The Issue

An electronic health record (EHR) implementation, particularly one that includes other system components such as patient access and patient revenue, can disrupt many areas of hospital operations. But one of the greatest financial risks may be its impact on the revenue cycle. During these implementations, organizations often see their days in accounts receivable (A/R) and denials increase while cash flow drops. Implementing an EHR at one of Presence Health's hospitals was accomplished in stages designed to ensure minimal disruption to the revenue cycle.


At Presence Health, the not-for-profit health system formed by the November 2011 merger of Provena Health of Mokena, Ill., and Resurrection Health Care of Chicago, an approach to systemwide conversion to a new EHR was designed not only to minimize disruption to the revenue cycle, which included integrated patient access and patient revenue systems, but also to ensure the continued
optimization of revenue cycle performance throughout the project.

Presence Health began the implementation at its pilot hospital, 375-bed Saint Francis Hospital in Evanston, Ill. It then applied lessons learned to implementations for the other hospitals in its system. Presence Health did this by employing a multistage approach that started 24 months before go-live at the first facility.

Key steps in the EHR implementation process for Presence Health were:

  • Optimize revenue cycle processes
  • Optimize the new health information system to support peak revenue cycle performance
  • Build a plan for the go-live window
  • Optimize and accelerate revenue cycle performance post activation

Action Steps for Providers

Other health systems should apply similar steps when implementing an EHR. During the pre-implementation phase, they should take the following steps to optimize revenue cycle processes:

  • Standardize and centralize the revenue cycle.
  • Analyze the most critical revenue cycle functions to manage and track through system conversion.
  • Install a set of stand-alone, independent, revenue cycle workflow management and reporting tools to create a highly accountable environment.

During the design phase, they should take steps to optimize the new EHR to support peak revenue cycle performance, such as:

  • Establish collaborative relationships between revenue cycle leaders and department leaders.
  • Create forums for collaborative, in-person, visual reviews of EHR modules.
  • Assign a dedicated liaison between IT and revenue cycle departments.
  • Identify risk mitigation focus activities.

During the go-live phase, they should plan for the go-live window by doing the following:

  • Establish a revenue cycle command-and-control center.
  • Implement daily revenue cycle leadership meetings.
  • Temporarily increase staff in high-volume patient access areas.

During the first year after the implementation, health systems should do the following:

  • Leverage reporting tools to highlight risk areas and allow for swift course correction.
  • Identify targeted improvement opportunities.
  • Focus on strong revenue cycle management.
  • Apply lessons learned from the pilot go-live to mitigate risk to other facilities in the system.

Download the PDF or read the full article. You can also see more Board's Eye Views

Publication Date: Saturday, September 01, 2012

Login Required

If you are an existing member, please log in below. Username and password are required.



Forgot User Name?
Forgot Password?

If you are not an HFMA member and would like to access portions of our content for 30 days, please fill out the following.

First Name:

Last Name:


   Become an HFMA member instead