Achieving Organizational Excellence Through Health IT @JohnHDaniels
Objectives Identify the various HIMSS Awards and their focus Determine the challenges and the opportunities of affecting organizational change Discuss those next steps that can define organizational success @JohnHDaniels
Recap How did we get here?
1999 Challenge 98K+ patients die annually due to medical errors!! Why?
Disconnected care settings Self Community Care Home Care Secondary Rehabilitative Tertiary Primary Long Term Care
Silos Providers of care and patients do not have access to all relevant information required to make the most informed decisions at the right time in the care delivery process Health info. sharing Complete health picture Inefficiencies Errors Incorrect diagnosis Isolated Decisions Inefficient health system usage Redundant services Increased costs Un-coordinated Care Silo ed care & care episodes Lost efficiencies Lost opportunity
Pressurring / Overload Medical Knowledge
2001 Opportunity Use information technology to help make healthcare
Pressurring / Overload Automate to optimize decision making Medical Knowledge
Automate to optimize care coordination Home & Community Self Rehabilitative Long Term Care Primary Tertiary Secondary
2009 Solution? ARRA Meaningful Use
Rewarding successes Industry awards
Success begins with a strategy Discover an EMR adoption roadmap
Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS Closed loop medication administration CPOE, Clinical Decision Support (clinical protocols) Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries - Lab, Rad, Pharmacy - All Installed Q2 2009 Q4 2013 0.3% 2.9% Progressively sophisticated 1.0% 12.5% 4.5% steps 22.0% that track the 3.6% 15.5% accessibility 38.4% 30.3% of information 31.6% 7.6% within an 7.2% 3.3% EMR All Three Ancillaries Not Installed 13.4% 5.8% Data from HIMSS Analytics Database 2014 HIMSS Analytics N = 5167 N = 5458
Why? Provide thought leadership Reflect the market Inform government policy Drive the market
Vision Ensure the most relevant clinical information is available to the clinician at the right place and at the right time
Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP ARRA Q2 2009 Q4 2014 0.3% 3.6% Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS Closed loop medication administration 1.0% 4.5% 17.9% 32.8% CPOE, Clinical Decision Support (clinical protocols) 3.6% 14.0% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries - Lab, Rad, Pharmacy - All Installed 38.4% 31.6% 7.2% 21.0% 5.1% 2.0% All Three Ancillaries Not Installed 13.4% 3.7% Data from HIMSS Analytics Database 2014 HIMSS Analytics N = 5167 N = 5467
Q2 2011 MU Payments Q4 2014 Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 1.1% 3.6% +227% Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS 4.0% 17.9% +347% Closed loop medication administration 6.1% 32.8% +437% CPOE, Clinical Decision Support (clinical protocols) 12.3% 14.0% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 46.3% 21.0% CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable 13.7% 5.1% -62% Ancillaries - Lab, Rad, Pharmacy - All Installed 6.6% 2.0% -69% All Three Ancillaries Not Installed 10.0% 3.7% -63% Data from HIMSS Analytics Database 2014 HIMSS Analytics N = 5441 N = 5467
Q2 2011 MU Payments Q4 2014 Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 1.1% 3.6% MU Stage 3* Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS Closed loop medication administration 4.0% 6.1% 17.9% 32.8% MU Stage 2 CPOE, Clinical Decision Support (clinical protocols) 12.3% 14.0% MU Stage 1 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 46.3% 21.0% CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable 13.7% 5.1% Ancillaries - Lab, Rad, Pharmacy - All Installed All Three Ancillaries Not Installed Data from HIMSS Analytics Database 2014 HIMSS Analytics 6.6% 2.0% 10.0% 3.7% N = 5441 N = 5467 *Anticipates Emphasis on Information Exchange
This is how long it takes to make significant national progress 2006 2007 2008 2009 2010 2011 2012 2013 2014 Stage 7 0.0% 0.0% 0.3% 0.7% 1.0% 1.2% 1.8% 2.9% 3.6% Stage 6 0.1% 0.8% 0.5% 1.6% 3.2% 5.2% 7.3% 12.5% 17.9% Stage 5 0.5% 1.4% 2.5% 3.8% 4.5% 8.4% 11.5% 22.0% 32.9% Stage 4 3.1% 2.2% 2.5% 7.4% 10.5% 13.2% 14.0% 15.5% 14.0% Stage 3 18.7% 25.1% 35.7% 50.9% 49.0% 44.9% 41.7% 30.3% 21.0% Stage 2 40.0% 37.2% 31.4% 16.9% 14.6% 12.4% 11.4% 7.6% 5.1% Stage 1 17.4% 14.0% 11.5% 7.2% 7.1% 5.7% 4.8% 3.3% 2.0% Stage 0 20.4% 19.3% 15.6% 11.5% 10.1% 9.0% 7.5% 5.8% 3.7% # of Hospitals N = 4,237 N = 5,073 N = 5,166 N = 5,235 N = 5,281 N=5,337 N=5,310 N= 5,458 N=5,467 Source: HIMSS Analytics Database
So, What Makes a Stage 7 Organization? Summary profile
IT implementation success characteristics Documented goals for vendor & organization Achieving end-user buy-in Strong organizational sponsorship Adequate systems acceptance testing Well-planned end-user training Minimal business and service disruptions Plenty of data conversion time
They are paperless, or near paperless Create no paper ALL clinically relevant data are accessible & available to the clinician in one location
They are fully committed to continuous process improvement through collaboration Strong IT leadership and executive champions Clinician / end-user champions
They use data to drive improved outcomes related to Process Quality Finance Safety Clinical Access
For example Who are your most efficient surgeons? A. Those that use the least resources B. Those that have the best outcomes
Are Stage 7 organizations achieving results? EMRAM studies on a Macro Scale (correlations with EMRAM Stages)
All hospitals within each EMRAM Stage TJC Top Performing Hospitals BY Number of Quality Metrics Excelling In 50% 40% 30% 20% 10% 0% 2.3% 0.4% 1.9% 1.7% 4.8% 6.2% 10.0% 10.1% 8.1% 6.4% 4.2% 6.4% 12.8% 6.5% 7.9% 30.1% Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 Source: HIMSS Analytics 6.5% 16.3% 18.1% 10.6% 3 or less 4 or more Tipping Point 12.9% 20.7% 39.8% 9.7%
Hospitals with an "A" Leapfrog Hospital Safety Grade by EMRAM Stage 70% All hospitals within each EMRAM Stage 60% 50% 40% 30% 20% 10% 0% 62.6% Tipping Point 30.8% 20.1% 21.8% 12.8% 14.3% 5.9% Stage 0.0% 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
Value-Based Purchasing (VBP) Program* + = 70% 30% TPS 100 = High Value Performance TPS 0 = Low Value Performance *Program from U.S. Medicare to earn additional reimbursement
Clinical Performance AVG Projected VBP Clinical Score 70 60 50 40 30 64.3 Tipping Point Tipping Point 49.0 45.5 45.9 45.9 44.6 42.7 38.9 Source: HIMSS Analytics TM Database Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
Patient Experience 70 AVG Satisfaction Score 60 50 40 47.3 43.7 38.6 39.6 43.8 44.4 43.9 35.7 30 Source: HIMSS Analytics TM Database Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
Total Performance Score (TPS) 100 90 80 70 60 50 40 30 20 10 0 96.5 92.9 92.6 84.5 84.9 86.8 88.2 89.7 Source: HIMSS Analytics TM Database Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 AVG Clinical Score AVG Satisfaction Score TPS
Association between EMR capabilities and hospital mortality? In General the more advanced the hospital s EMR capabilities the more likely the hospital is to have better risk-adjusted mortality rates when treating Heart Attack Heart Failure Stroke Several types of GI surgeries Pneumonia Sepsis Respiratory failure
Association between EMR capabilities and staff perceptions of hospital safety? In General the more advanced the hospital s EMR capabilities the more positive the staff are about their hospital s patient safety culture Hospital Survey on Patient Safety Culture
Association between EMR adoption pace and staff perceptions of hospital safety? In General the faster the hospital implements an EMR the less positive the staff are about their hospital s patient safety culture Grouped hospitals by the number of EMRAM stages they passed in a four year period and then analyzed AHRQ s Hospital Survey on Patient Safety Culture scores
What About Cost Efficiency? Research on the Effect of EMR Deployment
Average Operating Margin Financial Performance (Profitability) 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% -1.0% -2.0% 1.62% 2.84% 2.25% 1.53% -0.43% -0.34% -1.52% -0.58% Source: HIMSS Analytics Database 2.35% 0.77% 1.79% 3.53% 2.56% 2.32% 1.47% 4.06% 3.91% 2.55% 1.66% 2.52% 2.20% 6.19% 4.91% Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 In 2008 In 2011 2013
What s your EMRAM Score? Moody s wants to know!!
Bond Ratings Multi hospital system case study during 2009 / 2010 recession Bad debt up, cash flow down All hospitals were Stage 6 Bond rating did not change
Advanced EMR adoption = Good vision Good execution Commitment to excellence
Fewer malpractice claims One study found the rate of malpractice claims when EHRs were used was about onesixth the rate when EHRs were not used!!! The Relationship Between Electronic Health Records and Malpractice Claims Mariah A. Quinn, MD, MPH; Allyson M. Kats, MSc; Ken Kleinman, ScD; David W. Bates, MD, MSc; Steven R. Simon, MD, MPH Arch Intern Med. 2012;172(15):1187-1189. doi:10.1001/archinternmed.2012.2371.
Summing it up
ROI is possible There are benefits to advanced EMR capabilities but the ROI requires persistence and patience Work on the high touch AND high tech EMR adoption is NOT just an IT department initiative it requires an Organizational Development orientation
Value is achievable Health IT Value Suite S T E P S Satisfaction Treatment/Clinical Electronic Information/Data Prevention/ Patient Education Savings
The Road Ahead towards advanced EMR capabilities will lead you to a STEEEP place but the journey requires thought and strong leadership
Thank You John H. Daniels, CNM, FHIMSS, FACHE, CPHIMS Vice President, HIMSS jhdaniels@himss.org @JohnHDaniels