CLINICAL SYSTEMS APPLICATIONS
AND RELATED TECHNOLOGY:
TODAY AND INTO THE FUTURE
Prof. Steven H. Shaha, PhD, DBA
Centre for Public Policy & Administration
KLAS Research
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
Disclosures & Bio
PROF. STEVEN H. SHAHA, PHD, DBA
PROFESSOR, CENTER FOR PUBLIC POLICY & ADMINISTRATION
DIRECTOR, KLAS PERFORMANCE INSIGHTS, KLAS RESEARCH
100+ peer-reviewed publications, 200+ peer-reviewed presentations, 2 books
Advisory and consulting work for 10 governments in Asia, Australia and Europe including
France, Spain, Switzerland, Netherlands, Singapore and Malaysia
Advisory and consulting to over 50 non-healthcare organizations, including Disney,
Ritz-Carlton, Coca-Cola, New Line Cinema, IBM, AT&T, Time Warner, Kodak,
Johnson & Johnson, Marriott, U.S. Dept of Defense
Employment history includes: Coca-Cola, RAND Corporation, UCLA Medical Center,
Intermountain Health Care, Gartner Group, Inst Integrated Outcomes, Allscripts
Professor or Lecturer or at 14 professional academies and graduate schools, e.g.
Harvard, Columbia, Cornell, UCLA, MIT, UMass
Academic Appointments (current): Center for Public Policy and Admin, Harvard (lecturer),
Zayed Univ (UAE), University of Utah
Education:
PhD, Research Methods & Applied Statistics
DBA, Business Administration (PhD)
MA, MEd, BS
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
THE EPR-ENABLED POSSIBILITIES
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
Improved Stroke Outcomes
Impact
ofofStroke
Stroke
ofOutcomes
Outcomes
EMR/EHR
Toolkit:
Impact
Solution
Set:
Set:
Order
Admission
Stroke
ImpactImpact
Comparative
Quality
with
versus
without
with Intelligent
Order
Sets
and
Advanced
CDS
Comparative
Quality
with
versus
without
without
versus
with
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
Stroke Care Best Practices
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
CPOE w/ alerts alone
Improved Stroke Outcomes
Impact
EMR/EHR
Impact of
StrokeofOutcomes
Solution Set:
with Intelligent
Order
Setswith
andversus
Advanced
CDS
Comparative
Quality
without
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Stroke Care Best Practices
http://cwhonors.org/viewCaseStudy2010.asp?NominationID=186&Username=shssos, accessed 5-apr-13
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
With CDS-rich Order Set
CPOE w/ alerts alone
Improved Stroke Outcomes
EMR/EHR
Impact Impact
of StrokeofOutcomes
Solution Set:
Comparative
Quality
without
with Intelligent
Order
Setswith
andversus
Advanced
CDS
With CDS-rich
Order Set
100%
90%
40.5% Greater
Clinical
Excellence
80%
70%
60%
Without
50%
40%
30%
20%
10%
0%
Stroke Care Best Practices
http://cwhonors.org/viewCaseStudy2010.asp?NominationID=186&Username=shssos, accessed 5-apr-13
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
With CDS-rich Order Set
Improved Stroke Outcomes
Discharge Patterns
CPOE w/ alerts alone
Readmissions in 31 Days
9.4% more
(p<.001)
35.7 % fewer
(p<.001)
16.0% fewer
(p<.001)
21.4% fewer
(p<.001)
Discharge to Home
Discharge to SNF
Discharge to IP Rehab
Length of Stay
12.7% lower (p<.05)
(p<.001)
Average Direct Cost/Case
CDS-rich Order Set
Without Order Set
Financial Impact
11.4% lower (p<.05)
7.5% lower
0.35 fewer days avg.
CDS-rich Order Set
Without Order Set
Average Indirect Cost/Case
Estimated savings of £140k-340k annualized
http://cwhonors.org/viewCaseStudy2010.asp?NominationID=186&Username=shssos, accessed 5-apr-13
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
With CDS-rich Order Set
Improved Stroke Outcomes Continue
after Discharged
CPOE w/ alerts alone
Discharge Patterns
9.4% more
(p<.001)
16.0% fewer
(p<.001)
21.4% fewer
(p<.001)
Discharge to Home
Discharge to SNF
Discharge to IP Rehab
http://cwhonors.org/viewCaseStudy2010.asp?NominationID=186&Username=shssos, accessed 5-apr-13
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
With CDS-rich Order Set
Better Outcomes after Discharge
CPOE w/ alerts alone
Admissions to Skilled Nursing Facilities
Length of Stay
Readmissions in 31 Days
4.1 % shorter
(p<.001)
7.7 % fewer
(p<.001)
Care Coord Network
Pre
Care Coord Network
Pre
Additional Efficiencies
• Capacity for 130 additional admissions
with NO staffing increases
http://cwhonors.org/viewCaseStudy2010.asp?NominationID=186&Username=shssos, accessed 5-apr-13
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
EPR REALITIES: “NOT EVERYONE CAN…”
Good News
• Quest for Interoperability and Integration
• Focus on Implementation Excellence
• Importance of Local Uniquenesses
Challenges
 Quest for Interoperability and Integration
 Implementation Challenges
 Local Uniquenesses
 Conflicting Priorities
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
RESEARCH MODEL
•
•
•
•
3,000+ Provider surveys and calls annually
Scores on 25-item Survey
Provider Narratives and Quotes
Comparatives by Vendor, Market, Product
Type
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
COVERAGE LIST
Acute Care EMR
Ambulatory EMR
Ambulatory Specialty
Anesthesia
Anesthesia
Cabinets
Application Hosting (CIS/ERP/HIS)
Automated Medication Dispensing Units
Budgeting
Business Intelligence/Reporting
C-arm Cardiology
Cardiology
Hemodynamics
Claims and Clearinghouse Services
Clinical Decision Support - Order Sets
and Care Plans Clinical Decision Support - Point of Care Clinical Reference
Clinical Decision
Support - Surveillance Clinical Portals/Aggregation
Clinical Procedure Documentation
Clinical
Specialty
Community HIS CR - Multi Plate
CR - Single PlateCT - 64-slice+
CT - Under 64slice
CV/IR X-ray
Decision Support - Business
Dictation and Transcription
Digital X-ray
Digital X-ray – Mobile Discharge Planning
Document Management and Imaging
DXA
ECG Resting ECG Data Management Eligibility Enrollment Services
Emergency Department
EMPI
Enterprise Advanced Visualization
Enterprise Scheduling Extended Business Office
Financial Specialty
Financial/ERP Health Information Exchange (HIE)
HIE Consulting
Homecare
ICD-10 Consulting
Image Archive Outsourcing
Image Exchange
Imaging
Specialty
Implementation Clinical - Principal
Implementation Clinical – Supportive
Implementation Services - Financial ERP Implementation Services – Other
Infection Control and
Monitoring
Infrastructure Specialty Interactive Patient Systems
Interface Engines IT
Outsourcing (Extensive) IT Outsourcing (Partial) IV Workflow Management
Labor and Delivery
Laboratory
Laboratory Anatomic Pathology Laboratory Blood Bank Long-Term Care Mammography
- Digital Mammography Information Systems
Medical Device Integration Systems
Medical
Records Coding Medical Records Other Mobile Data Systems
MR - 1.5T
MR - 3T MR – Open
Nurse Call Oncology
Other Business Process Outsourcing
Other ME Solutions
Other Services
Outsourced Coding PACS
Patient Access – Eligibility Checking
Patient Access – Other Patient
Access – Patient Bill Estimation Patient Access – Registration QA
Patient Accounting and Patient
Management Patient Flow
Patient Portals Patient Privacy Monitoring
PET/CT Pharmacy
Pharmacy – Outpatient (Retail) Pharmacy Automation: High-Volume Unit Dose PackagingPharmacy
Automation: IV Robots Pharmacy Automation: Medication Carousels
Pharmacy Automation: Robots
(Oral Solid)
Planning & Assessment Point of Use Inventory Management
Practice Management
Quality Management R&F
RAC Management
Radiation Therapy
Radiology Real-Time
Location Systems (RTLS) Release of Information Revenue Cycle - Chargemaster ManagementRevenue
Cycle - Claims Management Revenue Cycle - Contract Management
Revenue Cycle - Electronic
Attachment
Revenue Cycle - Enterprise Collections Revenue Cycle - Medical Necessity Revenue
Cycle - Other
Revenue Cycle Outsourcing
Revenue Cycle Transformation Self-Service Patient Kiosk
Single Sign-On Smart Pumps - LVP
Smart Pumps – PCA Smart Pumps - Syringe
Specimen
Collection Barcoding
Speech Recognition
Staff Augmentation Staff/Nurse Scheduling
Storage
Surgery Management Talent Management
Technical Services
Teleradiology Services Time
and Attendance Transcription Services Treatment Planning
Ultrasound - CardiovascularUltrasound General Imaging
Ultrasound - Point of Care
Vendor Selection
Virtualization
VNA/Image Archive
Wireless Communications
Women's Imaging (Specialty)
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
COMPARATIVE VENDOR PERFORMANCE
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
COMPARATIVE VENDOR PERFORMANCE
Vendor A EMR Product Name A
Vendor B EMR Product Name B
Vendor C EMR Product Name C
Vendor D EMR Product Name D
Vendor E EMR Product Name E
Vendor F EMR Product Name F
Vendor G EMR Product Name G
Vendor H EMR Product Name H
Vendor I EMR Product Name I
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
EUROPE …
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
Vendor A
Vendor B
Vendor C
Vendor A
Vendor B
Vendor C
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
AN INTRIGUING PATTERN …
• Variability in scores among top vendors?
• Variability between economies?
• Deeper search led to ….
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
Average EMR Satisfaction
SATISFACTION: IT VS. CLINICIANS
Average EMR Satisfaction
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
WHERE ARE THE DIFFERENCES?
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
MEAN RATINGS FOR EMERGENCY SYSTEMS
Mean EDIS Rating (1-100 scale)
Niche
90
53.4% Higher
80
70
60
50
40
30
Enterprise
20
10
0
Niche Applications
Enterprise Solutions
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
USABILITY STUDY
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
32%
Vendor A
Cerner
92%
81%
Vendor Epic
B
90%
50%
Vendor C
Siemens
72%
64%
Allscripts
Vendor
D
67%
33%
Vendor E
MEDITECH v.6
67%
17%
Vendor F
McKesson Paragon
Usability When First Live
42%
0%
10%
20%
30%
40%
Success in Getting to High Usability
50%
60%
70%
80%
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
90%
100%
TWO APPROACHES
• Model A
– Less Prescriptive with Adaptability &
Customizability
– Implement & Adjust
– Users versus Application that adapts
 Model B
 More Prescriptive versus Adaptability &
Customizability
 Implement & Minimally Adjust
 Application versus User that adapts
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
COMPARATIVE USABILITY
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
Model A
40.0%
Model B
30.0%
20.0%
10.0%
0.0%
Usability When
First Live
Ultimate Usability
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
COMPARATIVE TIME TO CLINICIAN AS EXPERT
45.0%
40.0%
35.0%
30.0%
25.0%
20.0%
Model A
15.0%
Model B
10.0%
5.0%
0.0%
<1 Week
1–3
1–2
2–4
>4
Weeks Months Months Months
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
COMPARATIVE TIME TO CLINICIAN AS EXPERT
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
Model A
40.0%
Model B
30.0%
20.0%
10.0%
0.0%
<1 Week
1–3
1–2
2–4
>4
Weeks Months Months Months
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
PRESCRIPTIVE VS. ADAPTIVE?
60.0%
50.0%
40.0%
30.0%
Model A
20.0%
Model B
10.0%
0.0%
None
Minimal
Moderate
Extensive
Customization Customization Customization
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
PRESCRIPTIVE VS. ADAPTIVE?
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
Still 45% Customization
40.0%
Model A
Model B
30.0%
20.0%
Nearly 70% Customization
10.0%
0.0%
None
Extensive
Moderate
Minimal
Customization Customization Customization
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
Average EMR Satisfaction
IT VS. CLINICIANS: AVOIDABLE?
Average EMR Satisfaction
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
SHARED NEEDS
IT
• Quick, Impactful
Implementation
• System Stability & Reliability
• Efficiency
– Hassles
– Waste
• Quality of Care
– Benefits of Outcomes
– Error Avoidance
• Go home
– Sooner
– More worry-free
Clinicians
• Quick, Impactful
Implementation
• System Stability & Reliability
• Efficiency
– Hassles
– Waste
• Quality of Care
– Benefits of Outcomes
– Error Avoidance
• Go home
– Sooner
– More worry-free
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
CONTRASTING NEEDS
IT
Clinicians
• TCO
•
–
–
–
–
Maintenance & Upkeep
Interface requirements
Staff requirements
Vendor relationships
• Coding accuracy
– Financial repercussions
– Administration's needs
– Integrated across settings
• Infinite customers
– Needs and expectation
– Evolving requirements
Specialty-specifics
–
–
–
–
Workflows
Diagnostics
Documentation
Information access
• Population Management
•
Ease of Use
– Quick uptake
– Intuitiveness
•
•
Productivity
Clinical decision support
– Error avoidance
– Patient outcomes
• Across Settings …
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
CAN BOTH SETS OF URGENCIES BE MET?
• YES
– System
• Interoperability and Integration
• Adaptability to Evolving Requirements
– Coding
– Reporting
– Clinical Models
– Culture
• Balance of Stability with Adaptability
• Silos versus Team Work
• Micro versus Macro Perspectives
– Vision
• Population Health balanced with Individual Patient
Needs
• Exceptional Coding balanced with Information Value
• Efficiency balanced with Quality
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
WHAT MATTERS MOST …
Score
8.5
8.4
8.3
8.3
8.3
8.2
8.2
8.2
8.1
8.0
8.0
8.0
7.9
7.8
7.7
7.7
7.5
7.4
7.3
Commodities
Anchors
Customer Ratings
Product Works as Promoted
Ease of Use
Overall Product Quality
Delivery of New Technology
Lives up to Expectations
Likely to Recommend
Overall Satisfaction
Product Response Time
Forecasted Overall Satisfaction
Money's Worth
Quality of Phone/Web Support
Supports Integration Goals
Implementation on Time
Proactive Service
Quality of Implementation
Overall Communication
Quality of Training
Contracting Experience
Executive Involvement
Nuisances
Fires
Predictive Importance
(Correlation with Overall Satisfaction)
WHAT MATTERS MOST?
*Statistically Significant p<.01
Predictive Correlation to ‘Overall
Satisfaction’ in Time Series
KEYS TO SUSTAINABLE IMPACTS
FROM VENDOR
•
•
•
•
Delivery of “New Technology”
Supports Integration Goals
Relationship / Partnership
Usability
– Strong, focused implementation
– Internal relationships
– Mission-focused culture
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
KEYS TO SUSTAINABLE IMPACTS
FROM PROVIDER ORGANIZATION
•
•
•
•
Incorporation of “New Technology”
Quest for Integration Goals
Relationship / Partnership
Clinician Usability
– Strong, focused implementation
– Internal relationships
– Mission-focused culture
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543
CLINICAL SYSTEMS APPLICATIONS
AND RELATED TECHNOLOGY:
TODAY AND INTO THE FUTURE
Prof. Steven H. Shaha, PhD, DBA
Centre for Public Policy & Administration
KLAS Research
For questions or comments, please contact Prof. Shaha at steve.shaha@KLASresearch.com, 801-879-5543