Electronic Health Records
Cash Cow or Money Maker
Kate HorkingsHealth Information Services Operations Director
Our Locations
Southern Health Vital Signs
• Acute, Sub-acute, Mental Health, Aged & Community
• Service area of 2,800 square kms and 750,000 people
• 12,000 staff
• Annual turnover of $700 million
Southern Health Vital Signs
• 134,000 inpatient attendances
• 700,000 outpatient attendances
• 1.8 million Patient Master Index entries
• 2.6 million MR location moves annually
Why are we doing this?
Our Vision
• A paperless Medical Record always at hand
Advancedhealth recordmanagement
Improveerror rates
RemovePaper handling
VastlyImprove efficiency
EnhancedInformation
accessand distribution
Improveclinical
productivityImprove
accessibility
First placeto find
results and reports
Betterdecision support
Full history always at hand
Multi-site access for clinical discussions
Clinical focuson the patient
not theprocess
Results acknowledgement
HealthSMART clinical
integration
No clinician need to manage
record
Betterpatient outcomes
Improved care
Better service co-ordination
Increased privacy of Health
information
Preparing for an EHR System
How does a Health Service start?
An EHR is a journey,
not a destination
Think BIG, Start Small
Target Objectives
• Reduce clinical access times for current medical records by 100%
• Reduce clerical costs by 50% (per record movement)
• Reduce medical record movement to other sites by 100%
• Improve time to provide test results viewing in medical records by 95%
• Return floor space• Reduce incidence of lost records to 0%
Scanned MR – The Bridge to an EHR
Paper Based Record Includes:
Requesting the MR
Awaiting MR arrival
Receiving MR
Updating tracking screen
Sending MR to requestor
Systems / Databases Used:
Homer – PMI & Tracking
PRT – Mental Health Tracking
Lab Vision – Pathology
Merlin – Pharmacy
Electronic Health Record Includes:
Logging into EHR system
Typing in appropriate UR Number
Systems / Databases Used:
Homer – PMI
EHR System – including Interfaces with Pathology, Pharmacy etc.
The Southern Health ProjectDELIVERABLES
• Expand Casey model across SH to replace paper
records- Execute two year project (Infrastructure and business change)- Change Medical records processes and lower costs by 52%- Achieve 3 year return on investment
• Implement new functionality to gain additional benefits- Results acknowledgement- Electronic discharge summaries- Electronic alerts
The Southern Health Project
BENEFITS• Gain patient, staff and financial benefits proven at Casey• Greater efficiency at clinics @ Casey
• Enable clinicians to make informed decisions based on
timely access to accurate record and results information • Use clinical buy in to support HealthSMART clinical
system project and ultimately EHR• Safer working environment – less physical handling of
records
Outpatients Clinic Retrieval Process
Eliminated Processes
Get Outpatient List for Clinics
Search Local Records
Request additional Records from storage
Collate in booking order
Deliver to Clinic
Appointments Open Record
Treat Patients
Record Treatment observations
AppointmentsSearch SMR for Patient
Open Record
Treat Patients
Record treatment observations
2 hours 15 minutes
Scanned Record
Paper Record
• A significant number of processes are eliminated through the use of a scanned medial record.
Lessons Learnt
• Know your current processes
• Monitoring systems of a paper based department are still paramount
• Turn around time is critical
• Clinical buy-in is essential
• Forms management is critical
• Implementation plan – big bang or site based
Testimonials
“I think the CPF system is desirable in that it allows me quick and easy access to obtaining patient information at times when the patient record is off site or needed by others (eg the ward, coding) etc. It allows for rapid review of the patient’s presentation, management and staff involved which is often necessary in a short space of time.”
Medico Legal OfficerSouthern Health
Testimonials
“I loved the scanned record as it was;1. User friendly – very easy to use and teach somebody
else to use.2. Convenient to be able to look up patient information
quickly.3. Really great if a patient arrives for an appointment on
the wrong date as history is available electronically and patient can thus be easily seen.
All in all, makes for greater efficiency in clinic.”Manager, Outpatient Services
South East Sector
Financial - Operating Cost Control
2006 2007 2008 2009 201020052004
$3m
$4m
$5m
$2m
Year
Operational cost
As is
SMR roll out
Note: $ values approximated
Increased record numbers and record management cost drives up total costs
Costs are much less sensitive to increased records numbers and IT automation contains record management cost
Financial Return on Investment
Net Cumulative Cashflow - CPF Deployment
-3,000,000
-2,000,000
-1,000,000
-
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
Y1 Y2 Y3 Y4 Y5
Elapsed Time
Net Cumulative Cashflow Net Cumulative Cashflow Including Intangibles
(000) As Is SMR deploy
As Is v SMR
Cumulative Cash Flow
Op Ex Cap Exp Total Op Ex Cap Ex Total
Year 1 $4,168 $0 $4,168 $3,738 $1,978 $5,716 -$1,547 -$1,547
Year 2 $4,424 $37 $4,461 $3,354 $1,377 $4,731 -$270 -$1,817
Year 3 $4,763 $487 $5,250 $2,880 $0 $2,880 $2,371 $553
Year 4 $4,948 $4,948 $2,932 $0 $2,932 $2,016 $2,570
Year 5 $5,109 $225 $5,333 $2,681 $0 $2,681 $2,652 $5,223
$24,163 $18,940 $5,223
FINANCIALS – 3 year payback
Adding Value to Southern Health
Add
ed V
alue
Financial Accountability
Has a 3 year payback period
Contributes to a financially sustainable organisation with marginal growth
costs
Reduces the unit cost from $11.97 to $5.92
Project Savings
• Major operating cost savings will come from:• Labour• Storage• Consumables• Transportation
Paper Vs Scanning - some costs
Paper Department $23.04 per separation
Scanned Department $11.40 per separation
51% reduction
Tracking in a paper dept $1.17 per move
Tracking in a scanned dept $0.58 per move
51% reduction
Paper Record Construction $1.62 per record
Scanned Record Construction $0.00 per record
100% reduction
Remember….
Be brave, be determined, be resolute!
What may seem impossible today, may be
the norm tomorrow!
It’s not going away!
Moving to an EHR is not an alternative.
It is not an IF, it is a WHEN!
Don’t get left behind, the planning starts NOW!