Ambulatory information systems Wendell Murray

Ambulatory information systems

• Wendell Murray

• Wendell Murray Associates Inc.

• www.wpmassociates.com

• Phone: [phone]

• E-mail: [e-mail]

• Copyright © 2006 Wendell Murray All rights reserved

What I do

• Help physicians practices select and implement practice management (PM) and electronic medical records (EMR) systems

• Help healthcare entities of any type: ambulatory, hospital, nursing homes, etc. with operational, strategic and information system issues

• Specific example of PM/EMR system selection and implementation at Gateway Medical

What a client gets

• 40%-150% return on investment in information technology

• Quick evaluation and selection of a software vendor

• Best possible deal with the selected vendor

• Best possible implementation of a system

• Operational and strategic review of the practice

• Help in negotiating with insurance payers, particularly Independence Blue Cross and related companies

• Advice regarding relevant trends in the healthcare marketplace

• Unbiased, knowledgeable advice in all areas

• I have no financial or other relationships with any vendor

Areas of expertise and experience

• Financial management/analysis
• General management
• Operations management
• Strategy development
• Business analysis/planning
• Business process improvement
• Software/website development
• Supply chain management
• ERP system implementation
• Project management
• Industrial sales and marketing

Wendell Murray Background

• 1990s

• Owned, ran manufacturing businesses in northern NY State

• 1980s

• systems consulting
• financial work
• media/entertainment industry

• Companies

• Accenture
• Home Box Office
• Time Inc.
• The Walt Disney Co. (VP-Finance of Consumer Products)

• University of Vermont, Amos Tuck School (Dartmouth College-affiliated business school)

Current work

• Operational improvement, business and financial analysis, systems consulting

• Business development

• Focus on healthcare

• Ambulatory information systems

• Work in Italy

• Near-perfect knowledge of Italian language
• Many business, university and healthcare contacts
• Existing healthcare-related projects

Example of Gateway Medical

Gateway Medical Associates Project

• Gateway: large primary care practice in Chester County PA

• Decided to invest in an electronic medical records (EMR) system

• Ended up replacing practice management (PM) system in addition to EMR system

• Illustrative case of benefits of utilizing information system

Gateway Medical overview

• Primary care practice in Chester County PA

• 28 providers
• 7 medical offices, 1 administrative office
• 100,000 active patients
• 120,000 visits per year
• 120 employees
• $10 million in revenue

Gateway Medical Impetus to invest

• Decision to invest

• Push from CMS-funded project to encourage physicians to automate
• Pennsylvania one of several states selected for the project
• Good experience installing existing PM system in 1999
• Awareness of mandate from Medicare

Gateway Medical Physicians’ perspective

• Physicians perspective

• Most physicians also shareholders in practice
• View system as incremental cost
• Resistance to change
• Fear of technology
• Range of comfort with technology
• None to fairly adept
• Somewhat a function of age
• Spend if CMS mandates

Gateway Medical Project stages

• Project development

• Almost 2 years elapsed time to start seeing benefits
• Project started early spring 2005
• Request for proposals late spring 2005
• Proposal review summer 2005
• Software vendor selected fall 2006
• PM installed spring 2006
• EMR installation August-November 2006

Gateway Medical Ambulatory software vendors

• About 10 major suppliers

• Some large, e.g. GE, Mysis, Epic

• Others fairly small, some private, some public

• eClinicalWorks
• Allscripts (Healthmatics)
• Nextgen
• iMedica

Gateway Medical Consensus from survey

• Systems from all vendors work adequately

• Over 20 practices contacted

• No practice would use paper charts again

• No matter what the hassle or cost an EMR is worth it

• Implementation goes smoothly

• Interface to separate (PM) system works adequately

• Some replaced existing PM while installing EMR

• Incremental cost = cost of interfaces
• Many advantages to integrated system
• Less complicated
• Easier for vendor to update code
• Fewer “moving parts”
• Single database

Gateway Medical Benefits

• Quality of care is better

• Drug interactions
• 33,000 patients die yearly due to adverse drug reactions
• All patient information available immediately
• Clinical procedures
• Common treatment regimens implemented
• Better prevention tools
• Comprehensive documentation

• Operations are more efficient

• Electronic prescribing/refill management
• Lab ordering
• Electronic messaging internally/externally
• Dramatically improve reporting to payers
• Office workflow improvement
• Patient management
• Reduced clerical input

Gateway Medical Provider productivity gains

• Reality is that there are few, but….

• Patient encounters don’t take more time

• Providers generally don't see more patients, but.…

• Providers leave work earlier and….

• Providers can finish paperwork remotely, e.g. from home

Gateway Medical System cost categories

• Six segments of costs

• Initial license fees, i.e. “investment”
• Annual license and other fees
• Custom programming: interfaces
• Third-party licenses: underlying system, e.g. Microsoft licenses, Oracle licenses
• Third-party licenses: drug databases
• New hardware

Gateway Medical Equipment configuration

• Client/server architecture

• Servers

• 1 Application/database server
• 4 Terminal services servers

• Clients

• Existing PCs for office and some nursing staffs
• New wireless Tablet PCs for providers and each provider’s nursing assistant

• Wireless access points in each office

• Offices connected by T-1 lines

Gateway Medical System cost

• Third party software licenses $ 54,000
• Healthmatics license fee 232,000
• Hardware costs 205,000
• Implementation 131,000
• Discount ( 62,000)
• Total initial investment $ 560,000
• Yearly fees $ 68,000

Gateway Medical Staff/other expenses

• Reductions in headcount:

• Filing needs
• Nursing staff
• Other clinical support staff
• Other administrative staff

• Reductions consistent with experience of other practices

• Pro-active changes to procedures needed to realize these savings

• Eliminate transcription cost

Gateway Medical Reduction in headcount

• 2006 2007 Reduction

• Nursing 39 35 4

• Office staff 56 35 21

• Employed providers 11 11 -

• Other clinical 3 1 2

• Total headcount 109 82 27

Gateway Medical Reduction in wage expense

• 2006 2007 Reduction

• Nursing $1,267,000 $1,129,000 $138,000

• Office staff 1,740,000 1,253,000 487,000

• Employed providers 814,000 814,000 -

• Other clinical 93,000 40,000 53,000

• Total wages $3,914,000 $3,236,000 $678,000

Gateway Medical Other line items

• Revenue

• Possible increase due to higher coding
• Possible increase due to higher physician productivity
• $0 to $500,000 increase

• Other expenses

• Reduction in telecommunications costs
• Open source PBX and use of cable/ DSL rather than T-1 lines
• $80,000 savings
• Elimination in transcription costs
• $46,000 savings

Gateway Medical Possible increases in revenue

• Increase of 5% in volume of patients seen applicable to all areas (productivity increase)

• Increase of 5% in higher fee-for-service coding (so-called “up coding”

Gateway Medical Information systems changes

• Replace T-1 lines with DSL or cable Internet access

• Implementation of software PBX (private branch exchange) system with Asterisk

• Asterisk

• Open source software
• Widely implemented
• Uses Voice over IP (e.g. Internet and LAN) in place of telephone circuits
• Managed via software rather than hardware

Wendell Murray information

• Wendell Murray

• Wendell Murray Associates Inc.

• 602 Rosetree Lane

• Kennett Square PA 19348

• Tel: [phone]

• Mobile: [phone]

• E-mail: [e-mail]

• Website: www.wpmassociates.com