1. Louisiana Hospitals Shaking up the Snow Globe EMRs in the ED

2. 2004 State of the Union Address –President Bush called for electronic health records for most Americans within 10 years. In an executive order, he created the new Office of the National Coordinator for Health Information Technology within the Department of Health & Human Services (HHS) –May 2004, David Brailer, M.D., Ph.D., was appointed as the first national health IT coordinator for ONCHIT In the Beginning...

3. The Need of Health IT Lack of flow in health care IT: –Access to info: 30% of time, physicians can’t find the info in previous paper chart –Duplicate testing: drugs or tests ordered 11% of time, with patients complying 50% of time –Incomplete info: MDs not aware 1 of 4 Rx that a patient had been given –Uncertainty & repeat: 1 of 5 labs were ordered because of retrieval barriers Interoperability/connectivity: the crucial key! –EMR adoption is great, but we must be able to connect and communicate (not EMR silos) –Regional Health Information Organizations (RHIO) –Standards, standards, standards…

4. Economic Impact of EMR System

6. "Dr. Thomas Trieu of Ocean Springs, MS, scatters soggy charts from his water logged medical practice. His office received major damage and he doesn't know when he will be able to resume his practice." - J.D. Schwalm The Clarion-Ledger

7. Technology has caught up & can be integrated in clinical work The question is no longer why for EMR, but how to implement and at what speed Most importantly, the business case for providers to invest in EMR systems Health care, as an industry, spends many resources on managing information, but not on utilizing technology for information The Business Case for EMRs

8. Product 1)How good is the product? 2)What is the architecture? 3)Are they interoperable? 4)What is their install base? 5)Are their clients happy? 6)Is the product interoperable? Product Selecting EMR Vendor

9. Product Training / Implementation 1)Do they know how to implement? 2)Do they have experience with group like ours? 3)What are our rollout and training options? 4)Have they received any recognition? Implem.

10. Selecting EMR Vendor Product Company 1)Are they a well managed company? 2)Are they profitable? 3)Are they growing in the marketplace? 4)How is their customer support? 5)Is the product CCHIT certified? Implem. Company

11. Snow Globe Effect

12. Clinician Comments “Electronic charting is not totally horrible.” - RN “Prepare all MDs prior to installation.” - RN “Program is terrible, repetitive, very time consuming & inaccurate. You could make it much better with a different program. Any ER MD could improve this program.” - MD “Remove it! Start over!” – MD “Take is out would be the most improvement. It has formed me into a secretary typist. I did not train for that” - MD “Although it still has kinks, I would give it a 9/10. An additional terminal in dictation room would be nice” - MD

13. Return on Investment Reduction in Pharmacy call backs Improved compliance with Joint Commission’s Standards IM.3.10 (list of abbreviations, acronyms, and symbols not to use) Improved ability to effectively manage clinical and non-clinical data, including capturing, reporting, processing, storing and retrieving the information

14. Return on Investment Reduced amount of unproductive time spent feeding records to coders off-site Eliminated ability to assign non-billable diagnosis Higher visibility of patient wait times Higher visibility of Left Without Being Seen

15. 2004-2005 –Capturing essential patient data –AHRQ Rural Health Information Technology Project –Limited decision support and reporting, exchange –LA HIT policy summit; LA e-Health conference 2006-2008 –Rural Health Information Exchange Project –Critical Access Hospital – HIT Project –Exchanging information among selected providers 2010 –Full integration of local exchange and decision support So Where are We in Louisiana?

16. Louisiana Hospital Inform provides: –Pricing data on the most common Medicare inpatient and outpatient services –Quality data on surgical infections and the most common causes of hospitalization: heart attack, congestive heart failure and pneumonia –Demographic information, services offered and contact numbers for hospitals www.LAhospitalinform.org

17. Louisiana Consumers’ Right to Know Act –Web site to provide consumers comparative information on the cost, performance and quality of hospitals and health care providers –Patients will be able to view: Pricing for different procedures The number of times a physician has performed that procedure Physician complication rates Patient safety indicators defined by AHRQ such as bedsore rates, anesthesia complication rates, infection rates, blood transfusion errors and the number of deaths that result during low-mortality procedures

18. Redesigning Louisiana’s Healthcare System This newly “redesigned” system of care will: provide a medical home at its heart; be patient-centered; be linked by electronic medical records; be quality driven, sustainable; and accessible to all citizens

19. Thank you AHRQ for Giving Louisiana a Jump Start in the Health Information Technology Movement!

20. Hospitals…the “business” we are in…the people that we serve! Thank You. Rebecca Bradley Director Rural Health Programs Louisiana Hospital Association RBradley@LHAOnline.org