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Marshfield Clinic’S Integrated Medical-Dental Electronic Health Record Environment

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Marshfield Clinic’S Integrated Medical-Dental Electronic Health Record Environment Will Open Source Health IT Set You Free? Robert M. Kolodner, MD Chief Health Informatics Officer Open Health Tools, Inc. Friday, 4 March 2011 HRSA HIT and Quality Webinar “Overview of Open Source: Tools, Health IT, and Solutions for the Safety Net Community” Topics I. Context for Health IT II. The Current State of EHRs III. My Personal Journey IV. A Possible Next Phase for Open Source Health IT Kolodner - HRSA HIT and Quality Webinar 2 4 March 2011 Context • Outcome: Health & well-being • Enabler: Health Information • Means: Health IT solutions o By which the health information is . Captured . Accessed . Used 3 Kolodner - HRSA HIT and Quality Webinar 3 4 March 2011 3 Health IT Dimensions Personal Health Health Care Population Delivery Health Kolodner - HRSA HIT and Quality Webinar 4 4 March 2011 3 Health IT User populations Individuals & Caretakers Public Health, Care Quality Providers Improvement, & Research Staff Kolodner - HRSA HIT and Quality Webinar 5 4 March 2011 Today’s Focus Care Providers Kolodner - HRSA HIT and Quality Webinar 6 4 March 2011 Today’s Focus Electronic Health Records (EHRs) • Interoperability o Other EHRs, PHRs, HIEs, labs, pharmacies, etc. • Aggregate capabilities o Quality Monitoring / Reporting, Analytics, etc. • Telemedicine • Home telehealth Care Providers Kolodner - HRSA HIT and Quality Webinar 7 4 March 2011 Today’s Best Electronic Health Records Kolodner - HRSA HIT and Quality Webinar 8 4 March 2011 Today’s Best Electronic Health Records …are not yet a “Model T” Kolodner - HRSA HIT and Quality Webinar 9 4 March 2011 Brief History of “Group-Developed” Clinical Software • Bright, “innovator,” clinician-geeks wrote clinical software systems to meet their own needs • Software developed collaboratively for use in their clinics and hospitals by clinicians and computer scientists at academically-affiliated institutions created o L Weed, O Barnett, H Warner, C McDonald, G Stead, D Lindberg, J Myers… • Software developed collaboratively for use at multiple sites beyond the initial developer (COSTAR) • Software developed collaboratively by clinicians and developers at large multi-facility institutions (VA, IHS) Kolodner - HRSA HIT and Quality Webinar 10 4 March 2011 Open Source EHRs – A Very Incomplete List o VistA . VA (FOIA) . WorldVistA . Medsphere . DSS o RPMS . IHS . Medsphere o ClearView o Tolven o Misys Open Source Systems (MOSS) o OpenMRS o OpenEMR o OpenEHR Kolodner - HRSA HIT and Quality Webinar 11 4 March 2011 My Evolutionary Journey • Clinician (psychiatrist) • 31 years in government – VA & HHS/ONC • Thought I understood the value of Public Domain and Open Source health IT software • Realized that even with (open source) VistA or RPMS, I could not have the best, most efficient, safest EHR o Due to the fragmented, balkanized state of health IT • Could a different approach lead to a more effective approach? Kolodner - HRSA HIT and Quality Webinar 12 4 March 2011 A Different Way to Think About Open Source • Could the critical aspect be the PROCESS, not the product? o **Collaboration** o “Network effect” – more innovations from more people . Bigger effect if open source INCLUDED proprietary product users • Is an ECOSYSTEM necessary to be self-sustaining and achieve “viral” growth? o Self-organizing and self-defining o Impact of diversity “better” solutions available? • Could the critical driver for better solutions be USER CHOICE? o User choice re “best value” – worth paying more or not? o Antithesis of “product lock-in” (not just “vendor lock-in”) o Dependent upon architecture – “modularity” and interfaces o Not necessarily better with “open source” than “proprietary” . BOTH can be equally restrictive Kolodner - HRSA HIT and Quality Webinar 13 4 March 2011 Open Source Products (Vs. Proprietary) • Cheaper? [Total Cost of Ownership] – Not necessarily o There are less expensive, high quality, proprietary EHRs now on the market o Run and maintain remotely (in the “cloud”) -- where bandwidth is available • Mix-and-match better with other products? - No o Open source products focus on their user base . Multiple, “stove-piped,” open source EHRs exist o Barriers to “snapping together” modules / components . Architecture & interface standardization issues >> licensing • Should clinicians have to be geeks to have / use EHRs? – NO!! Kolodner - HRSA HIT and Quality Webinar 14 4 March 2011 What is “the Technology World” Like Outside of Health IT? • Characteristics of other (mature) technology sectors o Highly competitive: customer-driven (user-driven) market o Innovative: Rapidly changing solutions o Increasing value: More functionality at same or less cost o Companies compete by providing better value, not by competing on infrastructure o Exponential growth and greater opportunities once standard infrastructure established • Periodic disruptions causing market leadership to change using evolving business models o Lower cost more affordable by more customers Kolodner - HRSA HIT and Quality Webinar 15 4 March 2011 Next Step in Health IT – “Hybrid Open Source?” • Open source infrastructure (“platforms”) across products o Proprietary as well as open source o Hybrid solutions – open source, proprietary, or combination • “Tools” to speed transition and use o For developers to create solutions o For users to easily choose, combine, & configure their own solutions . Alternatively, lower cost to hire “solution providers” to do the work • An evolutionary path for existing products and solutions o Products become modular with standardized “linkages” o Some will choose to compete / ignore and become dinosaurs Kolodner - HRSA HIT and Quality Webinar 16 4 March 2011 Did You Know What the Future Was Going to Look Like? Kolodner - HRSA HIT and Quality Webinar 17 4 March 2011 The Future of Health IT • Health IT solutions o Available more quickly o Require less skill to use o Lower cost o More convenient “Faster, easier, cheaper, more convenient” Kolodner - HRSA HIT and Quality Webinar 18 4 March 2011 Anticipated Health IT Impacts • Better health and care outcomes o Improved health IT solutions for managing health information • Fosters innovation o “Low barrier to entry” for improvements • Unleashes user-driven collaboration o Not constrained by “product” boundaries . Proprietary or open source • Explosion of choices o EASY for users to select and implement Kolodner - HRSA HIT and Quality Webinar 19 4 March 2011 Notable Quote – W. Edwards DeMing “You don’t have to change; survival is not mandatory.” Kolodner - HRSA HIT and Quality Webinar 20 4 March 2011 Health Resources and Services Administration's Office of Health Information Technology and Quality Webinar Series “Overview of Open Source Tools Health IT and Solutions for the Safety Net Community” Integration of an Open Source EDR with a Proprietary EMR: Marshfield Clinic’s Integrated Medical-Dental Electronic Health Record Environment March 4th, 2011 Presentation By: Amit Acharya, BDS, MS, PhD Dental Informatics Scientist Marshfield Clinic, Wisconsin Marshfield Clinic ● Non-Profit Organization ● 52 locations and 2 hospitals ● 3,741,308 patient encounters in 2010 ● 376,708 unique patients in 2010 ● 86 different medical specialties ● 772 physicians ● 400+ research and educational projects ● 30,000 square miles of primary service area Family Health Center of Marshfield, Inc. ●Mission - to improve access to primary care services for the medically underserved and to enhance the health of our communities ●Partners with Marshfield Clinic to provide dental service along with other services ●Developed dental capacity that is not just accessible but welcoming to low-income children and their parents Health Information Technology’s Role in Eliminating Oral Health Access Disparities Develop HIT to enable the integration of oral health with medicine in order to succeed beyond the expressed demand for dental care (once the capacity is in place) and reach deeper into the need in the underserved population for dental preventive and other services ● Address dental health literacy in medicine for pregnant women or those planning a pregnancy ● Provide targeted physician anticipatory guidance to parents and referral to dental for children delinquent on dental exams ● Coordinate appointments for medical and dental visits to increase convenience for patients and reduce no-shows Creating Access to Dental Care Primary and Secondary Target Areas • 7 FQHC providing dental services to people from all of Wisconsin's 72 counties • 39 (FTE) dentists • 30,680 unique dental patients [2010] • 40,000 unique dental patients [budgeted 2011] • Number of jobs created in these communities: 88.7 (FTE) plus support staff Table of Number of Unique Patients by Payor by Dental Center: Clinic FY10 Dental Center Commercial/Self-pay Medicaid Low-income Multiple Financing Total Chippewa Falls 1196 7554 880 817 10447 Ladysmith 1551 4654 920 616 7741 Marshfield 92 553 163 73 881 Medford 320 2153 392 223 3088 Neillsville 491 2245 388 235 3359 Owen 468 746 127 93 1434 Park Falls 641 2658 504 333 4136 Rice Lake 153 1417 165 112 1847 Total CY 2010 in aggregate 4687 20440 3228 2325 30680 Percent 15.3% 66.6% 10.5% 7.6% 50+ Years of Informatics@Marshfield 1967 1968 1995 2005 2006 2007 First Informatics Electronic 100% Physician Weston CCHIT Chartless Clinical Trial Data Capture Computer Use Opens 1952 1978 1991 2001 2007 First First Lab MECCA EOC CTSA Telemedicine Application coding 1950 1960 1970 1980 1990 2000 2010 1960 1964 1975 1994 2002 2008 Coded IT Group SJH / MC RECIN PRMP Dental- Data formed form CMR Medical
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