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EHR / EMR Basics What it is, What you should know Ron Anderson, CPEHR, CPHIT Director of Business Development CHMB Solutions Delivering Business, Clinical & Technology Solutions to Transform Your Practice

What is EHR / EMR? Electronic Health Record (EHR) / Electronic Medical Record (EMR)

Terms are used interchangeably Common Definitions of EHR: "collecting data from multiple sources and using them at the point of care to support clinical decision making." “capturing discrete data for improved documentation and patient care processes” “an interactive system of documentation and support for patient care” Delivering Business, Clinical & Technology Solutions to Transform Your Practice

EHR Impacts on Practice • Current IT & brings new IT (Technology) • Costs & revenues (Capital) • Daily practice operations (Organizational) • Integrated Delivery of Healthcare (Community)

Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Good News: This has been done before • EHRs are not new (started in the mid-1980s) • Thousands of practices have successfully deployed (15% to 20% of US practice have EHRs) • Keys to success and organizational challenges are well understood

Success is highly correlated to preparation Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Phases of an EHR Project • Preparation (Planning) • Vendor Selection (Purchase) • Implementation (Build it) • Post Implementation (Live in it)

Delivering Business, Clinical & Technology Solutions to Transform Your Practice

People Required: Stakeholders • Physicians/owners • Nursing & MAs • Financial/Budgetary Representative • Medical Records • Billing Office • Front Desk (scheduling and registration)

Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Technology: More stuff, new stuff More • PCs & workstations (to support EHR for clinical staff) • Servers (to support EHRs, networks, interfaces) • Printers (to support new EHR print jobs like RXs) • Expanded computer networks (to link everything together)

New • Interfaces (to transfer data info into EHR) • Scanners (to scan paper documents into EHR) • E-faxing (to send faxes directly from EHR) Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Technology: Hardware & Networks Planning Considerations • Servers: cost, space, and support • PC/Workstations: wireless vs. hardwired, tablet vs. PC • Printers: location, function (reports vs. RX), print groups • Scanners: location, staffing, workflow • Network: Client/Server vs. ASP

Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Technology: Practice Management Planning Considerations: Do I keep what I have?

• If I keep my existing PM: – Will require demographic interface to EHR (so that registration data is transferred) – May require scheduling interface to EHR (so schedules are visible and usable to providers)

• If I purchase an integrated PM/EHR: – Limits selection to vendors that offer integrated solutions – Will require extract of demographic data from PM – Will require maintaining dual systems while

Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Capital: Expenses Out of pocket • EHR software and related accessories & services • Hardware/network and services • Annual support for software (EHR & network) Internal Labor • Project manager, IT staff, physician leader Other Considerations • Temporary decline in provider productivity • Financing expense Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Organization: Impact of EHR • Changes provider workflow • Changes nursing workflow • May change billing process • May change front desk process • Introduces new tasks (i.e. scanning, routing, interfaces) • Increases scope/complexity of IT infrastructure • Impacts internal labor (adds, deletes, reallocations) Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Organization: Impact of the EHR Project In order to be successful, each phase requires the allocation of time of key members of the organization • Planning • Vendor Selection • Implementation • Post-Implementation

Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Capital: Typical Expenses Out of Pocket (hardware, software, services) • Differences between Client/Server and ASP Internal Labor • 1 new FTE add • .5 FTE re-allocation Other Expenses • Planned reduction in visits over 30-90 days • Financing expense

Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Client/Server or ASP? • Client/ Server – you purchase, maintain equipment in your office or offsite data center and assume costs and IT overhead to ensure uptime • ASP – Application Services Provider – vendor assumes responsibility and costs for above.

May or may not also include software, support, implementation, training and support • No one size fits all answer • Largely a matter of what works best given practice resources, available budget and desired allocation of capital, staff and resources.

Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Benefits / Cost Justification • Automate clinical and financial workflow • Increased efficiency - Orders and results - Prescriptions, formularies - Care guidelines - Coding - Reduced Transcription costs

• Improved Documentation • Compliance • Accessibility of patient information • Delivery of care • Ability to participate in Quality Improvement Initiatives – PQRI, P4P, Clinical Trials and Reporting

Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Summary • Define additional job functions needed for your EHR implementation (People) – – – –

EHR Project Manager IT Analyst Physician Lead EHR Lead (post-implementation)

• Plan for the integration or interfacing of new and existing technology (Technology) – Expansion of current IT (servers, PC, printers, network) – Intro of new IT (scanners, interfaces, e-fax) – Defining PM strategy – Defining interface needs Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Summary • Identify factors that comprise the true cost of EHR implementation (Capital) – EHR software and related accessories & services – Hardware/network and services – Annual support for software (EHR & network) – Project manager, IT analysts, physician leader – Temporary decline in provider productivity – Financing expense

Delivering Business, Clinical & Technology Solutions to Transform Your Practice

Summary • Evaluate the potential impact of EHR implementation on your organization (Organization) – Changes provider & nursing workflow – May change billing & front desk process – Introduces new tasks (i.e. scanning, interfaces) – Increases scope/complexity of IT infrastructure – Impacts internal labor (adds, deletes, reallocations) – Impacts revenue/expense mix (Pros and Cons) Delivering Business, Clinical & Technology Solutions to Transform Your Practice