From the Editor RobFromberg_2012_r1

Robert Fromberg, Editor-in-Chief 

I miss the sense of new beginnings as a school year gets under way.

No doubt, many of you have spent the waning weeks of August combing shelves of your local stores for everything from three-ring binders to laptops, and delivering kids via car, bus, or even plane to their first day of a new school year.

For me, this season evokes strong memories, not only of the fresh package of school supplies clutched on my lap as I rode the bus to school, but also of the excitement of new teachers and subjects. And although I wouldn’t have said this at the time, I also appreciated the security of knowing that the teachers had a well-thought-out plan and would be monitoring our progress.

Unfortunately, that kind of tidy transition does not exist once you leave school. Sure, we start new projects; some, like a budget, are even annual. But these projects have to be implemented within a flurry of competing priorities already under way.

Consider implementing a new EHR. If it were a starting-a-new-school-year scenario, staff would enter a hospital that has no patients or existing systems, ready to be guided by experts along a carefully developed path toward implementation with allotted time and few distractions.

Implementing an EHR may carry the same bright promise as a new school year, but it is far from a new beginning. “[An EHR] implementation, particularly one that includes other system components such as patient access and patient revenue, can disrupt many areas of hospital operations,” according to the authors of “Maintaining Revenue Cycle Health During IT Change,” the cover story in this month’s hfm. The revenue cycle, in particular, is a well-known pitfall. “During these implementations,” the authors write, “organizations often see their days in accounts receivable and denials increase while cash flow drops.”

The article tells the story of how St. Francis Hospital in Evanston, Ill., minimized revenue cycle disruption during an EHR installation using a process designed to create an environment with some striking similarities to a new school year.

First, staff attempted to create a revenue cycle clean slate prior to EHR implementation. They undertook a systematic approach to revenue cycle standardization and improvement, assuming that “a high-performing revenue cycle is less vulnerable to disruption.”

Next, staff designed a thorough plan for integrating the EHR and revenue cycle that matched revenue cycle best practices with system functionality.

Finally, staff created a process for intensive real-time monitoring and response as the new system was activated, followed by continued monitoring and correction for a year after the installation.

A new school year brings hope. But it also brings anxiety, sometimes a crushing amount when entering a new school, or when the previous year holds bad memories. For most healthcare executives, an EHR implementation is a huge undertaking, and memories of past system implementations are far from fond. All the more reason to prepare a clean slate, a careful plan, and a process for monitoring and correction. Nothing fights anxiety—or fosters hope—like preparation.

Publication Date: Monday, September 03, 2012

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