EMR with Integration Focus

Electronic Medical Records and Systems Integration

Today's Event Sponsored by: Emdeon Practice Services helps practices meet the challenges of

healthcare with innovative solutions, including electronic health records, encounter documentation, document and image management, and wireless and Internet connectivity.

For more information:Call: 877.WEBMD.01Visit: www.webmdps.com

Visit Emdeon's Virtual Trade Show exhibit at:hdm.unisfair.com/prd.jsp?booth_id=13

http://hdm.unisfair.com/prd.jsp?booth_id=13

As President and CEO of The Quammen Group, Robecca is an accomplished senior executive in healthcare information systems, combining extensive healthcare administration, software vendor, and consulting practice experience. She has over 25 years experience in healthcare to include business development, sales, strategic and tactical planning, operations and organizational development, product development and delivery and emerging healthcare initiatives. With a career history and reputation for superior quality business solutions and customer service, Robecca has held senior management positions for large healthcare delivery organizations, the nation’s largest healthcare software vendor, and a large private healthcare consultancy. Most recently she founded The Quammen Group as a full-service healthcare consulting firm specializing in business planning and development, strategic planning, large-scale software and hardware implementation, software acquisition, outsourcing, and organizational development.

Robecca Quammen

Do We Have an Electronic Medical Record Yet?

• Systems integration issues that arise when adopting an EMR– Hospitals dealing with integrating legacy systems with new

systems, with departmental systems etc.– Stitching together EMR and Practice Management software at a

clinic and then connecting them to the hospital data– Data Security challenges, single sign-on, etc.– The role of technology and standards in creating interoperability

and data sharing across systems

• ESPECIALLY lessons learned on key hurdles and practical strategies that work...

Today’s Presentation

• Automation of current paper chart

• Repository of financial and clinical data

– Easily accessed, reviewed, updated

– Concurrent and retrospective use

• Clinicians

• Physicians

• Support personnel

• By-product of data gathered in HIS, CIS, and PM/EMR systems

Defining an EMR

Attending PhysicianNursingConsulting Physician(s)Respiratory CareCase ManagementNutritional ServicesRisk ManagementIV TeamPatient Financial ServicesInfection ControlWound ManagementPastoral CareClinical Process ImprovementCardiologyPT/OT/SpeechOthers

BARRIERS:• Access• Availability• Acceptance• Integration

ELECTRONICPATIENTDATA

EMR Focus on All Care Providers

• This frequently elusive metaphor for the traditional paper chart has been challenging to accomplish in every clinical setting, primarily due to

– Cost and availability of solutions

– Impact on the clinician workflow/practice

– Implementation

– Integration with Existing and Planned Solutions

Easier Said Than Done

Heightened Demand for SolutionsMultiple Unique User Demands

Clinical Reporting DemandsImpatience for Solutions

Financial & Operational ResultsCompetitive Market PressuresCapital & Operational Funding

Physician Affinity

CostAccess

Security Standards & Tools

Integration & Interoperability

EMR - The Balancing Act

EMR Adoption is a broad topicthat encompasses……

Systems

EMR Adoption is a topic that transcendsthe collection, storage, reporting,

and transmittal of data.

People

Business Practice

Why is Integration So Important?

Clear Vision and Priorities

Strategic PlanWork FlowsProcess vs. Task Orientation

Data OwnershipAccess and Security

Patience and Time

Big PictureCultureIntegration vs. Functionality

Individual Motivation

Personnel CostFear of Computerization

SystemsPeople

Business Practice

Legacy Vs. NewAvailabilityBest of BreedVendor StrategiesIntegrationInteroperabilityDevices/MobilityPortals/Single Sign-on

Compromise

Compromise

Compromise

Inherent Challenges for EMR Adoption

Legacy Laboratory and Radiology Systems (upgrade or replace?)

Orders/Results Upgrade/Replacement in preparation for CPOE or to Create Integration with Planned Clinical Documentation Projects

Results Repository Made Available to Remote and Mobile User

E-signature for Physician Signature of Medical Records

Physician Practice Management and EMR Systems

Advanced Clinical Documentation(workflow, rules)

Specialty Documentation (Critical Care and Women/Children’s)

Departmental/Multi-Disciplinary Systems (Rehab, Respiratory, Surgery, etc.)

Departmental Systems Impacting Care Process (Emergency, Pharmacy)

Where Does your EMR Journey Begin?

• Paperless or Partial Paperless System

• Population of a Data Warehouse for Clinical Reporting

• Comprehensive Clinical Decision Support (Rules, Workflow)

• Integration of Solutions for Continuum of Care

• Complete Remote Access for Physicians and Clinicians

• Complete or Partial Nurse Documentation

• Integration of IT with BioMed

• Multidisciplinary Charting

• Clinically Driven Revenue Cycle

Where Is your EMR Journey Taking You?

• COST - EMR Systems are Expensive to Implement and Support

• LEGACY SYSTEMS – Integrate, Displace, Replace

• INTEGRATION - Best of Breed/Disparate/Closed Systems

• DATA SHARING & Interoperability – Information Available As Needed

• STANDARDIZATION - Adoption of Nomenclature/Data Dictionary

• ACCESS – Device Strategy, Mobility, Remote

• SECURITY – Network, Application, Single Sign-On

• DATA INTEGRITY – Who Owns It?

• WORKFLOW – Enhance It, Don’t Break It!

• TRAINING – Of Just About Everyone – What Works?

Common Hurdles Along the Journey

Efforts have been arduous, lengthy, and expensive, but

effective EMR Adoption is within reach when completed as a series of initiatives.

So, How Are We Doing?

• Goal: Provide an Online Medication Administration Record (MAR)

– 1800+ bed integrated delivery system with multiple campuses and outreach clinics

– Orders/results/repository in place with clinical documentation system implementation underway

– MAR integration between HIS (third party) and RX (in-house developed)• Vendor usage of record format that did not 100% comply with HL7 standards,

resulting in a significant amount of custom code in the interface

• Complex nature of medications compounded the issue

• Change management becomes critical to insure systems are in sync

• Outcome: Through integration, this organization was able to accomplish its goal. Change management continues to be critical to the success of this initiative.

Real World Experiences #1

Brand XBrand X Brand XBrand X Brand XBrand X Brand XBrand X Brand XBrand X Brand XBrand X Brand XBrand X

OrdersOrders ResultsResults PharmacyPharmacy(MAR)(MAR)

DocumentationDocumentation•AssessmentsAssessments•I & OI & O•Progress NotesProgress Notes•Vital SignsVital Signs

Alerts and Alerts and RemindersReminders

Electronic Electronic Medical Medical RecordRecord

Care Care ProtocolsProtocols

CLINICAL DOCUMENTATION PROJECTCLINICAL DOCUMENTATION PROJECT

FUNCTIONSFUNCTIONS

PRODUCTSPRODUCTS

KEY:KEY: Proposed Phase IProposed Phase IProposed Phase IIProposed Phase II


FINANCE

RECEIVABLES

RADIOLOGY RESPIRATORY

MRIMRI CISCIS

INTEGRATIONINTEGRATION ENGINE

Scheduling

PACS

Ambulatory

Other Systems

Drug Dispenser

ER System

Dietary

Lab

Pharmacy

Reporting

Clin. Dec. Support

RepositoryRegistration/ADT/Results/

Orders/Order Status Update/Master Files

ADT/Orders/Order Status Update/Charges/Master Files

Registration/ADT/

Orders/O

SU Results

Regi

stra

tion

/AD

T/Ad

d-on

Ord

ers/

OSU

/Cha

rges

/Res

ults

Fin a nc ial Dat a

Fina

ncia

l / Cl

ini c

al D

ata

Registration/ADT

Registration/ADT/Orders/Results

Registration/ADT/Lab Orders/ Radiology Results

Pharmacy

Registration/ADT/Orders/OSU

Add-on Orders/OSU/Results

Registration/ADT/Orders/OSU

Registration/ADT/Lab Results

Registration/ADT

Charges

Transcribed Results

Pharmacy

LEDGEND

Bi-directional data flow

Unidirectional data flow

Existing Products #1

after

before

Impact of Integration on the MAR

• Goal: To Provide Cardiology Functionality to a New Specialty Facility

– Primary organization has implemented a third party clinical orders/results/documentation system

– Specialty (cardiology) organization selected a different third party vendor for their Cardiology Information System

• Lack of outbound charting records from specialty system effectively isolating data to that system

• Necessitated printing of record to transfer with patient

• Investigating CCOW single sign on utilizing industry available products

• Outcome: This organization accomplished the goals of the specialty area but did not provide a solution that meets the organizational requirements for having access to clinical data by anyone who needs it. They will be faced with manual solutions such as chart printing until they determine a method to populate a central EMR with integrated or scanned data from the specialty system. Additionally they are facing a common user issue in the need to allow single sign-on to multiple systems and are attempting to solve that problem with technology.


• Goal: To Provide Specific Departmental Functionality to the Respiratory Department with Emphasis on Charging and Work Scheduling

– Third party clinical orders/results/documentation

– Purchased and implemented specialty niche respiratory system

• Lack of outbound charting records from specialty niche respiratory system, effectively isolating data

• Necessitated printing of record to transfer with patient

• Interdisciplinary care charting was not accomplished

• Outcome: By permitting a departmental solution to be purchased and implemented to solve the specific problems of the respiratory department, this organization has lost significant opportunity to meet regulatory guidelines for interdisciplinary charting and to insure that all care givers have access to the complete patient experience as they are performing their specific functions.


• Goal: To Provide a Comprehensive EMR Solution in a Small Community-Based Facility in Which Funding was Challenging

– Purchased a single source solution for all departmental and nursing functions and a third party specialty ER system

– Chose to implement the comprehensive solution in three distinct phases over several years

• Phase 1 included the population of a repository for local and remote access by physicians and care givers

• Phase 2 introduced Medical Records, Pharmacy and Radiology functionality with a sub-phase to introduce an ER system

• Phase 3 will introduce clinical documentation

• Outcome: This organization knew its limitations with funding and staff to support multiple systems from multiple vendors and chose to purchase and implement a single source solution for departmental, advanced clinical and electronic medical record functions. They faced competitive pressures in their community to retain ER physicians and consequently purchased a niche ER system to meet their requirements. They chose to implement in relatively small increments to provide functionality and benefit to end users at various milestones.


Legacy HIS/CISRad/Orders/Rx

PA/Payroll/HR/ADT

ERPMM/GL

Integration Engine

Drug Dispensing

Medical RecordsCoding

OR Scheduling

EKGLAB

TV

ADT

ADTADT

ADT

ADT

(Ord

ers)

Orders

Results

Charges

Ord

ers

Resu

lts

Char

ges

ICD9(tape)ICD9

(tape)

ADT

ADT

Resu

lts

Charges

Current State (2004)Real World Experiences #4


PA/Payroll/HR/ADT

ERPMM/GL

Integration Engine

Drug Dispensing

MR Coding

OR Scheduling

EKGLAB

TV

ADT

ADT

ADT

ADT

ADT

(Ord

ers)

Orders

Results

Charges

Ord

ers

Resu

lts

Char

ges

ICD9(tape)ICD9

(tape)

Transcription Transcription

Integration Engine

Clinical Data Repository

ADT

Orders (statuses)

ADTResults

(text/discrete)

Transcription Tran

scrip

tion

(RAD

Res

ults

)

Tra nscri ption

Results(Tex t/d iscre te)

ADT

Orders

(statuses)

Resu

lts (t

ext/d

iscr

ete)

Orde

rs (s

tatu

ses)

ADT

ADT

Resu

lts

Charges

Phase 1Real World Experiences #4


PA/Payroll/HR/ADTERP

MM/GL

Integration Engine

Medical Devices

EKG

LABPhysician Billing

Orders - ResultsCharges

Transcription

Open EngineClinical Data Repository

Orders w/ statuses Results (Rad)

Results(Text/discrete)

ADT

Orde

rs

Lab R

esult

s (tex

t/disc

rete)

ED System

Results (ECG)

Results (RT/ECG)Orders (w/statuses)

Clin

ical D

ata

(text

) OrderStatuses

MDI(TP

R/BP)

Physician Billing

ADT

ADT

ADT

Orders - ResultsCharges

Phase 2

Example Second Phase #4

HospitalHome

or Office

Clinical Data Repository

RespiratoryTherapy

Radiology

Cardiology Registration

Laboratory

Medical RecordsOrders w/statuesResults

Orders w/statues

Results

Orders w/statues

Results

Orders w/st

atues

Results

Dem

ogra

phic

sVi

sit H

isto

ry

H & Ps · Op Reports

Discharge Summaries

EEGs

Sample Information Flow Diagram #4

• Goal: To Provide a Comprehensive EMR Solution in a Community-Based Facility in Which Funding was Challenging and Many Initiatives Were Already Defined and Underway

– Faced many projects to upgrade or replace existing functionality before moving forward with advanced clinical functionality

– Identified sum total of initiatives required to achieve the desired electronic medical record

• Established strategy to guide all purchasing decisions and align organization around key vendors and solutions

• Formulated 5 year budget projections to educate the organization on priorities based on funding availability

• Gained consensus from organization regarding pending and future EMR initiatives

• Outcome: This organization now has a roadmap to guide their information technology activities according to their operational strategic plan for the next 5 years. Annual review and validation of the plan is scheduled. This organization fully understands the implications of their short and long term activities as they relate to deployment of an EMR. Further they understand that the EMR deployment is a series of projects.


• Establish Health System Objective

– Completely paperless

– Hybrid medical record (part electronic/part paper)

• Establish relationships with all ancillary departments and vendors

• Future purchases: disparate systems versus integration

• Decisions driven from critical data to be available in the EMR based on feedback from advisory groups

• Development and adherence to Information Systems Strategic Plan

Strategies for Success: Establish Goals & Objectives

• Development of Current State Model

– Inventory of all departmental systems

– Inventory all existing interfaces

– Understand the mix of integrated and disparate systems

– Understand the integration limitations with various systems

• Evaluate Clinical Workflow

– Understand impact of decisions on current and proposed clinical workflow

• Patient Movement• Interdisciplinary • Nursing• Physician

Strategies for Success: Understand Current State

• Maintain Focus on Strategic Direction

– Unrelenting focus on goals

– Executive leadership

• Be realistic

• Be objective

• Be concrete (how & when questions)

– Clinician and physician involvement

• Seek Outside Advice and Counsel (these decisions are expensive and have huge organizational impact)– Experiences from staff who have worked in other environments– Vendor References– Internet– Consultants

Strategies for Success: Acquiring Systems

• Disparate Systems

– Potentially more robust functionality

– HL7 Compliance for Interfacing to EMR

– Cost of Ownership

• Additional Interfaces to support

• Additional application support fees

• Additional Upgrades

Strategies for Success: Disparate Systems

• Integrated Systems vs. Interoperability

– Departmental/user specific functionality

– Support and maintenance (impact on technical architecture)

– Data availability/sharing

– Clinical workflow

– Short and long term use of data

• Discreet data vs. textual

Strategies for Success: Integration & Interoperability

• Establish EMR Timelines

– Map out timelines for each project

– Overall timeline is driven by labor and financial resources

– Start with basics to ensure initial success

• ADTs

• Laboratory results (discrete and text)

• Radiology results (text)

• Cardiology results (text)

• Respiratory results (discrete)

• Documentation (H&Ps, Op Rpts, Discharge Summaries, Consults, etc.)

Strategies for Success: Establish Rational Expectations

• Choose an EMR product strategy that offers the greatest potential for success in your particular circumstances

– Choose as many modules as possible that are integrated into a suite of products

– Carefully choose products that have a strong history of integration with other products

– Use disparate system integration as sparingly as possible to accomplish your EMR goals

– Leverage a variety of technologies to create visual, functional, and database integration

• Gradually phase in the EMR to lessen the impact– Understand that the EMR is a series of projects and initiatives– Take best advantage of available technologies– Group products/modules in a way that allows users to recognize incremental

victories and obtain functionality in shorter time frames

Strategies for Success Summary

Successful adoption is measured by the user and validated in the meaningful application of data in the care delivery process.

encompasses much more than the relationship between the physical parts of the system.

Health OutcomesCost

In Closing, The Successful EMR Adoption

Robecca QuammenPresident/CEO

The Quammen Group1400 S. Orlando Avenue, Suite 204Winter Park, FL 32789407-758-3390 (cell)407-539-2040 (fax)

E-mail: [email protected]

Today's Event Sponsored by: Emdeon Practice Services helps practices meet the challenges of

healthcare with innovative solutions, including electronic health records, encounter documentation, document and image management, and wireless and Internet connectivity.

For more information:Call: 877.WEBMD.01Visit: www.webmdps.com

Visit Emdeon's Virtual Trade Show exhibit at:hdm.unisfair.com/prd.jsp?booth_id=13

http://hdm.unisfair.com/prd.jsp?booth_id=13

EMR with Integration Focus

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