Professional Documents
Culture Documents
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EHR—What Should I Know?
What is the elephant in the room?
Non-interoperable EHRs will further impede access by
creating proprietary information silos
To be of any value, EMRs must be interoperable &
interconnected to EHRs, both ambulatory and clinical
EHRs must be interoperable & interconnected
Without a web of EHRs, there are no Regional Health
Information Organizations (RHIOs)
The RHIOs all have different architectures
Without RHIOs there is no National Health Information
Network (NHIN)
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EHR—What Should I Know?
What is the Network Effect of
Networked EHRs?
The network of EHRs could act as a value multiplier.
Without a network the value multiplier is zero.
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EHR—What Should I Know?
What is the elephant in the room?
What does this mean—EHRs must be
interoperable & interconnected?
– Know before you buy—what connects to what?
– If EHRs aren’t connected, doctors will need electronic
and paper files
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EHR—Exponential Problems
What must be connected? An N x M
connection must work for:
Hospitals connecting to:
– Doctors
– Hospitals
– RHIOs
– Labs
– Pharmacies
– Imaging
– Electronic Health Records (1 x N)
EHR to EHR
– Continuity of Care Record (CCR)
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EHR—Fail Safe Points
What are the EHR Fail Safe Points
(FSPs)?
EHR is healthcare’s Y2K time bomb.
There a is concurrent national rollout of EHR;
standards not available until 2010.
The costs are very high, so are the penalties
1/3rd to 2/3rd of EHRs implemented have failed
There may not be time to earn the incentives
Nobody knows which applications will qualify for
certification
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EHR—Fail Safe Points
What are the other EHR FSPs?
There aren’t nearly enough resources to do the work
– EHR vendors can’t staff for a national rollout
– Healthcare IT resources to support providers are 50% below
the number required
Healthcare providers in-house IT department has:
– No experience with EHR
– Never built one
– Never bought one
– Never installed one
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EHR—Ambulatory Practices
I think it is advantageous for them to wait. Within
12-18 months they will likely have the
opportunity to acquire a plug-and-play EHR in-
house or SaaS.
Project management
Selection
Implementation
Adapting workflows
Training
Support
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Electronic Health Record
(EHR)
The need for change is real and
mandated
In the US there are more than 20,000 healthcare transactions
each minute.
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EHR—Snail Paced Adoption
NEJM
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EHR Barriers—Magnitude of
staffing barrier is grossly
underestimated
Barriers to Electronic-Records Adoption
(NEMJ)
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EHR Facilitators—will not have the
desired impact
Facilitators of Electronic-Records Adoption
(NEMJ)
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EHR Costs—to pass the
interoperability test are
understated
The Cost of Change
Canada budgeted US $450 per person to implement EHR.
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EHR—if it doesn’t connect, it
doesn’t work
Just because EHR’s have been
implemented, doesn’t mean they’re
of any value.
“I've witnessed more serious errors with the EHR than in my
previous 25 years as a physician. These are the errors in thinking
and decision making: cases where the physician was so distracted
by the order tree that she forgot an important order; cases where
the fragmented, disordered thinking was imposed by the EHR.”
Christine A. Sinsky, MD
"...our system for delivering medical care is clearly in crisis...At the heart
of the problem is the fragmented nature of the way health information is
created and collected,"
Bill Gates
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Most EHRs don’t operate beyond the walls of the
EHR—if this was reality TV,
there’d be no winners
Foundational Elements of National
EHR:
Completing the baseline EHR info-structure for 100 percent
of the population
Seamless communication across the continuum of care and
into community based settings. (The availability of
electronic medical records, for example, would integrate
primary care physicians and specialists into community
care facilities)
Extending order entry functionality and other decision-
support elements in acute care settings to support delivery
of high quality care
Empowering patients to manage their own care by creating
patient portals with self-care tools and basic personal 18
health information
EHR Enablers—who’s watching
the business processes?
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EHR Readiness Methodology
EHR
Readiness
Methodology
has a 6 phase
scorecard.
Enterprise Readiness
Assessment
The Enterprise Readiness Assessment
identifies gaps in:
Interoperability
Meaningful Use
Certifiability
EHR Cost Benefit/Funding
Analysis
The Cost Benefit Analysis
identifies:
http://ehrstrategy.wordpress.com/
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