 years Exception: retiring from practice in next 5 years CMS encouraging practices to move to EMR CMS encouraging practices to move to EMR

47. Questions and Answers

48. Thank You Now The Demonstration