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Technology in the Allergy - Immunology Practice

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					Technology in the Allergy/Immunology Practice: What’s the right I/T investment for my practice?

Rosemarie Nelson, MGMA Consultant AAAAI July 23, 2005

Objectives






Recognize ways that technology can facilitate more effective operational processes in the clinical environment. Identify the technology solutions available to your medical practice and develop a technology strategy that will result in practice growth while improving physicianto-patient relationships. Summarize an approach to speed your practice, your staff, and your patients down the information highway to better medical record keeping.

“It is not the strongest of the species that survives, not the most intelligent, but the one most responsive to change.”
-Charles Darwin

Paper Pushes Process
Incoming results Transcribed office notes Patient medication lists

Patient meds

File lab results Medical record

Billing system

Encounters
-dictation

Hospital networks
Transcription

What are we looking for from I/T?
Increased provider productivity  Easy to use  Increased capacity – Transactions/encounters – Providers  Access, access, access – Immediate – Remote  Quality of care and patient service


Who’s shots are overdue?


“Clinical” database within your financial information
– Export to Excel for an electronic “shot book”



Query your charge data for last date of service based on CPT Identify a recall list of patients who are due
– Call, mail, email!



Benefits to a stepping-stone approach to clinical recordkeeping
– Faster communications, – Less paper – Fewer chart pulls – Fewer mistakes – Less uncompensated work – See more patients more efficiently

The stepping stones:
 E-prescribing

programs create med lists

 Get

results workflow streamlined for better patient care visit notes that are easily searchable

 Get

Medication errors aren’t just in the hospital
Inadequate

availability of patient information, such as lab test results, is directly associated with 18% of adverse drug events.
– Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallavan T, et al. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA 1995; 274: 35-43.

Medication errors aren’t just in the hospital
The

use of electronic systems for ordering medicines reduced the incidence of serious medication errors by 86%; including dose errors, frequency errors, route errors, substitution errors and allergies.
– The Impact of Computerized Physician Order Entry on Medication Error Prevention. By: David W. Bates, Jonathan M. Teich, Joshua Lee, Diane Seger, et al. In: Journal of the American Medical Informatics Association (6) 313 (1999).

Automate Prescription Renewals
• Reduce clinical and administrative time for prescription renewals and pharmacy call-ins

• Dramatically reduce time spent on the phone
– Interruptions or managed transactions?

• Automatically fax requests to the patient’s pharmacy •Increase your patient’s access to your care and increase patient satisfaction

Master the Prescribing Process
 

Manage reissues during visits Deal with refill requests faster

–


Experience reductions of 12 minutes per refill (from 15 minutes using paper to 3 minutes using e-prescribing)* Reduce staff use time from 6 minutes per call to less than one minute per fax**

Fax savings over phone savings

–

*Journal of Healthcare Information Management – Vol.17, No.4.
**Susan Miller, RN, BHS, CMPE, Family Practice Associates of Lexington,

Health Management Technology, October 2003.

Medication Management


Two-thirds of physician visits end with a prescription* E-prescribing programs provide internal advantages – Active med lists for all patients – Drug-interaction checking
Accessible on the network







Wireless access via PDA or tablet computer
*Journal of Healthcare Information Management – Vol. 17, No.4.

Master E-prescribing


Download daily schedules to handhelds or tablets with patient demo information Maintain existing medications for each patient Network solution providing desktop access for nursing support
– Data entry during visit prep







Identify critical needs

– –

Dosing assistance Formulary management

E-prescribing Solutions
 


Allscripts/Touchworks (www.allscripts.com) Rxwriter (www.rxwriter.info) Epocrates (www.epocrates.com) AdvancePCS (iScribe) (www.iscribe.com) ZixCorp’s PocketScript (www.zixcorp.com) Rcopia (www.doctorfirst.com)






Incoming results & correspondence



30% of patients’ chart pulls are to look up test results* E-folders on network server

– – – –
–

Standardize on naming convention LastnameFirstnameDOS-file type NelsonRosemarie20041205-Mammo NelsonRosemarie20041205-LAB

 

Fax server on network
Experiment with www.efax.com PaperportPro (www.scansoft.com)
*www.abaton.com/healthcare/fastfacts.html

Scan in documents

–

Transcriptionist

Provider’s Tablet

Network server

Triage nurse

Get Office Notes Online


Improve communications
– Access for nurse phone triage

 

Reduce chart pulls Access for billers – Superbills not always legible Access for providers – Remote review of results – Support during call coverage



Just file your transcription electronically


Establish provider folders on the network server

– –

Desktop and wireless access via tablet computer Standardize on document name format for transcribed reports



LastnameFirstnameDOS-file type
NelsonRosemarie20031205-OV



Password protect folders

Better Performing Practices use E-tools
 E-forms:

OmniForm (www.scansoft.com)

– Create e-form for diabetes, immunization, etc. forms – Tool allows form to be scanned in and converted to data entry form
– Import POMIS/EMR fields to populate forms
 PMSFHx

electronically

– www.medicalhistory.com, www.medfusion.net , www.kryptiq.com

Medical Practice Management Technology Resources
WebServices and TeleServices Direct-to-Patient Messaging CareCatalyst www.kryptiq.com Claims clearinghouses and web eligibility services EDI Healthcare www.edihealthcare.c om Gateway EDI www.gatewayedi.com Medifax EDI www.medifax.com Forms, scanning tools, voice Daily/weekly feeds to your inbox Incremental transition to electronic patient records MPStat Network folders www.modernphysician. with transcribed com patient visit documents www.healthleaders.co www.physicianspr Scan test results m actice.com into network folders www.ihealthbeat.org www.memag.com Add fax server to network - file faxed patient documents in network folders Epractis Other Rx requests via www.epractis.com web services www.chcf.org Google Desktop Search (Beta) www.google.com Appointments via web services Test results via web services Web site practice management resources www.mgma.com

Visigo A6 ID scanner www.ambir.com/pp

HealthIT www.healthit.com Medfusion.net www.medfusion.net

PaperPortPro 10 www.scansoft.com OmniForm www.scansoft.com

Medstep www.med-step.com Practis www.practisinc.com RelayHealth www.relayhealth.com

Proxy Claim Web www.proxymed.com WebMD EDI services www.webmd.com or www.envoy.com Zirmed Claims Management www.zirmed.com

Dragon Naturally Speaking www.scansoft.com

What’s your objective?


Efficient operations
– Go home on time




Reduce staff turnover Eliminate the daily chaos See more patients each day
– Increase capacity without increased overhead





Feel in control of information when seeing your patient

What’s your strategy?
 The

incremental approach

 Focus

on the practice objective the components

 Evaluate
 Select

desired features for associated benefits

 Implement

to meet desired objective

Where to start?
 Create

multi-disciplinary team

– Front desk – Administration – Clinical support staff (nurse, MOA) – Providers (champions and non-techies) – Medical secretaries – Medical record staff
 Select

project coordinator/leader

Team initiatives
 Identify

practice objectives

– specific, measurable & attainable
 Evaluate  Select

component solutions

desired features for the associated benefits for desired objective

 Implement

“I don't understand why people are frightened of new ideas. I'm frightened of the old ones.”
John Cage

EMR, CPR, DHR, EHR
Medical Record  Computerized Medical Record  Digital Health Record  Electronic Health Record  Is it paperless?  Does it mean all users of the patient “chart” are entering data via software application?
 Electronic

Lessons Learned: Data Access/ Documentation
Consider the scenario of two physicians opening a practice with the desire to be paperless. They are proud of the fact that along with medical equipment, furnishings, and supplies, they bought an EHR, believing it has great value: They receive lab results and are alerted to the need to call a patient. As the patient is being prepared in the examining room they look up past history, track changes, and are reminded of upcoming health maintenance activities. They report that local pharmacies love getting printed faxes of prescriptions they write while the patient is preparing to leave. But they do not document in the EHR at the point of care! Instead, they take notes on scraps of paper, take their notebook computers home with them at night, and record their findings while watching their kids.

Successful implementation?

Critical to successful EMR implementation
 Selection

of the system your providers and staff will use
– Data mining results are poor if little data is captured!

 Vendor

support and training

– – – –

Initial implementation project plan Interface to POMIS New PC user training Application training for providers

EHR
Definition Vision Design Implementation

Functional Process Imprv
I/O Guidelines Vocabulary

System Build Tailoring
Documentation Unit Testing Approval

Migration Path Benefits
Requirements Current Systems Process Mapping New Fnc & Tech RFP

Standards Change Control
Technical Interfaces Data Conversion

Installation Pilot Install
Integration Test Training Acceptance Test

Vendor Selection RFP Review Narrow Field Demos & DD Choose Approval Contracting Financing

Security
ID Mgt/Audit DRP/BCP Network Test Planning
Used with permission, Margret\A Consulting, LLC

Cut Over
Roll Out Backload Data Operation Review

Benefits Real
Maintenance

Successful System Selection Process
1.
2. 3. 4. 5. 6. 7. 8. 9. 10.

Kickoff & create users “Top 10” features/functions Onsite demos (let vendors educate staff) Identify how workflow will change Issue RFP/RPQ to 3-5 vendors Phone references (user-to-user) Analyze results, review materials (user documentation) Select 2-3 “finalists” Visit references (peer-to-peer) “Interview” the installers & rate each Simultaneous contract negotiation

Readiness Assessment Process
 

Determine operational needs Identify opportunities to optimize technology adoption Survey providers
Knowledge transfer
– Vendor “state of the industry” – EMR migration path – Coordination with existing application environment




Survey Providers
1.

What is your objective to be achieved with the implementation of an EMR? What is the problem(s) you are trying to resolve? (This answer should be the key driver in the selection and implementation process.) What is your preferred solution to automating the medical record keeping process?
What must the EMR do/provide for you to be willing to use it?

2.

3.

Needs assessment to RFI/RFP


Needs assessment
– What do we want to achieve? – What work processes are we trying to affect?



RFI – how will your product assist us in meeting these needs?



RFP – how much will your solution cost to meet our needs?

Costs
Software – include 3rd party applications  Hardware  Infrastructure development & maintenance  Implementation  Education  Planning


– Development of implementation plan – Identify measurable outcomes – Choose meaningful metrics and goals


Administration

Implementation costs
 Training

 Overtime

associated with entering patient data disruption during transition resistance

 Business

 Employee
 Lost

productivity

Tool for evaluating quotes
 Foundation

for eHealth Initiative

– EHI-EHR Master Quote Guide Document
 http://ccbh.ehealthinitiative.org/commu

nities/community.aspx?Section=97&Ca tegory=359&Document=643

ROI
 Excel

spreadsheet tool

– EMR ROI Calculator

Don’t overlook…


Develop a Strategy for Existing Data
– Determine what existing patient information will be included in the EMR system Allow time for individual, hands-on training Structure buffer time into schedule for first weeks of live operation of EMR system Delegate a power-user to trouble-shoot problems

 

Dedicate Time to Training
– –

Allow Time for Adjustment



Develop an On-Going Plan for Support
–

Vendor management
 Vendor  Buy

speak

what is available today

– Tomorrow is an ever moving target
 Create

detailed specifications and requirements put too much detail into statement of work.

 Cannot

External I/T consultant
 Assist

in evaluating

– Current state of I/T resources – Type of services need going forward


Potential areas of growth and/or change in business

 Assist

in determination if division of responsibility is required between existing and new I/T vendors

Resources


The KLAS Reports www.healthcomputing.com




The Digital Physician www.digitalphysican.com
Knowledge Storm www.knowledgestorm.com




Jewson Enterprises www.jewsonenterprises.com Identify the source – are questionnaires self-reported by vendors? Do the services eliminate survey responses that are extreme?

Information ONLY – does NOT imply a product recommendation; no endorsement or guarantee.

EMR Resources
WebServices and TeleServices Direct-to-Patient Rx and Medication database solutions Small physician practice market (5 or less physicians) MediNotes Charting Plus www.medinotes.com Soapware www.docs.com e-MDs (tops) www.e-mds.com eClinicalWorks www.eClinicalWorks. com Specialty Market GCare –GI www.gmed.com EncounterPro www.jmjtech.com Mid-size (6+physicians) to large practices Exclusive to very large physician practices (75+physicians) EPIC www.epicsystems .com Inte-Great www.integreat.co m DIMS (Document Image Management Solutions) Impact.MD Allscripts www.impactmd.com Freedom Chart www.srssoft.com PaperPortPro www.scansoft.com ASP Market

Medfusion.net

Medicalhistory.com

Allscripts TouchWorks www.allscripts.com DrFirst - Rcopia www.DoctorFirst.com RxWriter www.micro4.com AdvancePCS (iScribe) www.iscribe.com ZixCorp – PocketScript www.zixcorp.com

NexSched www.nexsched.com MedVoice www.medvoice.com TeleVox www.televox.com PhoneTree www.phonetree.com Epractis www.epractis.com

Misys www.misyshealthcare. com Intergy (Medical Manager - WebMD) www.intergy.com Alteer www.alteer.com A4, Ntierprise www.a4healthsystems. com NextGen – MicroMed www.nextgen.com PMSI – PracticePartner www.pmsi.com Centricity – Logician/Millbrook GE Healthcare www.medicalogic.com www.millbrook.com Praxis www.infor-med.com

Amicore (Penchart) www.amicore.com AthenaHealth www.athenahealth. com

CareCatalyst www.Kryptiq.com

Others: Greenway, ChartMaxx, SynaMed; Disappointing: iMedica Engagements w/ clients using: IDXtend-BAR-GroupCast, Misys-Tiger-Vision, PracticePartner, NextGen-EPM-EMR, Centricity-Logician-Millbrook, ImpactMD, Medical Manager, HealthPro, VitalWorks, Prime Clinical, EPIC, MediTech, Keene, TurboDoc,Ntierprise, QuickRecovery, InteGreat, G-Care, Intergy, Ntierprise, AthenaHealth

Trends
 Scan
 Voice

and share – PaperPort Pro10

recognition – Dragon Naturally Speaking
requests via web sites

 Rx

 Fax

server and online storage transcription

 Online

What do you do first? (The 2-Minute Consult)
1.

Create folders on network and electronically file each transcribed report (naming convention: LastnameFirstnameYYYYMMDD) Give triage nurses access to file folders and train all staff on how to find a patient file
Add a fax-server to your network and start receiving results reports electronically (file in the same folder with transcription) Talk with your website vendor about adding interactive services to allow patients to request prescription re-issues Observe your staff workflow and interview your staff to determine whether your office would benefit from e-prescribing or a document management system and develop a task force to investigate the available products

2.

3.

4.

5.

Summary
IOM report recommendation on physicians core competencies:
…utilize information technology to communicate, manage knowledge, mitigate error, and support decisionmaking.
“Health Professions Education: A Bridge to Quality” April 2003


				
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