Journey to the Electronic
H
lth R
d
Health Record:
Enabling Seamless Care
D li
& H
lth
Delivery & Healthcare
Transformation
Judy Murphy,
RN, BSN, FACMI, FHIMSS Vice President, Information Services1
Aurora Health Care
We will cover …
We will cover
• A little bit about Aurora Health Care
• Aurora Health Care: An Electronic Health
Record (EHR) Case Study
– Use our experiences to exemplify key points about the EHR implementation process
– Describe the benefits and challenges we’ve seenDescribe the benefits and challenges we ve seen – Discuss where we’ve been; what we’ve learned – Elaborate on where we’re going next and why
• Wrap-up
• Questions
Slide 1
‧ Integrated Delivery Network ‧ Private non-profit teachingSlide 1
Private, non profit, teaching ‧ 14 Hospitals (60-900 beds) ‧ 120 Clinics‧ 130 Retail Pharmacies ‧ 18 QuickCare Clinics ‧ Home Health Services ‧ Hospice Services L b S i ‧ Laboratory Services ‧ 26,000 employees ‧ 3,700 physicians on staff ‧ 950 employed physicians ‧ $3.2 billion annual revenue ‧ 0.5 million IP days/year ‧ 1.1 million OP visits/year ‧ 250,000 ED visits/year
‧ 2.5 million clinic visits/year 284 000 H i it /
‧ 284,000 Home visits/year
Aurora Information Technology
Aurora Information Technology
‧ Average annual Capital budget - $32m USD
‧ Average annual Operating budget - $56m USD (about 3% of total) – 550 employees
– 6 departments6 departments
‧ Electronic Health Record
– $200m+ USD investment over 10 years (hardware, software, labor)
labor)
– 17,000 user logins with 6,500 concurrent users during prime shifts
19 000 d d i i l di 5 000 bil d i
– 19,000 connected devices, including 5,000 mobile devices ‧ One of the nation's “Most Wired" hospitals –
2004, 2005, 2006, 2007 and 2008
The EHR is a
Journey …
Not a
The EHR is a
Means to an
Destination
End …
Not an End
Unto Itself
www.aurorahealthcare.org
Aurora's Vision
Aurora s Vision
Aurora Health Care was created around a single idea: There is a better way to provide health care.
We will be satisfied only when Aurora gives people We will be satisfied only when Aurora gives people better access, better service, and better results
than they can get anywhere else.
Working together, the people of Aurora will find a better way.
OLD WAY:
H
i l
C
f h U i
Hospital as Center of the Universe
Home Care eHealth Patient Specialists Primary Care Home Care Hospitals Specialists 8
NEW WAY:
P i
C
f h U i
Patient as Center of the Universe
Primary Care Specialists Hospitals eHealth Home Care Primary Care Patient
Murphy, J. “The Center of the Universe: A Closer Look at a
Patient-Centric Care Model”. Nursing Informatics Commentary, Journal of H lth I f ti M t 6 7 (S i 2008)
9
Th Pl h t l
http://www.hhs.gov/healthit/resources/HITStrategicPlanSummary.pdf
The Plan has two goals,
Patient-focused Health Care and Population Health.
Each goal has four objectives and the themes of privacy
and security, and security, interoperability, adoption, and collaborative governance. (Published June 3, 2008) g 10
Clinical IT Strategy
Clinical IT Strategy
Right Care RightElectronic
Right Time Right Place Care Management VisionHealth
Record
Right Information Right Decisions Place Right Price 13Key Strategic Technologies
Key Strategic Technologies
‧ Electronic Health Record (EHR)
– Clinical information integrated into a single, across-the-continuum patient record
– Best practices incorporated to support care management – Personal Health Record included
‧ Mobile Technology
– Access to the EHR with mobile/wireless devices ‧ Digital Imaging
– Cardiology, Radiology, Mammography W b T h l
‧ Web Technology
– Patient, physician, workforce integration – eHealth/Personal Health Record
Electronic Health Record
•
Patient focused electronic record
Electronic Health Record
•
Patient-focused electronic record
– Enterprise Master Patient Index – Anytime, anywhere access
•
Integrated Architecture for Core Systems
– Allows different applications to interact with
ti t d t common patient data
•
“Best of Breed” software for select systems
Interfaces from “feeder” systems
– Interfaces from feeder systems
– Examples: Lab, Dictation, Transcription,
Coding, Billing
Flow of Information
Old Old
Visits to Internist 1983 - 2008
ED Visit for Chest Pain - 2001
Admission to Hospital - 2007
Flow of Information
New Visits to Internist Cli i
New Visits to Internist 1983-2008 Clinic Data Visit to ED 2001 ED Data Repository Admission to Hospital 2007 Hospital 17
EHR Repository as of Aug 2008
EHR Repository as of Aug 2008
Patients 3.6 m
Documents 30 m
Laboratory Results 290 m
Pharmacy Orders 7 m
Decision Support in CPOE (1):
Enterprise-wide Order Sets
Enterprise wide Order Sets
Decision Support in CPOE (2):
Discern Alerts
Discern Alerts
Decision Support in CPOE (3):
Drug Alerts
Drug Alerts
Drug-Drug interaction checking Drug-Allergy checking
Dose-Range checking
Links to Evidence on internet from patient chart
Links to evidence li k
a click away
2
Patient communicates allergies, current meds
Registration
Clin Doc
P
O d
2
3
Physician orders medication via CPOE1
Patient Registers; bar-coded wristband createdRegistration
PowerOrders
Point of Care Integrated Medication3
7
Integrated
g Administration Process4
Ph Medication chargerecord to patient bill
Products
Pharmacy
Patient
Billing
5
6
Electronic Medication Administration Record (eMAR)4
Pharmacy fills order; checks for interactionsMAR
Medication with bar code administered to patient with positive patient ID and interaction checking ( )updated
eMAR
Key Successes
Decision Support – Evidence-Based Medicine (easy to d th i ht thi )
Key Successes
do the right thing)
Inbox, Result Review, Electronic signature
Timeliness of result availabilityTimeliness of result availability
Completeness of record - longitudinal, cross site
Medication Profile
Remote access to data (75% of physicians have access from home or office)
Access to data without chart pull - for returning phoneAccess to data without chart pull for returning phone calls or prescription refills
Ease of concurrent reminders and retrospective reporting for drug recalls or care management data retrieval
30
Key Challenges
Key Challenges
Care Team Workflow Redesign and how computer isCare Team Workflow Redesign and how computer is used at POC (mobile computing devices)
Training and Support
Availability of System - aka, NO DOWNTIME (back-up data access strategy)
Response Time
Response Time
Response Time
Response Time Response Time
Support … maintaining the gains ...
The “Triple Constraint" to Manage
in IT Implementations with
in IT Implementations with
Clinicians
PEOPLE
32PEOPLE
Electronic Health Record
Ad
i
Adoption
Ubiquitous Computerization in
H
lth
?
Healthcare?
“That it will ever come into general use,
g
,
notwithstanding its value, is extremely
doubtful because its beneficial
application requires much time and gives
application requires much time and gives
a good bit of trouble, both to the patient
and to the practitioner because its hue
p
and character are foreign and opposed
to all our habits and associations.”
- The London Times, 1834
Commenting on the “stethoscope”