1 A REVIEW OF EHR IMPLEMENTATIONS, STATE OF MICHIGAN KLAS Research Overview for: Advisory Committee...

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A REVIEW OF EHRIMPLEMENTATIONS, STATE OF MICHIGAN

KLAS Research Overview for:

Advisory Committee on Operational Efficiency (ACOE)Blue Cross Blue Shield of Michigan

February 28, 2006Blue Cross Blue Shield of Michigan

______________________________________________________________________________________________Blue Cross Blue Shield of Michigan is an independent licensee of the Blue Cross and Blue Shield Association

http://www.bcbsm.com/

KLAS Confidential ©2005 KLAS Enterprises, LLC, All rights reserved2

Who We Are… Founded in 1996

Market Research & Intelligence Firm

Monitors & reports performance of (HIT) vendors

Conducts up to 1000 Interviews/month

6 Years Research Data– 4,500+ Hospitals– 1,000+ Clinics– 300+ Vendors– 500+ Products

Value to HIT Industry (Providers, Vendors, Consultants, Investment Bankers)

All Provider “contributors” receive free access to KLAS Summary Data

www.healthcomputing.com


DiamondDiamondInvisionPt. Acct

InvisionPt. Acct

CreditUnion

CreditUnionAnsosAnsosInvision

Pt. Mgt

InvisionPt. Mgt

TSITSI

PyxisPyxis

SMSImaging

SMSImaging

PredictiveDialer

PredictiveDialer

Surgi-Server

Surgi-Server

HDX Eligibility

HDX Eligibility

CernerClassic

CernerClassic

SIGNA-TURE

SIGNA-TURE PremisPremis TPSTPS QuadramedQuadramed

DirectDeposit

CompMasterPHS

CernerOCF

CernerOCF

Chart-script

Chart-script

PostPro

EAD

StarCard

Omega TDP

Trend- star

Lawson

BLT

STARS

RegistrarRegistrar

ChampsChamps

THE INTEGRATION CHALLENGE

39 39 InterfacesInterfaces (11 real time 28 batch) 50 Medical Device Interfaces (21 unique) (11 real time 28 batch) 50 Medical Device Interfaces (21 unique)

©2004 KLAS Enterprises, LLC, All rights reserved


Raising the Bar by Measuring Performance!

Year Average Score

Comments

1998 66.75 First real measurement with substantial data

1999 62.26 Down 4.5 due to Y2K distraction by vendors

2000 69.55 Refocused on delivery and service.

2001 72.47 Public ratings more prominent, vendors take notice

2002 73.74 Improvement continues, vendors see trends.

2003 74.99 Performance measured means performance improvement!

2004 78.22 Performance Scores up 11.5% from 1998


Annual Survey Counts


Mission Statement

““To improve the delivery of To improve the delivery of Healthcare Information Healthcare Information Technology by honestly, Technology by honestly, accurately and impartially accurately and impartially measuring vendor measuring vendor performance for our performance for our provider partnersprovider partners.”.”


Sample EvaluationVendor Relationship Evaluation 1=Poor/Low/No 5=Average 9=Excellent/High/Yes

Vendor A Vendor B Vendor C

1. How long with product? 4 / 5 4 / 5 3 / 4 2. Implemented (new or release) in last 3 years Yes / Yes Yes / No Yes / Yes 3. Core part of IS plan Yes / Yes Yes / Yes Yes / Yes 4. Worth the effort 7 / 9 8 / 9 8 / 9 5. Lived up to expectations 5 / 9 7 / 8 9 / 9 6. Vendor is improving 4 / 9 6 / 7 9 / 8 7. Proactive service 5 / 5 4 / 7 9 / 7 8. Real problem resolution 5 / 5 5 / 7 9 / 8 9. Money's worth 5 / 8 8 / 9 9 / 9 10. Enterprise commitment to technology 5 / 8 5 / 5 9 / 9 11. Would you buy it again No / Yes Yes / Yes Yes / Yes 12. Vendor executives interested in you 9 / 9 7 / 7 9 / 9 13. Avoids nickel and diming Yes / Yes Yes / Yes Yes / Yes 14. Keeps all promises No / No Yes / No Yes / Yes 15. Good job selling 5 / 4 7 / 8 7 / 8 16. Contracting experience 5 / 5 7 / 7 8 / 9 17. A fair contract Yes / Yes Yes / Yes Yes / Yes 18. Contract is complete (no omissions) Yes / Yes Yes / Yes Yes / Yes 19. Product works as promoted 2 / 5 8 / 8 8 / 8 20. Product quality rating 5 / 5 8 / 8 9 / 9

•Our nurses are at a point now where they really appreciate the help that or BPOC system offers. It has been amazing to watch the transition. I think the biggest signal to the nurses of the power of this tool was the number of medication errors that are being eliminated on a monthly basis. When they realize that these are errors, which could have occurred on their watch without having our BPOC tool in place, it really makes them appreciate it more.


KLAS HIT Market Segments

Acute Care CDR, Orders, ChartingAcute Care Reg/Scheduling/PA (Large/Small)Ambulatory Billing & Scheduling (Large/Small)Ambulatory EMR (Large/Small)Claims ManagementDictation & TranscriptionDocument Management/Imaging (Acute/Ambulatory)Emergency Department SystemsEMPIEnterprise Image DistributionEnterprise SchedulingFinancial Decision SupportFinancial/ERPHome HealthHospiceInterface Engines

Laboratory (Large/Small)Long Term CareMedical Records/CodingMedication AdministrationMedication DispensingMobile Data SystemsPACS (Acute Care/Ambulatory)Patient Monitoring SystemsPharmacy (Large/Small)Radiology (Large/Small)Specialty NicheStaff/Nurse SchedulingSurgery ManagementTime & AttendanceVoice Recognition

30 HIT Categories Separating General Market, Community

Hospital & Physician Practice Solutions


“That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and to the practitioner because its hue and character are foreign and opposed to all our habits and associations.”

from The London Times in 1834Commenting on ... the “stethoscope”

A Computer in the Exam Room?


BCBSM Research InitiativeKey Deliverables

Conduct a statewide inventory of successful EHR implementations within Michigan to:

1. Reveal current level of EHR adoption in Michigan 2. Discover top initiatives that have been successfully implemented 3. Find and describe top provider organizations with solutions designed for deep clinician use, interoperability, and scalability.


Research MethodologyStep 1:– Looked at most robust sites out of

4,500 current participants in KLAS database.

– KLAS interviewed 28 Acute or Ambulatory vendors to confirm their top 3-5 clinical implementations in Michigan

Criteria for selection. Vendor must have:– a comprehensive clinical solution

nationwide– Robust solutions implemented in the

state of Michigan– The ability to scale across multiple

clients and multiple facilities


Vendors to interview by market segment


KLAS interviewed the most advanced clinical sites– 37 Acute, 54 Ambulatory

Two separate questionnaires for interviews

Step 2:

Step 3:Weighted key questions from evaluation

Used overall score to determine top 5 sites in each market segment


Weighting for Acute Questionnaire


Weighting for Ambulatory Questionnaire


Top 5 Acute Sites


How do the “Top 5” large acute vendors score on the KLAS radar?


How do the “Top 5” small acute vendors score on the KLAS radar?

•CPSI—Scores at 77.98 on separate scale for small HIS vendors


Major ancillary clinical systems are installed (i.e.,

Pharmacy, Lab, Radiology).

Major ancillary clinical systems feed data to a CDR, forReviewing of results by physicians. Information fromdocument imaging systems may be linked to the CDRat this point.

Nursing documentation, charting, care planning, andthe eMAR system is integrated with the CDR.Some level of medical image access from (PACS) isavailable

CPOE for use by any clinician w/clinical dec. support.

Closed-Loop medication administration fully live.Barcode med admin integrated with pharmacy/CPOE

Full physician documentation and integrationin CDR. Advanced Clinical decision support.Full complement of PACS systems integrated

Stage 1

Stage 2

Stage 3

Stage 4

Stage 5

Stage 6

Regional sharing of clinical information.Medical record is completely paperless

Stage 7

The HIMSS Clinical Transformation Staging Model* (stages, not steps or hierarchy)—Large Acute

* HIMSS Analytics - 2005

1st 2nd 3rd 4th 4th

Trinity Hurley Munson Spectrum DMC


Major ancillary clinical systems are installed (i.e.,

Pharmacy, Lab, Radiology).

Major ancillary clinical systems feed data to a CDR, forReviewing of results by physicians. Information fromdocument imaging systems may be linked to the CDRat this point.

Nursing documentation, charting, care planning, andthe eMAR system is integrated with the CDR.Some level of medical image access from (PACS) isavailable

CPOE for use by any clinician w/clinical dec. support.

Closed-Loop medication administration fully live.Barcode med admin integrated with pharmacy/CPOE

Full physician documentation and integrationin CDR. Advanced Clinical decision support.Full complement of PACS systems integrated

Stage 1

Stage 2

Stage 3

Stage 4

Stage 5

Stage 6

Regional sharing of clinical information.Medical record is completely paperless

Stage 7

The HIMSS Clinical Transformation Staging Model* (stages, not steps or hierarchy)—Small Acute

* HIMSS Analytics - 2005

1st 2nd 3rd 4th 4th

Pine Rest

SchoolCraftMem.

CentralMichigan

Mem.HealthCare

HollandComm.Hospital


Top Acute Sites-Key findings

4 of the top 5 Large hospitals doing CPOE, 1 of Top 5 Small hospitals doing CPOE4 of top 5 acute sites are CernerSeveral of the Top 5 sites in the acute space are multi facility IDNs“Physician buy-in” and Having “Implementation Champions” were key to success in the large and small acute sitesHurley Medical Center, running Eclipsys TDS—40% of Docs doing CPOE, for 50% of total orders in hospital


3 Major sites have chosen Epic/Philips for new clinical systemAmbulatory driving inpatient decisions (nationwide)Replacement of existing clinical systems (Beaumont)McKesson delivering with new solutions (Bronson)Providers spoke about successes:

– Improved patient safety, reduced med errors

– Fast access to patient records– ROI from reduced costs for

paper, filing, FTEs, etc.Providers spoke about challenges:

– Barcodes on meds– Physicians dragging their feet– Cost of implementing EHR– Alert fatigue

Other Notable Acute Sites—Future Plans


CPOE4th Annual Study published Feb 2006

Goal: Speak with/validate every CPOE hospital in US/Canada

How does Michigan compare to the U.S. average?


e-PrescribingGoals of study– Interview 332 ambulatory

organizations to determine their perception of ePrescribing solutions

– Find out if stand-alone ePrescribing solutions are of interest

– Which vendors are being considered most often


Physician/Clinician Portal Study

Which vendors are providing portals?

Goal: Assess the level of clinician/physician portal activity


Parting Thoughts

CPOE: The tip of the iceberg– Michigan ahead of most other states

E-Prescribing only a driver when there is a roadmap to more complete usage

Portals are becoming more common, but it’s still early– Incentives to participate?– Funding?

Vendor consolidation continues

1 A REVIEW OF EHR IMPLEMENTATIONS, STATE OF MICHIGAN KLAS Research Overview for: Advisory Committee...

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