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E-Prescribe: Adopting Health Care Information Technology ADG associates presenting: Barbara Antuna Jessica Carpenter Patrick Esparza Brian Frazior. Project Problem. Need to reduce medication errors Currently seeing about 62.5 errors per 1,000 medication orders - PowerPoint PPT Presentation
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E-Prescribe: Adopting Health Care Information Technology
ADG associates presenting:
Barbara AntunaJessica Carpenter
Patrick EsparzaBrian Frazior
Advance Development Group
Project Problem
• Need to reduce medication errors– Currently seeing about 62.5 errors per 1,000
medication orders
• American Recovery and Reinvestment Act – CPOE needed for “Meaningful Use”
• Medicare Incentives– CMS offering financial incentives
• Proposed Solution: – Computerized Physician Order Entry
Sources: The Leap Frog Group. Factsheet: computerized physician order entry. Accessed from: http://www.leapfroggroup.org/media/file/FactSheet_CPOE.pdf on October 1, 2009. Centers for Medicare and Medicaid Services. E-Prescribing Measure. Accessed from: http://www.cms.hhs.gov/ERxIncentive/06_E-Prescribing_Measure.asp on October 1, 2009. Dolan, PL., Prepare to meet "meaningful use" EMR requirement. American Medical News. June 15, 2009. Accessed from: http://www.ama-assn.org/amednews/2009/06/15/bica0615.htm on October 1, 2009.
Advance Development Group
CPOE Readiness Assessment
• Strategy– How needed is this project and how committed to the project is the
organization?– Stakeholder involvement and expectations
• Structure/Culture– Timeline, financials and staff expectations
• Technology– Does the hospital have enough technology resources– Electronic records already in place?
• Management Control Processes– Does the organization have the proper management in place to
implement a project of this size
• Clinical IT/Project Management– Does the IT department have the expertise and tools needed
Source: Health Care Excel. CPOE Readiness Assessment Version 1. Accessed from: http://www.hce.org/Education/ToolKits/CPOE_Toolkit/03_TOOLS/05-CPOE-ReadinessAssessment-DRAFT-Tool.pdf on October 1, 2009
Advance Development Group
Readiness Assessment Results and Strategic Fit
Advance Development Group
Qualify
• HIMSS(Healthcare Information and Management Systems Society) EMR Adoption Model
Advance Development Group
Justification - Financials
• American Recovery and Reinvestment Act (ARRA)– Health Informatics Initiative
• Require a meaningful use system by 2011 • Non-compliance results in financial penalties starting in 2015
• Reduction in cost due to fewer medication errors– Reduced risk of liability– Reduced costs associated with Adverse Events
• Reduction in cost due to more efficient methods– More accurate methods for cost tracking – Time and efficiency savings in finding/recording information in charts
• Medicare incentives– 2008 Medicare Improvements for Patients and Providers Act
• Bill provides economic incentives for physicians to e-prescribe
Advance Development Group
Justification - Regulatory
• ARRA– Will have a system that functions under federal guidelines
• Better ability to provide Joint Commission requirements– Increase efficiency for producing required reports– More accountability
• Assist with compliance of policies at the point of prescribing
• Accurate record of all drugs administered
• Up to date information on drug availability at the point of prescribing
• Reporting Requirements– National Health Quality Measures (NHQM)– Reporting Hospital Quality Data for Annual Payment Updates
(RHQDAPU)– Physician Quality Reporting Initiative (PQR)
Advance Development Group
Patient Safety and Quality of Care
• Studies show a vast reduction in errors• Hospitals that use CPOE have fewer complication
and death rates
Source: Bobb, A., Gleason, K., Husch, M., et al. The epidemiology of prescribing errors: the potential impact of computerized prescriber order entry. Arch Intern Med, 164., 2004.
• Reduce transcription errors prescriptions
• No legibility issues • Notes can be attached to record with clarifying decisions • Allergy warnings always available and linked to drug selection • Reduce missed doses• Ability to track and audit changes in drug treatment during admission • Identifies drug interactions at the point of prescribing • Availability of up to date medication histories
Advance Development Group
Patient Satisfaction
• Increased efficiency – Quicker turnaround from time physician orders
prescription to when patient receives
• Improved patient safety– Fewer problems with unclear orders, dosage
mistakes, and duplication of drug therapies
• Keeping up with technological advances
Source: McCarthy, G., Deliver Tangible ROI: Three healthcare organizations see reduced costs, enhanced efficiency and increased compliance with CPOE systems . Health Management Technology., Accessed from: http://www.healthmgttech.com/features/2009_june/0609_deliver.aspx on October 5,2009.
Advance Development Group
Initial and Ongoing Costs
Source: Ohsfeldt., RL, Ward, MM., Schneider, JE., et al., Implementation of hospital computerized physician order entry systems in a rural state: feasibility and financial impact. JAMIA., 12 (1)., 2005.
• Organization already has existing clinical information system , leads to reduction in up-front costs.• Approximately $1.5 Million in initial costs for a 200 bed facility – best case scenario• Approximately $4.2 Million in initial cost for a 200 bed facility – worst case scenario
Advance Development Group
ROI
• Case StudiesEarly Case Study:
• Brigham and Women’s Hospital
• Implemented in 1992 – saw profits 6 years later that are continually and steeply increasing.
• State of Massachusetts Study• CPOE systems could prevent 55,000 medication errors in Massachusetts and save $170 million statewide per year ($2.7 million per hospital). • Expect to see payback within 26 months through reducing hospitalizations generated by errors.
Source: Blue plan: EMRs don't offer good ROI, but CPOE does. Accessed from: http://www.fiercehealthfinance.com/story/blue-plan-emrs-don-t-offer-good-roi-but-cpoe-does/2008-03-12#ixzz0UPgd0E7s.,on October 5, 2009.
Source: Kaushal, R., Jha, AK., Franz, C., et al., Return on investment for a computerized physician order entry system. JAMIA., 13(3), 2006.
Advance Development Group
Stakeholders
Indirect Stakeholders
Direct Stakeholders
HOSPITAL
CEO
CFO
CIO
PatientsPrescribing
Providers
Pharmacy/ Pharmacist
Payers/Pharmacy Benefits Managers
(PBMs)
Government (Federal and State)
Healthcare Facility
Advance Development Group
Stakeholders
• Patients• Prescribing Providers• Pharmacy/Pharmacists• Payers/Pharmacy Benefit Managers
(PBMs)• Government (Federal and State)• Healthcare Facility
Advance Development Group
Stakeholders - Patients
• Power and Interest– Reasonable level of power and minimal interest– Goal is to keep the patients satisfied
• Responsibilities– Financial asset to the healthcare system– Paying for a portion of the hospital services including e-
prescription• Needs and Wants
– Accurate, timely, and authorized prescriptions– Increased safety and quality of care
• Role in Driving System Architecture– Reduce involvement in prescribing workflow– Increase access to prescription history
Advance Development Group
Stakeholders - Prescribing Providers
• Power and Interest– “Committed” with a great deal of power and interest– They must find the system easy and efficient to use
• Responsibilities– Primary users of the system– Highly affected by changes in current workflows
• Needs and Wants– Reduction in medical errors– Increased efficiency in medical prescription
• Role in Driving System Architecture– Design considerations to improve and not hinder current
workflows
Advance Development Group
Stakeholders - Pharmacy/Pharmacists
• Power and Interest– “Committed” with minimal power but high interest– Must be willing and able to accept e-prescriptions
• Responsibilities– Pharmacies must be willing to upgrade systems to support e-
prescribing• Needs and Wants
– Increased efficiency due to problems with current paper-based prescriptions
– Automated prescription renewals– Patient safety and care– Reduction in time spent mediating between payers and providers
resulting in reduced costs• Role in Driving System Architecture
– Partners in working through common concerns– Ensure electronic prescription standards are met
Advance Development Group
Stakeholders - Payers/Pharmacy Benefit Managers (PBMs)
• Power and Interest– “Committed” with high power and high interest – They will need to be managed closely
• Responsibilities– Will need to work with providers as well as pharmacies– Possibly upgrade systems to accept electronic prescriptions
• Needs and Wants– Reduction in prescription costs through the promotion of
cheaper therapeutically equivalent drugs– Reduction in medical errors resulting in lower medical costs
• Role in Driving System Architecture– Must interact with the e-prescription system to act as an
intermediary between the provider, patient, and pharmacy
Advance Development Group
Stakeholders - Government (Federal and State)
• Power and Interest– “Committed” with high power and high interest– Goal is to reduce health care costs
• Responsibilities– Provide patients safe and high quality health care– Promote electronic prescription through financial incentives,
laws, and education• Needs and Wants
– Increase quality of care– Cost savings through the use of generics and formulary
compliance• Role in Driving System Architecture
– Defining e-prescription requirements and data standards
Advance Development Group
Stakeholders – Healthcare Facility
• Power and Interest– “Authorized” with high power and high interest– Goal is to maintain an efficient, cost effective prescription
system• Responsibilities
– Put forth financial backing to implement e-Prescription system
• Needs and Wants– Return on investment– Improved quality scorecard results– Satisfied physicians and community
• Role in Driving System Architecture– Provide budgetary approval
Advance Development Group
Workflow – Actors
• People– Providers– Provider Office Staff– Dispensers– Dispenser Staff– Payers– Patients
• System– EMR, both at provider locations and hospitals– PIS– Payer IS– HIE
Advance Development Group
Workflow Current State – Patient/Provider
Advance Development Group
Current State – Dispenser/Payer
Advance Development Group
Future State – Patient/Provider, Dispenser/Payer
Advance Development Group
Staff Satisfaction and Productivity
• Satisfiers and Improved Productivity– Eliminates provider office staff and transmission of prescription– Improvement in dispenser workflow due to increased legibility of
prescriptions– Improvement in dispenser workflow due to less payer covered formulary
checking– Provider able to identify payer covered meds– Provider given access to dosing at point of care– Provider given drug-drug and allergy information at point of care– Better security of provider license and DEA information
• Dissatisfiers– Change in workflow for provider– Will not entirely eliminate office staff involvement– May not necessarily change anything for the patient
Questions?