1. DRT- enabled EHRs Presented by: Mark R. Anderson, FHIMSS, CPHIMS CEO, AC Group DRT- enabled EHRs Presented by: Mark R. Anderson, FHIMSS, CPHIMS CEO, AC Group

2. Mark Anderson, FHIMSS, CPHIMSS Healthcare IT Futurist CEO of AC Group –Conducted > 300 Technology Software Searches for Hospital and Physician Organizations –National Speaker on EHR > 450 sessions since 2000 –Semi annual report on Vendor product functionality and company viability 36+ Years In Healthcare IT –CIO Position at Three Multi Facility Regional IDN’s –Installed over $1B in technologies since 1972 –Former CIO of a 2,300+ physician (500+ Practices) IPA Http://www.acgroup.orgPage No: 2

3. The Genesis The Genesis

6. The Focus is People The Focus is People

8. HITECT Requirements In order to qualify for the incentive payments, both physicians and hospitals have to prove three things: – 1. Use of a certified EHR product with ePrescribing capability that meets current HHS standards. – 2. Connectivity to other providers to improve access to the full view of a patient’s health history. – 3. Ability to report on their use of the technology to HHS. The second area is “meaningful use”

9. Value of EHRs EHRs save you time –EHRs have proven to save nursing and clerical time –but it takes much longer to enter the information –On average – 9 times longer to enter the data The information is readable –True, but the clinical note as expanded from 1 page to 5 pages –The critical information is lost in the extensive detail You have more discrete data –yes, over 700 data elements –but you only use about 3% of these data elements

10. Value of EHRs E & M coding improves –In theory, but many EHR vendors have no 3 rd party validation studies. –For many specialists, less than 20% of their actual revenues comes from the Basic E & M codes EHRs provide orders and alerts –You can get the same results with a DRT enabled EHR. EHRs reduce errors and improve Quality of Care –We assume this is true, but with a 4% adoption rate, the actual results are still pending.

11. Why are Practices not using what they Purchased? Source: AC Group Annual Survey of buying patterns New England Journal of Medicine

12. Why have EHRs Failed? Cost average over $60,000 per provider over 5 years. Data entry time increases 9 fold with an EHR. Data is not shared between providers, treating the same patient. Training is technical, not operational Simple 1 page note now become 5 pages More failures (73%) than successes (27%) Changes the way the physician practices medicine. So what the answer?

13. DRT Enabled EHRs What is DRT?

14. Allows the provider to use the EHR for viewing of patient clinical information. After the physical exam, the provider dictates their note like they have the past 20+ years. The dictated report is sent to a transcription service for transcription or via Dragon The Software takes the dictation, creates a clearly defined patient note and then automatically populates the EHR with practice specific discrete recordable and reportable data directly into the practice’s EHR. DRT is Discrete Reportable Transcription

15. Data Entry Time Number of seconds for data entry of discrete clinical data Source: 573 Patient charts Seconds

16. Data Entry Time The average physician spends 33 seconds dictating an establish office visit 92% of all office visits are established If the average physician sees 40 patients a day, total dictation time of 30 minutes plus time to search for the data. Using a traditional EHR application, the same number of patients would require 140 minutes of data entry time. Physicians are not willing to spend an additional 90 minutes per day for data entry. (40 X 92% x 33 seconds) + (40 x 8% x 125) = < 30 minutes per day

17. Estimated Reduction in Transcription Costs Actual Reduction in Transcription Costs by Quarter if you use one of the top EHR products

18. Estimated Reduction in Transcription Costs Actual Reduction in Transcription Costs by Quarter if you use one of the top EHR products EHR Vendor Marketing

19. So How does an DRT enabled EHR Help a Physician?

20. DRT Enabled EHR Allows the physician to continue their current process for charting Allows the practice to collect –family history, –social history, –medical history, –Current Meds –Allergies –Vital Signs

21. DRT Enabled EHR Allows the physician to interact with the patient regarding: –ROS –HPI –Assessment –Orders Some Physicians have allow their staff to enter ROS and HPI following approved clinical protocols

22. DRT Enabled EHR Physician conducts their physical exam Physician dictates their PE and their assessment and then places orders. The dictated wave file is sent to transcription for typing. The typed paragraph is sent to the physician for review. Once approved, the transcription section is auto placed in the specific section of the EHR. Additionally, the transcription section runs through natural language processing technology enabling discrete and reportable data to be capture and auto populated into the EHR.

23. DRT Enabled EHR Disadvantages: –Does not eliminate all transcription right away But what EHR vendor is eliminating Transcription –No E & M Coding But a 20% reduction in productivity offsets any E & M coding enhancement But a 20% reduction in productivity offsets any E & M coding enhancement –You only capture 70% of the discrete data But the average practice only uses 3 – 6% of the EHR discrete data today.

24. Natural Language Processing Search tools to optimize both sensitivity and specificity

25. Analyzing the Data Clinical elements are extracted to support both process and outcomes measures. NAME: XXXXXX DOB: XXXXXX MR#: XXXXXX DATE: XXXXXX CHIEF COMPLAINT: TYPE 2 DIABETES, HYPERTENSION, AND HYPERLIPIDEMIA. SUBJECTIVE: THE PATIENT'S BLOOD SUGARS ARE WELL CONTROLLED. WE DISCUSSED HIS GOAL OF MAINTAINING HIS A1C TO REDUCE RISK OF DIABETIC COMPLICATIONS. DIABETES TREATMENT REGIMEN: DIET AND EXERCISE FREQUENCY OF HOME GLUCOSE MONITORING: TWICE-WEEKLY BLOOD GLUCOSE RANGE: 96-178 DIABETIC FOOT EXAM: NO ABNORMALITIES NOTED. ANNUAL OPHTHALMOLOGIC EXAM: RETINAL EYE EXAM PERFORMED ON 1/1/06, WITH NORMAL EXAM. OBJECTIVE: VITALS: WEIGHT 198 POUNDS, BLOOD PRESSURE 140/78, PULSE 68 THE PATIENT'S BLOOD PRESSURE IS UNCONTROLLED. WE DISCUSSED THE IMPORTANCE OF MAINTAINING HIS BLOOD PRESSURE TO REDUCE HIS RISK OF HEART ATTACK, STROKE, AND KIDNEY DYSFUNCTION. WE DISCUSSED THERAPEUTIC OPTIONS AVAILABLE FOR IMPROVING HIS BLOOD PRESSURE CONTROL. WE WILL PLAN ON ADDING HCTZ 25 MG TO THE LISINOPRIL 40 MG DAILY THAT HE CURRENTLY TAKES FOR HYPERTENSION. THE PATIENT'S CHOLESTEROL IS WELL CONTROLLED ON LOVASTATIN 40 MG DAILY. LABORATORY: WE REVIEWED LABS FROM OCTOBER 31, 2006. HEMAGLOBIN A1C = 6.0 ON 10/31/06. LDL = 95 ON 2/28/06. MICROALBUMIN = 30 ON 6/20/06. ASSESSMENT: TYPE 2 DIABETES, CONTROLLED. HYPERTENSION, UNCONTROLLED. HYPERLIPIDEMIA, CONTROLLED. PLAN: PATIENT IS TO CONTINUE CHECKING HIS BLOOD SUGARS TWICE WEEKLY. WE WILL SWITCH THE PATIENT'S LISINOPRIL 40 MG DAILY TO LISINOPRIL/HCTZ 20/12.5 MG TWO TABLETS DAILY FOR BLOOD PRESSURE. ELECTRONICALLY VERIFIED AND SIGNED BY JACK SMITH MD Search Technology - Finds clinical elements within the document - Populates the structured database - Ability to create/modify searches KeyBPBP DateA1C ValueA1C Date… 231140/7812/1/066.010/31/06…

26. Proven Results 62% Reduction in Transcription costs – day 1 No change in interaction with patient Ability to capture discrete data via transcription Populate EHR via dictation instead of physician data entry. 70% of discrete data with 18% of the effort Transcription costs decreases on follow-up visits by 82%. Note looks and sounds professional versus the 5 page computer generated note that does not sound like a professional ever read it.

27. DRT Disadvantages Does not eliminate all transcription right away –But what EHR vendor is eliminating Transcription No E & M Coding – But a 20% reduction in productivity offsets any E & M coding enhancement You only capture 30% of the discrete data –But the average practice only uses 3 – 6% of the EHR discrete data today.

28. The Challenge The Challenge So which EHR product are DRT enabled today ?

29. Which Vendors Offer DRT All vendors can offer a DRT enabled EHR Vendors need to realize that the EHR is NOT the solution. Vendors need to realize that the EHR is just a tool to help generate a clear and concise note that can be shared between common providers of care. A combination of Transcription and EHR is the best model for true universal adoption. The EHR vendor that can best enable Transcription in their EHR will WIN!!!

30. Take Home Message EHRs Can Improve Patient Service and Provide Financial Benefits. HITECT will require “Meaningful Use” DRT Enabled EHRs is the easiest way to meet “meaningful use”. EHR Implementation is a “Bet the Practice” Proposition That Requires Adequate Resources and Investments to Achieve Success. The DRT Enabled EHRs provide the best Value today

31. For More Information Mark R. Anderson, FHIMSS, CPHIMS CEO and Healthcare Futurist AC Group, Inc. 118 Lyndsey Drive Montgomery, TX 77316 (281) 413-5572 eMail: mark.anderson @ acgroup.org www.acgroup.org