Louisiana Hospitals: Shaking up the Snow Globe EMRs in the ED (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 8, 2008, Rebecca Bradley, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (1.5 MB).

Slide 1

Louisiana Hospitals: Shaking up the Snow Globe Electronic Medical Record (EMRs) in the Emergency Department (ED)

Slide 2

In the Beginning...

• 2004 State of the Union Address
  • President Bush called for electronic health records for most Americans within 10 years. In an executive order, he created the new Office of the National Coordinator for Health Information Technology (ONCHIT) within the Department of Health & Human Services (HHS).
  • May 2004, David Brailer, M.D., Ph.D., was appointed as the first national health IT coordinator for ONCHIT.

Slide 3

The Need of Health Information Technology (IT)

• Lack of flow in health care IT:
  • Access to info: 30% of time, physicians can't find the info in previous paper chart.
  • Duplicate testing: drugs or tests ordered 11% of time, with patients complying 50% of time.
  • Incomplete info: MDs not aware 1 of 4 Rx that a patient had been given.
  • Uncertainty & repeat: 1 of 5 labs were ordered because of retrieval barriers.
• Interoperability/connectivity: the crucial key!
  • Electronic medical record (EMR) adoption is great, but we must be able to connect and communicate (not EMR silos).
  • Regional Health Information Organizations (RHIO).
  • Standards, standards, standards...

Slide 4

Economic Impact of EMR System

Slide 5

The colored photograph shows an aerial view of a hurricane.

Slide 6

Economic Impact of EMR System

"Dr. Thomas Trieu of Ocean Springs, MS, scatters soggy charts from his water logged medical practice. His office received major damage and he doesn't know when he will be able to resume his practice."
- J.D. Schwalm
 

The Clarion-Ledger

Slide 7

The Business Case for EMRs

• Technology has caught up & can be integrated in clinical work.
• The question is no longer why for EMR, but how to implement and at what speed.
• Most importantly, the business case for providers to invest in EMR systems.
• Health care, as an industry, spends many resources on managing information, but not on utilizing technology for information.

Slide 8

Selecting EMR Vendor

Product

1. How good is the product?
2. What is the architecture?
3. Are they interoperable?
4. What is their install base?
5. Are their clients happy?
6. Is the product interoperable?

Slide 9

Selecting EMR Vendor

Training/Implementation

1. Do they know how to implement?
2. Do they have experience with group like ours?
3. What are our rollout and training options?
4. Have they received any recognition?

Slide 10

Selecting EMR Vendor

Company

1. Are they a well managed company?
2. Are they profitable?
3. Are they growing in the marketplace?
4. How is their customer support?
5. Is the product Certification Commission for Healthcare IT (CCHIT) certified?

Slide 11

Snow Globe Effect

The slide contains clipart images showing a small caricature getting wet by a storm cloud.

Slide 12

Clinician Comments

• "Electronic charting is not totally horrible."—RN
• "Prepare all MDs prior to installation."—RN
• "Program is terrible, repetitive, very time consuming & inaccurate. You could make it much better with a different program. Any ER MD could improve this program."—MD
• "Remove it! Start over!"—MD
• "Take it out would be the most improvement. It has formed me into a secretary typist. I did not train for that."—MD
• "Although it still has kinks, I would give it a 9/10. An additional terminal in dictation room would be nice."—MD

Slide 13

Return on Investment

• Reduction in Pharmacy call backs.
• Improved compliance with Joint Commission's Standards IM.3.10 (list of abbreviations, acronyms, and symbols not to use).
• Improved ability to effectively manage clinical and non-clinical data, including capturing, reporting, processing, storing and retrieving the information.

Slide 14

Return on Investment

• Reduced amount of unproductive time spent feeding records to coders off-site.
• Eliminated ability to assign non-billable diagnosis.
• Higher visibility of patient wait times.
• Higher visibility of Left Without Being Seen.

Slide 15

So Where are We in Louisiana?

• 2004-2005
  • Capturing essential patient data.
  • AHRQ Rural Health Information Technology Project.
  • Limited decision support and reporting, exchange.
  • LA HIT policy summit; LA e-Health conference.
• 2006-2008
  • Rural Health Information Exchange Project.
  • Critical Access Hospital—HIT Project.
  • Exchanging information among selected providers.
• 2010
  • Full integration of local exchange and decision support.

Slide 16

www.LAhospitalinform.org

Louisiana Hospital Inform provides:

• Pricing data on the most common Medicare inpatient and outpatient services.
• Quality data on surgical infections and the most common causes of hospitalization: heart attack, congestive heart failure and pneumonia.
• Demographic information, services offered and contact numbers for hospitals.

Slide 17

Louisiana Consumers' Right to Know Act

• Web site to provide consumers comparative information on the cost, performance and quality of hospitals and health care providers.
• Patients will be able to view:
  • Pricing for different procedures.
  • The number of times a physician has performed that procedure.
  • Physician complication rates.
  • Patient safety indicators defined by AHRQ such as bedsore rates, anesthesia complication rates, infection rates, blood transfusion errors and the number of deaths that result during low-mortality procedures.

Slide 18

Redesigning Louisiana's Healthcare System

This newly "redesigned" system of care will:

• Provide a medical home at its heart.
• Be patient-centered.
• Be linked by electronic medical records.
• Be quality driven, sustainable; and accessible to all citizens.

Slide 19

Thank you AHRQ for Giving Louisiana a Jump Start in the Health Information Technology Movement!

Slide 20

Hospitals...the "business" we are in...the people that we serve!

Thank You.

Rebecca Bradley
Director Rural Health Programs
Louisiana Hospital Association
RBradley@LHAOnline.org