# Presentation: 142722

## MASSACHUSETTS eHEALTH COLLABORATIVEAHRQ Annual Meeting

**September 26, 2007**

## MAeHC ROOTS ARE IN MOVEMENT TO IMPROVE QUALITY, SAFETY, EFFICIENCY OF CARE

**Universal adoption of electronic health records**
**MA-SAFE**

**$50M commitment to heath information infrastructure**
**Recognition of “systems” problem**

## MAeHC BOARD OF DIRECTORS

**MAeHC BOARD OF DIRECTORS**

**Health plans and payer organizations**
**Blue Cross Blue Shield of Massachusetts**
**Fallon Community Health Plan**
**Harvard Pilgrim Health Care**
**Massachusetts Association of Health Plans**
**Tufts Associated Health Maintenance Organization**
**Healthcare purchaser organizations**
**Associated Industries of Massachusetts**
**Massachusetts Business Roundtable**
**Massachusetts Group Insurance Commission**
**Non-voting members**
**Center for Medicare & Medicaid Services**

**Hospitals and hospital associations**
**Baystate Health System**
**Beth Israel Deaconess Medical Center**
**Boston Medical Center**
**Caritas Christi**
**Fallon Clinic, Inc.**
**Lahey Clinic Medical Center**
**Massachusetts Hospital Association**
**Massachusetts Council of Community Hospitals**
**Partners Healthcare**
**Tufts-New England Medical Center**
**University of Massachusetts Memorial Medical Center**
**Governmental agencies**
**Executive Office of Health and Human Services**

**Healthcare professional associations**
**American College of Physicians **
**Massachusetts League of Community Health Centers**
**Massachusetts Medical Society**
**Massachusetts Nurses Association**
**Consumer, public interest, and at-large**
**Health Care for All**
**Massachusetts Coalition for the Prevention of Medical Errors**
**Massachusetts Health Data Consortium**
**Massachusetts Taxpayers Foundation**
**Massachusetts Technology Collaborative**
**MassPRO, Inc.**
**New England Healthcare Institute**
**Massachusetts Health Quality Partners**
**Tufts University Medical School**
**UMass Medical School**

## PILOT SELECTION

## MAeHC ARCHITECTURE AND DATA FLOWS

***Provider-level:  ***
***EHR***

## FRAMEWORK

**What do we want to create**
**and why?**

**Market dynamics**
**Definition of business concept**
**Economic model**

**Business concept **
**development**

**How are we going to build it?**

**Infrastructure build**
**Stakeholder acquisition**
**Customer acquisition**
**Performance metrics**

**Business creation**

**How do we plan to implement our strategy?**

**Organization model**
**Resource identification**
**Launch plan**

**Implementation planning**

## REVENUES

**Medical charges**
**Medical charges**
**Medical charges**
**Medical charges**
**Medical charges**

**REVENUES**

**Description**

**Lower patient volume during implementation**
**Higher patient volume**
**Higher charge capture**
**Better receivables management**
**Better ability to benefit from existing incentives or P4P**

**Impact on ROI**

**Main driver**

**Reduced schedule during implementation period**
**Redeployment of staff time from administrative tasks (e.g., chart-chasing) to patient interactions and/or conversion of paper medical records space to exam room**
**More efficient scheduling – better ability to track and fill missed appointments**
**More complete coding and documentation**
**Lower claim rejection due to filing errors**
**Better tracking of accounts receivable (or elimination of need for billing service)**
**Better benchmarking and ability to document metrics required for incentives**

**One-time or ongoing**

**One-time**
**Ongoing**
**Ongoing**
**Ongoing**
**Ongoing**

**+**

**+**

**+**

**+**

**Physician offices**

**1**

## COST (I)

**category**

**Information technology**
**Information technology**
**Physician/ staff time**
**Staff time**
**Admin supplies**
**Staff time**
**Staff time**

**COST (I)**

**Description**

**IT investment and installation**
**IT maintenance**
**Higher physician and staff training time**
**Lower transcription costs**
**Lower postage, fax, copier costs**
**Lower staff medical records handling time**
**Higher staff scanning time**

**Impact on ROI**

**Main driver**

**Hardware, software, network, broadband**
**Workflow design**
**IT system design, setup, integration**
**Support, maintenance, upgrades of hardware, software, and network**
**Broadband service**
**Training time for workflow design and system usage**
**Direct entry into EHR (typing, template, voice recognition)**
**Referral letters, reports, diagnostic results entered and sent electronically (scanned, fax server, electronic data exchange)**
** ****No chart search, pull, re-file time**
**Scanning hard copy information for inclusion in patient record**

**One-time or ongoing**

**One-time**
**Ongoing**
**One-time**
**Ongoing**
**Ongoing**
**Ongoing**
**Ongoing**
**Ongoing**

**+**

**+**

**+**

**Physician offices**

**1**

## COST (II)

**category**

**Staff time**
**Staff time**
**Staff time**
**Staff time**
**Malpractice insurance**

**COST (II)**

**Description**

**Lower staff prescription refill process time**
**Lower staff order and results management time**
**Lower coding time**
**Better quality of life**
**Lower premiums**

**Impact on ROI**

**Main driver**

**E-prescribing solution streamlines refill process**
**Orders sent directly to diagnostic facility**
**Results imported directly into record**
**Automated orders-results reconciliation**
**ICD-9 codes linked from clinical record**
**Less time, lower frustration, from more streamlined administrative tasks**
**Lower liability exposure due to lower error rates, better documentation, better ability to track & follow-up patients, and other factors**

**One-time or ongoing**

**Ongoing**
**Ongoing**
**Ongoing**
**Ongoing**
**Ongoing**

**+**

**+**

**+**

**+**

**+**

**Physician offices**

**1**

## SET PRIORITIES AND LAY OUT THE ROADMAP

| Network Data
Source | Results
Delivery | Research | Decision
Support | Disease
Mgmt &
Comm.
Health | Clinical
Trials
Screening
& Mgmt | Public
Health
Lab
Reporting | Public
Health
Surveil-
lance | Creden-
tialing | Eligibility,
Referrals,&
Precertifi-
cation |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| Hospitals | H | H | H | H | H | H | H | H | H |
| External Labs | H | H | H | H | H | H |  |  |  |
| Pharmacies | L | H | H | H | H |  | M |  |  |
| Phys. Practices |  | H | M | H | H |  | M | M | H |
| Amb. Radiology | M | M | M | M | M |  |  |  |  |
| Cardiology | M | M | L | M | M |  |  |  |  |
| Public Health |  | M | M | M |  |  |  |  |  |
| Payors |  |  |  | M |  |  |  |  | H |

**Revenue potential**

## THE BIG PICTURE IS AS MURKY AS IT EVER WAS...

**The message on quality and measurement is starting to sink in, but there is no sense of urgency**
**Large groups and hospital-employed moving faster, but small practice penetration is lethargic**
**Small practices don’t see this as a “competitive advantage”**
**Current reimbursement model doesn’t provide enough focused incentives to accelerate adoption, largely because of upfront capital and technical capacity hurdles**
**Supply- and demand-side too fragmented**
**P4P without EHRs too shallow to make a difference**
**Even if adoption increased on its own, the market won’t implement these systems to deliver value**
**Bad systems and/or bad implementations offer little, if any, value**
**Failure in retail market is on the order of 30%**
**EHRs don’t spontaneously generate meaningful clinical data – required behavior and process changes are rarely implemented by practices on their own **
**Physicians don’t capture (or understand) the full benefit of connectivity, so they won’t invest in it on their own**
**Not clear how to develop interoperable network in *****laissez-faire***** model – medical trading areas not formally organized in a way that facilitates definition of local network business**

## ...AND THE CLOSER YOU GET....THE MURKIER IT GETS 

**The economists are right – public goods problems are real**
**Physicians aren’t clambering for this  **
**They want some business functions – like document transfer and lab results – but not pounding the table for shared patient information**
**Inter-operability isn’t as hard as people say it is.......it’s much worse**
**Highly variable degree of sophistication among even the best vendors**
**Just because they told the CCHIT they can do something doesn’t mean that they’ve done it before, or that it won’t require a large amount of $$$ development, or that they’re willing to do it**
**No one has really done this before, regardless of what they or their references told you**
**Capacity constraints of health care organizations (both hospitals and physician offices) and vendors, and coordination requirements among the many players, is an enormous challenge**
**Everyone’s not ready when you are.....and vice versa**
**Everyone’s not ready to work on the same weekends that you need them to**

## SOME OBSERVATIONS FOR THE WEARY (OR SOON TO BE WEARY)

**There is no secret sauce, silver bullet, cookie cutter, or shortcut – each market is different**
**Who’s got the market power?  Physicians, hospitals, or insurers**
**If you don’t have the CEO, you don’t have the organization**
**The vision will get you going, but it won’t keep you going**
**It takes business people to create businesses**
**Businesses are mercenary**
**Most physician offices are businesses – they’re just not very good ones**
**What you’re trying to sell is only as valuable as someone is willing to pay for it**
**Everything has competition**
**No one will pay to be a guinea pig**
**Those with “deep pockets” *****despise***** being approached just because they “deep pockets” **
**Assume that a grant is a gift that will keep on costing**