EHR 2.0 Collaboration

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1 2.0 Collaboration Electronic Health Records User Experience October 5, 2010 Tina Buop CIO, Muir Medical Group IPA,., Inc Debra Spindel VP, Nautilus Healthcare Management Group, LLC

2 Agenda Introduction Fully Functional Meaningful Use Connectivity & HIE Common Differences Lessons Learned Q& A 2

3 Introduction Two separate large groups (IPAs/MSOs) implemented Practice Management and Electronic Health Record Solutions without collaboration.. Shared Findings Distinct Differences Common Lessons Learned 3

4 Introduction MMG The Muir Medical Group IPA, Inc. (MMG) is an Independent Practice Association located in the San Francisco East Bay. MMG provides services to over 600+ Physicians & Mid level Providers MMG provides clinical and technical leadership, solutions and support to automate the independent practices and to connect them to an integrated ecommunity. 108 Providers Implemented 28 Practices across 50 connected locations 15 Specialties 165,000 patients in the system & growing 1,700 2,300+ visits per day Interfaces: Labs, Imaging Results, Hospital Notes, Transcription, Phone Appointment Reminders, Eligibility Checking, eprescribing, ECG, Spiro, Advanced Holter & Stress Treadmill Enterprise Chart Community 4

5 Introduction: Nautilus Healthcare Mgmt Group Physician Services Division Technology Implementation & Support Billing & Revenue Cycle Management Group Practice Management Accounting/Financial Management Management Consulting IPA Management Division Greater Newport Physicians IPA Cedars Sinai Foundation IPA deployed since physicians and growing 65 practices 18 specialties Hosts full suite of NextGen applications Provides full implementation and on going technology support for medical group clients

6 Basic EMR, Fully Functional Data from: May

7 Fully Functional HL7 PHR / PORTAL PHARMACY LABS HL7 Net worked IMAGE RESULTS HL7 Electronic Health Record Net worked SCANNING USB USB PAYERS HOSPITAL or SURGERY CENTER PRINTING ecommunity CONNECTED DEVICES & RESULTS FAX 77

8 Achieving Meaningful Use 8

9 The MMG evision Hospitals State Information Highway National Health Information Network (NHIN) 9

10 Nautilus HIE Connectivity Vision Hospitals IPA Nautilus/NextGen Community Clinical Portal (ER access, non- EMR physicians) Primary Care Specialist Hospitalist Reference Labs Non-NextGen s

11 Common Physician Governance / Priority Setting Dedicated Clinical personnel (not IT) Dedicated IT personnel Dedicated Support personnel & processes Ticket / Issue Leads & tracking capability Sales Implementation Support Various Specialties & Practice Sizes We are very different/more complex Stark / Hospital /IPA Funding 11

12 Differences Southern California vs. Northern California HIE vs. Enterprise Chart for data sharing Physician Engagement / Cost Infrastructure Service Offerings Remote IT Support MSO Services Accounting Billing Practice Management Other wrap around services 12

13 Implementation Approach Sales EPM Support/ IT & Clinical Data Sharing Sales Contracting Process EPM Implementation Deployment Support: IT and Clinical Data Sharing/Interoperability 13

14 Lessons Learned Sales/Adoption Sales EPM Support/ IT & Clinical Data Sharing Physician decision making process is lengthy Physicians believe that they operate differently for core business processes Physicians are very concerned about cost, even with subsidized product offerings Practices need to contribute and commit for their success skin in the game Contract is critical: set expectations for timelines, commitment, change mgmt and leadership Include financial penalties for delays 14

15 Lessons Learned EPM Sales EPM Support/ IT & Clinical Data Sharing EPM Practice Management and Billing/Collections Office Inefficiencies become very visible Need defined Practice Business Operations Demographic conversion decision point Certified Billers and Certified Coders become more critical We don t teach billing; we teach billers how to use the system Patient Statements not distributed as regularly as some practices believe Timely filing is critical First check after go live between 7 11 days Effectively articulate the benefits of shared master files (i.e. payers, contracts, referring physicians) 15

16 MMG Lessons Learned Sales EPM Support/ IT & Clinical Data Sharing Phased Based Approach to Implementation Charting, erx, Scanning & Tasking Labs & Provider Approvals Imaging Results & Hospital Notes Inboxes Consulting Notes Reporting Patient Recalls Billing Decisions to discontinue paper fee ticket Practice Optimization & hands on support during go live It is a journey; not an over night destination Competition is valued and encouraged Inefficiencies become high lighted chart in trunk Gained efficiencies can t be given up Providers are doing more with echarts (more thorough tracking and contra indications) 16

17 Nautilus Lessons Learned Sales EPM Support/ IT & Clinical Data Sharing Preparation, planning and training are key Workflow assessment and redesign make or break success Physicians must practice adequately in advance of go live Need effective scanning and abstracting protocols Big Bang Go Live Approach : all providers in a practice location go live with most functionality on a given date Charting, erx Labs orders & result signoff Imaging Results Messaging Coding in (no paper fee ticket) Hands on support during go live Robust follow up; refresher training; monitoring Small practices are just as challenging as large ones 17

18 Lessons Learned Support Sales EPM Support IT & Clinical Support/ IT & Clinical Data Sharing Physicians expect near perfection with support Create clear parameters for support issue turnaround time Interfaces are expensive Regulations encourage community development and less island mentality Outsource if possible: you will eventually need to be part of an ecommunity Manage upgrades, patches & template changes Plan for server environment changes Expect to build custom reports 18

19 MMG Lessons Learned Data Sharing Sales EPM Support/ IT & Clinical Data Sharing Data Sharing and Interoperability At MMG, we started with separate practices within our NextGen enterprise no visibility of data In 2009, converted to Enterprise Chart wherein all clinical data is available to all physicians in the MMG enterprise Extensive education and overcoming physician fears was required Now, physicians very happy with enhanced access and improved continuity of care Looming privacy regulations in California are a concern 19

20 Nautilus Lessons Learned Data Sharing Sales EPM Support/ IT & Clinical Data Sharing Data Sharing and Interoperability In Nautilus NextGen enterprise, each practice is separate shared MPI but no visibility of clinical or financial data Utilize NextGen s HIE application to facilitate data sharing between practices, hospitalists and external entities Meds, allergies, chronic dx, histories Hospital radiology reports, labs, transcribed documents Closed loop referrals: can attach data electronically and send to specialist; get consult note back Must be easy for physicians to access data or they won t Patient connectivity via integrated web portal 20

21 Patient Portal Features Document distribution Test results, orders, patient educ. Secure messaging Broadcast messaging Appointment reminders/requests Patient online forms Medication list and refills Statement view and online bill pay BTW - Patients LOVE this! 21

22 Q & A 22