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The Transition from Paper to Electronic Records
- 1. CONFIDENTIAL Electronic Records Matthew Kim Research Intern | Healthcare +1 512-651-3495 Austin Office mkim@glgroup.com November 2015
- 2. Contents I. Overview of Industry II. Medical v. Electronic III. Ambulatory v. Hospital IV. Selection Criteria V. Implementation VI. Market Share VII. Conclusion
- 3. Contributors John D’Amore President and Chief Technology Officer Diameter Health •Former President and Founder at Clinfometrics •Has over a decade of experience in health IT and medical informatics •CM since 2013 and has done three GLG events Mike Mytych Founder and Owner Health Information Consulting, LLC •Has conducted over 100 EHR vendor selections for physicians and hospitals •Has been in the healthcare IT space for over 30 years •CM since 2002 and has done six GLG events Michael Sills, MD, FACC Vice President Informatics and Technology at Baylor Quality Alliance •Former Medical Director of Non-Invasive Department at BUMC •Spent 12 years serving as President of Cardiology Consultants of Texas •CM since 2013 and has done one GLG event Richard Wong, MD Cardiologist Kaiser Permanente Medical Group •Involved in hospital’s information system on local and regional levels •Has extensive research experience with various EHR vendors •CM since 2006
- 4. History and Transition 1960-2000 • Larry Weed and Problem Oriented Medical Problem • First Electronic Medical Record at The Regenstrief Institute • Emergence of World Wide Web 2000-2009 • The Era of George W. Bush • George W. Bush Creates Office of National Coordinator of Health IT • Doubles Funding for Healthcare IT Projects to $100 Million 2009- Present • American Recovery and Reinvestment Act (ARRA) of 2009 • Health IT for Economic and Clinical Health (HITECH) Act • Promote Adoption and Meaningful Use of Health IT 4
- 5. Three Components of Meaningful Use 5 The use of certified EHR in a meaningful way. The use of certified EHR technology for electronic exchange of health information to improve quality of health care. The use of certified EHR technology to submit clinical quality and other measures.
- 6. Three Stages of Meaningful Use 6
- 7. Three Stages of Meaningful Use • Electronically capturing health information in a standardized format • Reporting clinical quality measures and public health information • Using information to engage patients and their families in their care Stage 1:2011 • More rigorous health information exchange (HIE) • Increased requirements for e-prescribing and incorporating lab results • More patient-controlled data Stage 2:2014 • Improving overall quality, safety, and efficiency • Access to comprehensive patient data through patient-centered HIE • Improving population health Stage 3:2016 7
- 8. 8 Medical Records v. Health Records ElectronicMedicalRecords(EMR) • Digital version of paper charts in the clinician’s office • Contains medical and treatment history of patients in one practice • Information in EMRs does NOT travel easily out of practice EMR’s do not follow the patients: stay with the associated provider ElectronicHealthRecords(EHR) • Built to share information with other healthcare providers • Contains information from all the clinicians involved in a patient’s care • Designed to be accessed by all people involved in a patient’s care EHR’s follow the patients:specialist, hospital, nursing home, laboratories, etc.
- 9. But really… EMR EHR SYNONYMOUS 9
- 10. 10 Ambulatory v. Hospital Electronic Health Records AmbulatoryElectronicHealthRecords • Outpatient care – medical care provided on outpatient basis • Physician practice – single system • Less expensive • Integration is less challenging and complex • Clinical documentation is less complex and detailed HospitalElectronicHealthRecords • Inpatient care – patients who requires admission to a hospital • Larger practices – collection of disparate systems in various departments • More expensive • Integration is more challenging and complex • Clinical documentation is more complex and detailed
- 11. Top Factor in Selection Criteria 11 Sizeof Institution
- 12. Implementation Process Assess Your EHR Needs Set “SMART” EHR Goals Make Key Decisions Narrow the Field Design and Issue a Request for Information (RFI) Compare Vendors Schedule Site Visits Conduct Demonstrations Contact References 12
- 13. A Look at The Top Hospital EHR Vendors KeyCharacteristics MajorPlayers 13 Relentless Improvement High Quality Good Customer Service Reliability
- 14. Hospital EHRs: Top Vendors 14 • Private American company • Consistently the #1 EHR vendor for market share • Clients have won the most Davies Awards • Public American company • Consistently in Top 5 for market share • Clients have won many Davies Awards • Private American company • Consistently in Top 5 for market share • Clients have won many Davies Awards
- 15. Hospital EHRs: 2015 Market Share 15 Epic 20.3% Cerner 19.1% MEDITECH 16.3% CPSI 7.1% McKesson 6.9% Rest of Market 30.3% InpatientEHRMarketin theU.S. AllInpatientHospitals EHRVendorMarketShares No Vendor Share Cum % 1 Epic 20% 20% 2 Cerner 17% 37% 3 MEDITECH 17% 54% 4 Other 14% 68% 5 McKesson 8% 76% 6 CPSI 7% 83% 7 Siemens 5% 88% 8 HMS 5% 93% 9 Healthland 4% 97% 10 Allscripts 4% 100%
- 16. Hospital EHRs: 2015 Market Share 16 AllInpatientHospitalSystems EHR VendorMarketShare
- 17. Epic: Relentless Dominance > Current market leader • Most commonly selected EHR by eligible professionals participating in meaningful use > Founded in 1979 by computer scientist and current CEO, Judy Faulkner > Clients: • Kaiser Permanente in Oakland, CA • Cleveland Clinic in Cleveland, OH • Johns Hopkins Medicine in Baltimore, MD • Massachusetts General Hospital in Boston, MA • Mount Sinai Health System in New York, NY EPIC HAS BEEN NAMED THE BEST OVERALL SOFTWARE SUIT AND OVERALL PHYSICIAN PRACTICE VENDOR FOR FIVEYEARS INA ROW. 17
- 18. Epic: Physician & Industry Perspectives • Does an incredible job on implementation process • Just follow the advice from start to finish Implementation • Provides integration necessary to reach MU • Makes it more feasible to reach MU requirements Integration 18
- 19. Cerner: Don’t Count Us Out > Second greatest market share > Founded in 1979 by current Chairman and CEO, Neal Patterson > Largest independent health information technology company in the world > Consistently receives high marks in independent user satisfaction surveys > Clients: • University of Pittsburgh Medical Center in Pittsburgh, PA • Indiana University Health in Indianapolis, IN • Banner Health in Phoenix, AZ • Memorial Hermann Health System in Houston, TX • Adventist Health System in Winter Park, FL 19
- 20. MEDITECH: We’re Still Here > Third greatest market share > Founded in 1969 by current Chairman, Neil Pappalardo > Committed to being environmentally friendly > Supports more than 43 unaffiliated nonprofit organizations > Clients: • CHRISTUS Health in Austin, TX • Swedish Covenant Hospital in Chicago, IL • Henry Mayo Newhall Hospital in Valencia, CA • Citizens Memorial Healthcare in Bolivar, MO • St. Agnes Healthcare in Baltimore, MD 20
- 21. A Look at The Top Ambulatory EHR Vendors KeyCharacteristics MajorPlayers 21 Relentless Improvement Good Customer Service Reliability High Quality
- 22. Ambulatory EHRs: Top Vendors 22 • Private American company • Consistently the #1 EHR vendor for market share • Expensive • Private American company • #1 EHR for Customer Satisfaction • Cost effective: No Implementation Fee • Public American company • Consistently in Top 3 for market share • Expensive
- 23. Ambulatory EHRs: 2015 Market Share 23 AmbulatoryEHRMarketWith>100Beds AllAmbulatoryHospitals EHRVendorMarketShares No Vendor Share Cum % 1 Epic 23% 23% 2 Practice Fusion 22% 45% 3 Cerner 14% 58% 4 Allscripts 10% 68% 5 MEDITECH 9% 77% 6 CPSI 7% 83% 7 McKesson 5% 88% 8 NextGen 4% 92% 9 eClinicalWorks 4% 96% 10 Healthland 4% 100% Epic 28% Practice Fusion 14% Cerner 13% Allscripts 12% MEDITECH 10% Rest of Market 23% AmbulatoryEHRMarketWith<100Beds Practice Fusion 21% Epic 16% Cerner 14% CPSI 13% MEDITECH 8% Rest of Market 28%
- 24. Practice Fusion: Rising Up the Ranks > Commonly selected EHR by eligible professionals participating in meaningful use > Founded in 2005 by former CEO, Ryan Howard > Free support and training > Designed for individual and solo practice > Clients: • Carolina Complete Medical in High Point, NC • Health Aim Inc. in Walnut Creek, CA • Oak Tree Osteopathy in San Diego, CA • Concierge Family Practice in Austin, TX PRACTICE FUSION HAS NO IMPLEMENTATION FEE, CONTRACTS OR TERMINATION PENALTIES. 25
- 25. What does this mean for GLG clients? 26 Key Questions: What are the common pitfalls with EHR systems on the market? What is the competitive landscape like? How is the market for EHR evolving? Are you familiar with the implementation of various EHR systems? Council Members of Interest: John D’Amore Mike Mytych Michael Sills, MD Richard Wong, MD Companies of Interest: Epic Systems Cerner Corporation MEDITECH Practice Fusion
- 26. Takeaways > Transition to electronic records is contingent on how fast the world is evolving > EMRs and EHRs are essentially synonymous • Mainly use “EHR” term because its stated as that in Meaningful Use > Issues and workflows are different between ambulatory and hospital EHR’s • EHR system for an outpatient setting is not suitable for an inpatient setting • EHR system for an inpatient setting is not suitable for an outpatient setting > Epic is dominant and shows no signs of slowing down > GLG must be knowledgeable about clients’ interest in this industry • Recruit CMs who have expertise with the selection and implementation process of various EHR systems • Recruit CMs who are familiar with market share of various EHR vendors 27
- 27. Questions? 28