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Journey to the Electronic H Health Record:Enabling Seamless Care Delivery & Healthcare Transformation

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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 Services

1

Aurora Health Care

(2)

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

(3)

Slide 1

‧ Integrated Delivery Network ‧ Private non-profit teaching

Slide 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

(4)

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

(5)

The EHR is a

Journey …

Not a

The EHR is a

Means to an

Destination

End …

Not an End

Unto Itself

(6)

www.aurorahealthcare.org

(7)

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.

(8)

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

(9)

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

(10)

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

(11)
(12)
(13)

Clinical IT Strategy

Clinical IT Strategy

Right Care Right

Electronic

Right Time Right Place Care Management Vision

Health

Record

Right Information Right Decisions Place Right Price 13

(14)

Key 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

(15)

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

(16)

Flow of Information

Old Old

Visits to Internist 1983 - 2008

ED Visit for Chest Pain - 2001

Admission to Hospital - 2007

(17)

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

(18)

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

(19)
(20)
(21)
(22)
(23)
(24)
(25)

Decision Support in CPOE (1):

Enterprise-wide Order Sets

Enterprise wide Order Sets

(26)

Decision Support in CPOE (2):

Discern Alerts

Discern Alerts

(27)

Decision Support in CPOE (3):

Drug Alerts

Drug Alerts

Drug-Drug interaction checking Drug-Allergy checking

Dose-Range checking

(28)

Links to Evidence on internet from patient chart

Links to evidence li k

a click away

(29)

2

Patient communicates allergies, current meds

Registration

Clin Doc

P

O d

2

3

Physician orders medication via CPOE

1

Patient Registers; bar-coded wristband created

Registration

PowerOrders

Point of Care Integrated Medication

3

7

Integrated

g Administration Process

4

Ph Medication charge

record to patient bill

Products

Pharmacy

Patient

Billing

5

6

Electronic Medication Administration Record (eMAR)

4

Pharmacy fills order; checks for interactions

MAR

Medication with bar code administered to patient with positive patient ID and interaction checking ( )

updated

eMAR

(30)

Key Successes

ƒ Decision Support – Evidence-Based Medicine (easy to d th i ht thi )

Key Successes

do the right thing)

ƒ Inbox, Result Review, Electronic signature

ƒ Timeliness of result availabilityTimeliness of result availability

ƒ Completeness of record - longitudinal, cross site

ƒ Medication Profile

ƒ Remote access to data (75% of physicians have access from home or office)

ƒ Access to data without chart pull - for returning phoneAccess to data without chart pull for returning phone calls or prescription refills

ƒ Ease of concurrent reminders and retrospective reporting for drug recalls or care management data retrieval

30

(31)

Key Challenges

Key Challenges

ƒ Care Team Workflow Redesign and how computer isCare Team Workflow Redesign and how computer is used at POC (mobile computing devices)

ƒ Training and Support

ƒ Availability of System - aka, NO DOWNTIME (back-up data access strategy)

ƒ Response Time

ƒ Response Time

Response Time

Response Time Response Time

ƒ Support … maintaining the gains ...

(32)

The “Triple Constraint" to Manage

in IT Implementations with

in IT Implementations with

Clinicians

PEOPLE

32

PEOPLE

(33)

Electronic Health Record

Ad

i

Adoption

(34)

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”

(35)

Thank You,

Judy

y

judy.murphy@aurora.org

參考文獻

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