By this point in time, approximately 80 percent of orthopedic practices and health systems have made conversions to electronic medical records. Regardless of the vendor, the change is always challenging, and creates problems that are magnified in high volume and high margin specialties like orthopedics. The implementation of an electronic medical record should drive your practice or department to adapt, and subsequently adopt new mechanisms of service delivery. These changes not only help your practice or department meet the challenges created by the electronic medical record, but will also help prepare you for the challenges of tomorrow. About the Speaker: Joe Greene is currently the Program Manager of Outreach and Development for the University of Wisconsin Hospital and Clinics in the Department of Orthopedics and Rehabilitation. In this role, Joe coordinates business and philanthropic development activities for the UW Hospital department and University of Wisconsin Department of Orthopedics and Rehabilitation. He represents the needs of all orthopedic subspecialties and has worked for the UW since 1991 when he initiated his career there as an athletic trainer and clinician. He has worked in management and administration across the Department since 1997. In addition to his role with the UW Hospital, Joe also is the CEO and Owner of OrthoVise. OrthoVise is an Orthopedic advisory firm that assists orthopedic practices of all types with operational and business development needs. His experiences have allowed him and his advisors the opportunity to consult formally with orthopedic practices since 2010. He has particular areas of interest that include Orthopedic and Sports Medicine Program Business Development, Service Line Development, Health Information Technology and EMR Operational Optimization for Orthopedics, Innovative Service Delivery Implementation, Smart Staffing, and Workflow Enhancement.

1. Optimize Your EMR for Orthopedics
Essential Strategies that Drive Patient Engagement,
Financial Success and Physician Happiness
S

2. Joe Greene
University of Wisconsin Hospital and Clinics
Department of Orthopedics and Rehabilitation
Program Manager, Outreach and Development
OrthoVise, LLC
CEO and Owner
S

3. Objectives
S Appreciate the current EMR landscape
S Philosophically discuss the EMR and orthopedics
S Appreciate the continuum of EMR adoption
S Learn specific operational and IT optimization strategies
S Understand opportunities to leverage your EMR and
your Healthcare Information Technology investment

4. The EMR Landscape
S

5. Today
S The implementation environment is stabilizing
S At least in the United States!
S Incentives will diminish
S 19.2 billion disbursed by CMS to 440,998 registered providers
S Attrition and consolidation of vendors
S Shift to enhanced support and service
S Shift to an international focus
S At least with large vendors

6. “We are at about 50% EHR adoption and
about 5% workflow adjustment.”
Farzad Mostashari MD
Former National Coordinator, Health Information Technology
U.S. Department of Health and Human Services
S

7. "The systems on the front line have to be
usable so that doctors actually want to
interact with the electronic health record, or
[so that] nurses or others can access critical
information that will eventually not just save
money or improve the quality of care but
save lives,"
Karen Desalvo MD
National Coordinator, Health Information Technology
U.S. Department of Health and Human Services
S

8. US Hospital Implementations
2012 and 2013

9. Leveraging your Investment
S Clinical and Business Analytics
S Reporting
S Quality and Safety
S Outcomes
S Population Health
S Interoperability

10. "Simply implementing computer systems won't
dramatically improve quality overnight. Very careful
system design and configuration, along with a lot of
thoughtful human process improvement, are
necessary in order to make the technology truly
helpful”
S

11. The EMR and
Orthopedics
S

12. Sound Familiar?
“The system is great for a family practice doc – it just isn’t
set up for an orthopedic surgeon. We have very different
needs.”
“I’m spending an extra 3 hours every clinic day completing
my documentation and orders”
“I’m an orthopedic surgeon, I want to be in the operating
room, not spending all of my time documenting in the
system”

13. Sound Familiar?
“My staff can’t do what they used to be able to do for me
once we moved to this EMR”
“I’m seeing 25% less patients than I used to be able to”
“I’m not happy, and my life outside of work is being
affected.”
“I’ve just decided not to see as many patients as I used to”

14. Orthopedics is Different
S High Volume
S High Margin
S Highly Competitive and Driven Physicians
S Increasingly Specialized
“Specialty clinics have many unique workflows – these
require specialized tools. Like all specialties, orthopedics
must be treated uniquely”

15. “There are three key elements of success.
The first is opportunity
The second is recognizing it
and the third is the effort to make it happen.”
S

16. The EMR: A Necessary Sense
of Urgency?
S We view the EMR as an opportunity
S For driving service delivery changes that may have
been indicated for a long time
S Staffing, Workflow, Access, Triage, Quality, etc.

17. “An EMR implementation magnifies the need for
changes that are indicated to meet the future needs
of healthcare service delivery.”
S

18. The Continuum of
EMR Adoption
S

19. Stages of EMR Utilization
Implementation
Stabilization

20. Implementation and
Stabilization
S Implementation and Stabilization
Focus is on addressing key issues and establishing a
baseline of user productivity and happiness. During this
phase, solutions tend to be technical in nature and
operations are dependent on the implementation team for
guidance.

21. Operationalization
S Operationalization
Shift in governance and accountability to operational
groups. Clinical operations begin to reduce their reliance
on the implementation team for guidance and focus turns
to using the system to support operations and operational
goals.

22. Optimization
S Optimization
Longer-term efforts to extract business value from your
system, increasing alignment between system and
organizational objectives. System enhancements are
driven by operational priorities and clinicians and the IT
team moves into a supporting role.

23. Operationally Driven Project
Why Shift?
S Patient Centered
S Changes are Physician and Clinician Driven
S Local Ownership of Issues
S Facilitate Business and Operational Processes
S To Utilize Available IT Resources More Efficiently

24. Stages of EMR Utilization
Implementation
Stabilization
Operationalization
Optimization

25. Specific Optimization
Strategies
S

26. Specific Strategies
S EMR Specific Enhancements
S Staffing and Workflow Enhancements
S Orthopedic Service Delivery Innovation

27. EMR Specific Enhancements
S Security assignments
S Documentation strategy
S Optimization team formation
S Order Handling
S Reporting and Analytics
S Content Build

28. Staffing and Workflow
Enhancements
S Workflow Philosophy
S Eliminate all physician non-value added activity
S Optimally this means the physician:
S Maximizes face time with patients
S Sees patients that they convert to surgeries
S Performs essential orders and documentation only

29. 2012 AMSSM Poster
The Impact of Athletic Trainers in a Sports Medicine
Practice Improving Efficiency and Productivity

30. To Scribe or Not to Scribe?
S Joint Commission and CMS recognition
S High volume surgeons
S Technologically challenged surgeons
S Orthopedics : Ideally you have someone who can
document for every 20-22 patients daily
S Formal Scribe vs. Fully Enabled Allied Health Provider

31. The Impact of Scribing
S Improved patient satisfaction
S Improved provider satisfaction
S Documentation is enhanced from a content and billing
standpoint
S Don’t stop at just scribing!

32. A Note on HPI Documentation
S A 1997 CMS Rule (Pre EMR) that defines HPI (History of
Present Illness) documentation as the responsibility of the
provider.
S Check with your Medicare Carrier (Novidien, WPS, etc.)
on their interpretation of this rule.
S Scribing is allowed if the scribe is in the room and records
the information in the presence of the provider.
S Even with conservative interpretation, don’t lose sight of
the overall value.

33. Step One
S Chief Complaint
S Pain Scale Rating
S Vitals
S Past Medical History
S Medication Reconciliation
S Allergy Review
S Education Preferences

34. Step Two
S Brief History
S Physical Examination
S Order Radiographs
S Start Documentation
S Present Case to Physician

35. Step Three

36. Step Three
The Extender Role
S Documentation of HPI
S Order Entry
S Billing/Charges
S Start/Finish Documentation

37. Step Four
S Patient Education
S Exercise Prescription
S Letters
S DME Fitting
S Billing/Charges
S Follow Up Instructions
S AVS Preparation

38. Surgical Conversion Rate
The most important ambulatory metric?
S The percentage of available new appointments that are
converted to surgery within a given time frame.
S Exceptional global overall measure of:
S Scheduling and registration
S Access programming
S Triage and patient placement
S Ancillary staff utilization
S Physician utilization

39. Canadian Study: PLOS ONE
July, 2013
S Surgery or Consultation : A Population-Based Cohort
Study of Use of Orthopaedic Surgeon Services
S October 2004 – September, 2005
S 477,945 patients visited an orthopedic surgeon in
Ontario, Canada
S 79.3% of patients did not receive surgery after 18
months
S 20% surgical conversion rate

40. Cost Containment or
Revenue Generation
A Balancing Act

41. Staffing and Workflow
Enhancements: Takeaways
S Fully enable your extenders
S Maximize surgical conversion rate
S De-centralize build
S Create an “Optimization Team”
S Integrate your IT Analyst : Teach them about what you
do and what you need. Don’t assume they know.

42. Orthopedic Service Delivery
Innovation is critical!
S Smart Staffing and Workflows
S Access, Triage, and Patient Placement
S Immediate Care Clinics
S Post Surgical Care
S Bundling and Analytic Utilization
S Care Management

43. Leveraging Your
Investment
S

44. “I am becoming increasingly convinced that
what is truly important in healthcare is
inversely related to what is easily
measurable.“
Vernon Weckerth PhD
Professor Emeritus
University of Minnesota
Masters of Public Health
ISP Executive Study Program
S

45. Leveraging Your Investment
S Registry Reporting
S Functional Outcomes Reporting
S Quality and Safety Reporting
S Business and Clinical Analytics Reporting

46. The AJRR Registry
S Sponsored by the
AAOS and Industry
S Knee and Hip
Arthroplasty
S 235+ Institutions and
Growing Quickly

47. Own the Bone Registry
S Sponsored by the AOA
S Fragility fracture prevention
S Reporting and Education
Components
S Requires cloud data entry
by clinicians
S EMR should facilitate

48. NASS Spine Registry
S NASS Sponsored
S In development

49. Patient Reported Outcomes
S Getting Data In and Data Out
S Very Challenging IT and Operational
Workflows
S Tablet vs. Kiosk vs. Portal
S Real Time Access to Outcomes Data
S Copyright and Cost Implications

50. Quality and Safety Reporting
S Surgical Site Infections
S AHRQ Patient Safety Indicators
S SCIP Measures
S Readmit Rates
S Hospital Acquired Conditions

51. Business Analytics
S Volume and Access Measures
S Surgical Conversion Rate
S Revenue by Procedure Code
S Volume by Zip Code
S Referring Provider Volume
S Key Indicators: ie. Charges, Payments, Days in A/R,
Adjustments

52. “Having what you want is a function of letting
go of what you have”
Anonymous
S

53. “Problems cannot be solved with the same
level of awareness that created them.”
Albert Einstein
S

54. Thank You
Time for Questions
S

55. The Patient Journey
The Guided CarePath helps create a single streamlined patient experience
through the entire journey of a total joint replacement.

56. Guided CarePath
Smart
Checklists for
Patients
Delivered online
and available 24/7
from home