Lucy Mancini Newell

CFOs have an important opportunity to participate in activities surrounding an electronic health record (EHR) implementation in their organizations.

At the heart of any EHR initiative are clinical participation, advocacy, and leadership. CFOs should be among the initiative's leaders, given the likely continued financial pressures on health systems for some time to come. The CFO can help other members of the C-suite understand how an investment in an EHR affects and benefits the healthcare organization, both short term and long term.

EHR Implications for the C-Suite

Healthcare organizations historically have selected and implemented IT that readily provides an ROI and that lasts for a long time. An EHR is quite a different type of initiative because it is more of a concept than a single product or technology. No single software application or technology can create an EHR, which provides support to multiple clinical disciplines and directly affects every clinical workflow. Rather, an EHR requires a number of software applications (whether self-developed or from one vendor or a variety of vendors) and technologies to create the desired goal of automating the clinical environment to improve patient care and patient safety.

Achieving this goal is easier said than done. Implementing an EHR is a multiyear project that requires funding not only for the preparation and implementation phase, but also for its continuing use for many years to come. In addition, investing in process improvement as well as the training of physicians, other clinicians, and the IT staff who will support the EHR is invaluable. For these reasons, healthcare organizations should invest in an EHR as a multiyear project rather than as a one-time investment. Once an EHR project is budgeted, ongoing funding is critical.

Ultimately, the C-suite-and the CFO in particular-has an important role in the EHR journey. Because an EHR can have a strong impact on clinical operations, C-suite members-through their advocacy, leadership, sponsorship, and interest-contribute significant value to the initiative by demonstrating organizational understanding of the EHR's role in patient care delivery. Implementing technology as far-reaching as an EHR will inevitably be disruptive, so C-suite leaders can provide perspective to make the transition easier. Strong communication and an understanding of the impact the EHR will have on clinicians will smooth the way for issues that will require tough executive decision making to ensure the organizational transformation.

The CFO and the COO should be members of the organization's EHR executive governance committee not only to witness the progress and challenges of implementing the EHR but also to provide organizational support and insights to pave the way for future success. The CFO and the COO also can help develop criteria for measuring progress, changes, and outcomes of the EHR initiative. Having measurement criteria is key to tracking EHR efforts and showing a tangible level of progress throughout the implementation and after the go-live. People are drawn to methods that show progress and keep them motivated.

What CFOs Can Do

Gartner, an IT research and consulting firm, in recent years has advocated use of the total-cost-of-ownership (TCO) model as an industry standard to assess IT costs, replacing the previously ubiquitous ROI. Because the organization will make a significant investment initially and long-term to support the EHR environment, CFOs might find it useful to use the TCO model to help all C-suite members understand the fiscal implications and monitor EHR investment. The better this model is understood, the better able senior executives will be to make informed decisions during the budget process. An EHR cannot provide an immediate ROI; rather, the initiative requires a shift in thinking about the long-term investment of resources-people, processes, technology, money, time, and knowledge-needed to create a clinical environment that promotes better outcomes and ensures patient safety.

CFOs can also contribute to an EHR project by working with clinician leaders to develop meaningful metrics to benchmark targeted improvements. One caution is that metrics may be viewed by clinicians as potential tools for punishment or for negatively affecting the work environment. For example, if metrics show that labor savings can be realized by documenting patient information in real time, clinicians might be concerned that the CFO and other C-suite members might use this information to decrease staff.

In reality, the data can help increase an understanding of the dynamics and mechanics of patient care delivery. CFOs have a great opportunity to educate and integrate metrics while helping the governance committee and executive oversight committee benchmark EHR progress.

An EHR can create a more efficient and cost-effective way to provide patient care. First, the access to clinical information, shared across the health system or continuum of care at a single point in time, facilitates clinician decision making and prevents duplicate requests for services. Second, automating clinical documentation and standardizing patient care services allows costs and outcomes to be tracked readily. CFOs should help determine any other areas to track for improving efficiencies and effectiveness.

Finally, CFOs likely will face many challenges during the EHR journey, such as the following:

  • Investment will be a multiyear effort and may continue indefinitely to remain current with technology.
  • All processes will be scrutinized and require effort to update, standardize, and integrate into the selected EHR. (This effort can take from one to two years in preparation for EHR implementation.)
  • Executive support, advocacy, and sponsorship will need to be maintained over a long period.
  • Safeguarding against institutional fatigue will be ongoing as the organization continues to provide patient care while preparing, training, testing, and implementing the EHR.
  • Incentives may be needed to ensure physician participation throughout all phases of the EHR initiative. (Some organizations provide financial incentives to physicians due to their lost productivity while others choose not to.)
  • Instead of simply automating paper processes that are broken, effort and resources will need to be focused on rethinking the delivery of care and the interaction of clinicians with the EHR.
  • Change is quite painful for professionals who have optimized their manner of productivity, so change management should be a cornerstone of any such undertaking.

CFO Leadership Is Needed

This remains an exciting time for CFOs to be a part of an EHR project. Remembering that EHRs affect every patient care process as well as clinicians reinforces the need for executive oversight and involvement. Although the initiative will strongly emphasize physician participation, this should be augmented by the leadership of the CFO and other C-suite executives.

Because improving patient safety and providing efficient, high-quality patient care remain at the center of every health system's strategic business plan, it follows that an EHR project, with its ubiquitous impact, requires the involvement, sponsorship, advocacy, and oversight by C-suite executives. Moreover, a hospital can truly benefit from a multidisciplinary approach to its EHR initiative-one in which the CFO plays an integral role.

Lucy Mancini Newell, FHIMSS, is principal, The Stellar Group Consultants, Cary, Ill. (LManciniNewell@earthlink.net).  

Publication Date: Thursday, April 01, 2010

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