TREND OF DIGITAL HOSPITALS

DRIVING PATIENT’S SAFETY AND QUALITY OF CARE THROUGH IT

STEVEN YEOGENERAL MANAGER, HIMSS ANALYTICS ASIA PACIFIC & MIDDLE EAST

6th September 2013

CONTENT

• Asia Pacific EMRAM Trend

• Key challenges for hospitals in adopting EMR

• Values

• Summary

3 FUNDAMENTAL HEALTHCARE ISSUES

• Cost

• Quality of Care

• Access to care

A COMMON GLOBAL PROBLEM

• Safety• Privacy• Engagement

» Clinicians» “Consumers”

• Maturity• Paper

‘Management’

THIS LOOKS FAMILIAR?

HIMSS ANALYTICS ASIA PACIFICEMR ADOPTION MODELSM

EMR ADOPTION IN THE U.S. MARKET TRENDED 2006 – 2012 (% OF U.S. HOSPITALS)

Tracking EMR adoption assists in the creation of policies and strategies that drive EMR adoption and improve patient care

Source: HIMSS Analytics ® Database

Data from HIMSS Analytics® Database ©

Cross Country EMRAM Score Distribution (2013 Q2)

Stage United States*

Canada* Australia Malaysia SingaporeUnited Arab

Emirates

Saudi Arabia

Germany* Italy* Poland* Portugal* Spain*Nether-lands*

Stage 7

1.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.3% 0.0% 0.0% 0.0% 0.5% 0.0%

Stage 6

9.1% 0.5% 0.0% 0.5% 57.1% 12.8% 2.9% 0.0% 0.6% 0.0% 0.0% 4.3% 3.8%

Stage 5

16.3% 0.3% 3.5% 4.7% 14.3% 14.9% 14.7% 8.3% 6.6% 0.0% 26.1% 40.9% 34.6%

Stage 4

14.4% 2.2% 0.9% 2.8% 14.3% 4.3% 5.9% 1.9% 1.8% 0.7% 4.3% 6.7% 3.8%

Stage 3

36.3% 33.6% 0.4% 0.5% 0.0% 6.4% 27.9% 8.3% 3.4% 0.0% 21.7% 1.9% 1.9%

Stage 2

10.1% 26.9% 52.0% 1.9% 14.3% 25.5% 14.7% 34.9% 26.7% 10.3% 4.3% 18.8% 55.8%

Stage 1

4.2% 14.8% 4.4% 1.4% 0.0% 21.3% 8.9% 0.6% 41.4% 13.0% 4.3% 9.6% 0.0%

Stage 0

7.8% 21.7% 38.9% 88.2% 0.0% 14.9% 25.0% 45.7% 19.5% 76.0% 39.1% 17.3% 0.0%

N = 5,441

N = 640 N = 229 N = 212 N = 7 N = 47 N = 68 N = 324 N = 498 N = 146 N = 23 N = 208 N = 52

Data from HIMSS Analytics® Database ©

Cross Regional EMRAM Score Distribution

Stage Asia Pacific Middle East United States * Canada* Europe*

Stage 7 0.2% 0.0% 1.9% 0.0% 0.1%

Stage 6 2.3% 7.0% 9.1% 0.5% 1.4%

Stage 5 4.5% 14.8% 16.3% 0.3% 14.9%

Stage 4 2.5% 5.2% 14.4% 2.2% 2.8%

Stage 3 0.5% 19.1% 36.3% 33.6% 4.0%

Stage 2 28.0% 19.1% 10.1% 26.9% 27.2%

Stage 1 6.2% 13.9% 4.2% 14.8% 18.8%

Stage 0 55.8% 20.9% 7.8% 21.7% 30.7%

N = 600 N = 115 N = 5,441 N = 640 N = 1,354

EMR Adoption Model Scores, % of Hospitals, Q2 2013

* Data Retrieved: Q1, 2013

Stage Short Description 2012 Q4 2013 Q1 2013 Q2

Stage 7 Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 0.2% 0.2% 0.2%

Stage 6 Physician documentation (structured templates), full CDSS (variance & compliance), closed loop medication administration 2.6% 2.2% 2.3%

Stage 5 Full complement of R-PACS displaces all film-based images 4.1% 5.3% 4.5%

Stage 4 CPOE, Clinical Decision Support (clinical protocols) 3.0% 3.0% 2.5%

Stage 3 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 0.4% 0.4% 0.5%

Stage 2 Clinical Data Repository (CDR), Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable 27.5% 26.0% 28.0%

Stage 1 Ancillaries – Lab, Radiology, Pharmacy – All Installed 3.8% 6.1% 6.2%

Stage 0 All Three Ancillaries (LIS, RIS, PHIS) Not Installed 58.4% 56.9% 55.8%

N= 469 N= 508 N= 600Data from HIMSS Analytics® Database © 2013 HIMSS Analytics

Asia Pacific EMR Adoption ModelSM

Cross Country EMRAM Score Distribution (2013 Q2)

Stage Australia New Zealand Singapore Malaysia Thailand

Stage 7 0.0% 0.0% 0.0% 0.0% 0.0%

Stage 6 0.0% 0.0% 57.1% 0.5% 0.0%

Stage 5 3.5% 5.6% 14.3% 4.7% 6.2%

Stage 4 0.9% 0.0% 14.3% 2.8% 0.0%

Stage 3 0.4% 0.0% 0.0% 0.5% 1.5%

Stage 2 52.0% 91.7% 14.3% 1.9% 9.2%

Stage 1 4.4% 2.8% 0.0% 1.4% 32.3%

Stage 0 38.9% 0.0% 0.0% 88.2% 50.8%

N = 229 N = 36 N = 7 N = 212 N = 65

Data from HIMSS Analytics® Database ©Data Retrieved: 2013 Q2

Stage Short DescriptionSmall

(≤ 100 beds)Medium

(101-200 beds)Large

(>200 beds)

Stage 7 Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 0.0% 0.0% 0.0%

Stage 6 Physician documentation (structured templates), full CDSS (variance & compliance), closed loop medication administration 0.0% 0.0% 6.7%

Stage 5 Full complement of R-PACS displaces all film-based images 7.1% 12.5% 20.0%

Stage 4 CPOE, Clinical Decision Support (clinical protocols) 0.0% 12.5% 3.3%

Stage 3 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 28.6% 20.8% 33.3%

Stage 2 Clinical Data Repository (CDR), Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable 7.1% 16.7% 16.7%

Stage 1 Ancillaries – Lab, Radiology, Pharmacy – All Installed 0.0% 8.3% 13.3%

Stage 0 All Three Ancillaries (LIS, RIS, PHIS) Not Installed 57.1% 29.2% 6.7%

N=14 N= 24 N= 30Data from HIMSS Analytics® Database © 2013 HIMSS Analytics

australia KSA EMR Adoption ModelSM (2013 Q2)

CONTENT

• Asia Pacific EMRAM Trend

• Key challenges for hospitals in adopting EMR

• Values

• Summary

CHALLENGES FOR ADOPTION IN HEALTHCARE ORGANIZATIONS

• Lack of financial resources• Lack of basic IT infrastructure• Use of open-source technology in developing countries• Lack of professional healthcare IT Staff• Lack of incentives for private hospitals to adopt EMR E.g. Raffles

Hospital • Nursing documentation not considered a priority• Unable to justify the Returns of Investments (ROIs) • Managing competing priorities to meet organisational budget and

goals

KEY ISSUES IN ACHIEVING STAGE 6 & 7

• Nursing functions not a priority; unable to move past Stage 2 of the EMRAM

• No pre-packaged unit dose medications for closed loop medication administration

CONTENT

• Asia Pacific EMRAM Trend

• Key challenges for hospitals in adopting EMR

• Values

• Summary

04/19/2023

17©2011 Healthcare Information and Management Systems Society

Reasons for Adopting HIMSS EMRAM BenchmarkStage Capabilities Benefit

Stage 7 Medical record Fully electronic, Able to contribute CCD as by product of EHR/EMR, Data Warehousing

Paperless environment for better care & medical outcomes . Clinical analytics derived from EMR data used to improve outcomes by inputs back to operational EMR. Rich analytics due to ability to capture data at every point.

Stage 6 Physician Documentation, Full CDSS

Higher level of Patient Safety, Patient Care, Enhanced Effectiveness of Care

Stage 5 Closed Loop Medication Administration

Patient Safety, 5 Rights

Stage 4 CPOE, CDSS Patient Safety

Stage 3 Clinical Documentation(Flow sheets), CDSS

Allow Team-Based Care

Stage 2 Clinical Data Repository Force Standardisation. Single source of Truth

Stage 1 Ancillaries Automation of Departmental Workflow. Basis for Electronic Orders

Stage 0 -- --

CONTENT

• Asia Pacific EMRAM Trend

• Key challenges for hospitals in adopting EMR

• Values

• Summary

IN SUMMARY

• Government and hospitals are investing in IT to deliver better patient care – safety, quality and access.

• HIMSS Analytics EMRAM (EMR Adoption Model) provide a good framework for government to baseline and track hospital’s IT capability.» Creation of policy and strategy» Drive EMR adoption and patient care

• Hospitals can learn from other hospitals that had successfully achieved the stages and getting the ROI.

• Management needs to have clear strategy for building its EMR environment to meet its corporate objectives with its investment and outcome.

IN SUMMARY

• Government and hospitals are investing in IT to deliver better patient care – safety, quality and access.

• HIMSS Analytics EMRAM (EMR Adoption Model) provide a good framework for government to baseline and track hospital’s IT capability.» Creation of policy and strategy» Drive EMR adoption and patient care

• Vendor needs to continue to invest in R&D on capabilities in their solutions to meet customer’s needs.

Steven Yeosyeo@himss.orgTel : +65-98485259