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What Finance Needs to Know
About EHR’s
Hint - It’s Not the Technology
Michael A. Rosencrance
VP, Information Services
November 14, 2012
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Spectrum Health
An Integrated Health System
Complete Continuum of Care
Priority Health
Net Revenue $2.4 billion
Delivery System
Net Revenue $2.3 billion
Access
Delivery
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Spectrum Health at a Glance
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19,000 employees - West Michigan’s largest employer
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1,500 physicians
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2,550 active volunteers
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9 hospitals, including the only dedicated children’s hospital
in West Michigan
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183 service sites
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$204 million in community benefit provided in fiscal
year 2012
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Where We Are – Delivery System
Delivery System
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Grand Rapids – Butterworth Hospital,
Blodgett Hospital,
Helen DeVos Children’s Hospital,
Special Care Hospital
Greenville – United Hospital
Lakeview – Kelsey Hospital
Reed City – Reed City Hospital
Fremont – Gerber Memorial Hospital
Zeeland – Zeeland Community
Hospital
183 service sites
More than 70 physician practice sites
Comprehensive post-acute care
And Now for Something Completely Different
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McDonald’s Health System
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Are You Serious?
What are our major problems?
Why do people eat at McDonald’s
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Access
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Service*
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Outcomes
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Consistency*
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Cost of Service
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Inexpensive (Value)*
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Patient Experience
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Top Ten Global Brand**
* epinions.com survey
** Business Week
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The Real Reason…..
Clearly defined processes
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Standard work
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Continuous improvement
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Management assistance
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Not Buying It…..How About This?
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Toyota Production System
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The NUMMI Experiment
1984 – Toyota/GM Joint Venture
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New United Motor Manufacturing, Inc
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Occupies the former GM Fremont, CA plant
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Uses the same employees and management
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Complete operational and financial turnaround
What did GM take away from this?
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Not a thing!
Process First, Technology Last
“We get brilliant results from average people, managing brilliant
processes. We observe that our competition often gets
average (or worse) results from brilliant people managing
broken processes.”
- Fujio Cho, Vice Chairman
Toyota Motor Corp.
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Applying Lean Principles
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So What’s the Point?
EHR’s ≠ ROI
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The Easy $$$ from EHR’s
Low hanging fruit
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Medical record handling
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Transcription
Some staff redeployed
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Scanning
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Clinical content development
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The Knowledge Gap
Explosion of medical journal articles
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1978-1985 – 1.88M articles published
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1995-2001 – 2.79M articles published (48%)
Institute of Medicine – Crossing the Quality Chasm
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17 years from randomized controlled trials to practice
Cookbook Medicine
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So What’s Wrong with Cookbook Medicine?
Its more than a recipe….
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Clinical Content is
standardization but it remains just
a guide.
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Proper diagnosis must still take
place.
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BUT…..potential to shorten the
cycle time from research to
practice WILL impact outcomes.
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But At What Price?
Physician Dissatisfaction
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From physician to clerk
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Taking work home
Burden on Primary Care Physicians
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Medications/Problems
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Social/Family history
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Center of all activity
We must rethink the paradigm…
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Accountable Care Organizations
“A group of healthcare providers who give coordinated care,
chronic disease management, and thereby improve the quality
of care patients get. The organization’s payment is tied to
achieving health care quality goals and outcomes that result in
cost savings.”
HealthCare.gov
(US Dept of Health and Human Services)
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ACO’s – Managed Care 2.0
Lead with Quality
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Meaningful Use – America’s Quality Agenda
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P4P
Successful Equation
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Like MC 1.0 – manage risk
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Continuum of Care within the ACO
Right care, right location, right time
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EHR’s and ACO’s
Key to ACO success = Data….lots of data
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EHRs will be the primary source
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Remove unnecessary care, reduce variation (identified thru data)
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Up to 80% of physician clinical decision not data driven*
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Manage chronically ill using…..data.
* Darst JR, et al. Deciding without Data. Congenital Heart Disease. 2010;5:339
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Post 9/11 – Bio Terror Threat
Nationwide Health Info Network
Public Health
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Epidemic tracking
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ICD-10 tie in….more specificity
Bio Terror Assessment
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Syndromic surveillance
Big Data = Big Brother?
Courtesy of filmapia.com
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Big Brother – Audits and the OIG
Direct Connection EHR to Service
Allows Computer Assisted Coding
Ease Transition ICD9 – ICD10
Government Fraud Crackdown
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“Cracking the Codes”
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EHR Tools Design/Review
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Balance Use vs Guidance
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Compliance and Education
EHR  Genomics
“The Patient Will See You Now”
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Predictive analytics
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Personalized Healthcare
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Anticipating Your Health Events
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Key Takeaways
EHR’s ≠ Improved Performance
A tool to narrow the knowledge gap
Change the practice paradigm
Absolutely necessary to succeed in an ACO environment
Will also provide the foundation for HIE’s and analytics
Some risk of abuse w/o careful management
The first step to personalized care
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Questions?
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Sources
Gregory Goth, A New Age of Biosurveillance is Upon Us (govhealthit.com, Oct 2011)
(http://www.govhealthit.com/news/new-age-biosurveillance-upon-us?page=0,1)
Carey James Kriz, The Patient Will See You Now (Maryland: Roman and Littlefield
Publishers, 2008)
Fred Schulte, Cracking the Codes (publicintegrity.org, Oct 2012)
(http://www.publicintegrity.org/health/medicare/cracking-codes)
Institute of Medicine, Crossing the Quality Chasm (National Academies Press, Apr 2001)
WBEZ, This American Life – NUMMI, (thisamericanlife.org, Mar 2010)
(http://www.thisamericanlife.org/radio-archives/episode/403/nummi)
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