Notes

Outline

The Challenge of Clinical I.T. Adoption National Institute of Standards and Technology and Concurrent Engineering Research Center Information Technologies for Healthcare:  Barriers to Implementation August 1, 2002 C. Martin Harris, M.D. Chief Information Officer The Cleveland Clinic Foundation

Challenges of Clinical I.T. Adoption for Providers Internal workflow

Workflow Principles

Functions Requiring Coordination

Workflow Grinding Points Time with Patient Documentation Requirements Pre-Approved Processes Clinical Service Coordination Denials of Service Office Expense Mgmt        Coordination of Clinical        Documentation and Billing/        Administration

Clinical Information Technology Critical Adoption Factors:  A Practical Experiment

Guiding Principle

An Experiment Maintain Throughput Qualitative Workflow Improvements Quantitative Workflow Improvements Clinical Quality Improvement

Electronic Medical Record  Current Use - Statistics and Trends

"Physician Appointment Schedules" Physician Appointment Schedules Physician In-Basket Results Review Physician Driven Order Entry Problem List Management Clinical Documentation (tools include dictation with e-sign) Patient / Referral Letters Health Maintenance and Other Alerts

Patient Snap Shot

Medication Order Entry

Drug Interaction Alert

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Positive Workflow Impact General Benefits work is categorized and pushed to provider available from any location Results Management manages all tests ordered in a session identifies incomplete diagnostic testing plans Episodes of Care all interventions such as testing and drugs can be easily linked to clinical problems over time

Positive Workflow Impact Communications all care providers, MD’s, RN’s, schedulers, front desk receptionists, utilize system as a communication tool status of patient in the facility is a function of work process basis for online communication with patients Rules Management administrative and clinical decision making can be supported by real-time decision support tools

Negative Workflow Impact Start-Up training impact on patient throughput Documentation mixed input model required external documents Administration does not eliminate many paper related forms

"Clinical Cost Management and Service..." Clinical Cost Management and Service Improvement

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Other Opportunities No Show Rate Comprehensive Batch     Real-Time Verification Guarantor Billing for New Covered Services Enhanced Chart Capture Including Point of Service Testing Transcription Cost Management Record Circulation Cost

Global Practice Impediments to Clinical IT Adoption Cost although service is improved, costs are usually incremental to existing practice expenses Reimbursement reimbursement improvement opportunities are limited

Global Practice Impediments to Clinical IT Adoption Administrative some progress but predominantly regional between payors, providers and employers online verification, authorization, remittance Clinical lack of a universal patient identifier variable diagnostic testing standards for data interchange (data and images) rapidly expanding sources of clinical information

Summary Clinical IT adoption positively influenced by workflow improvement general benefits results management episodes of care communications rules management Cost remains a significant challenge especially for small practices where the majority of medicine if practiced Reimbursement strategies have not changed to include the adoption of I.T. with demonstrated best practice methodologies and outcomes Data communications standards are limiting external information integration into the local practice arena