Dan O'ConnorThe industry push for value-based care calls for the perfect marriage of care quality improvement and delivery cost containment, but many healthcare financial leaders and providers are unsure of how to approach this balance. With the pressure to improve clinical and financial performance, healthcare leaders need to optimize their technology investments to meet the evolving expectations of both end users and patients. The following five tactics establish better clinical-financial alignment for a more efficient electronic health record (EHR) system. 

Incorporate End-User Usability

Within a unified EHR system, end users are not limited to clinical care providers. Front-end, business office, and revenue cycle management staff also must interact with the system daily. When incorporating end-user input into a system, healthcare leaders should obtain feedback from both the clinical and financial teams by involving them in during the development phase.

Consider the Health System

When customizing EHR functionality, consider the end-user experience, knowledge-level, and technical savvy across all health system facilities. Often when organizations plan system implementations, they bounce ideas off subject matter experts. Although this select group is vital for end-user adoption and training, their enthusiasm and adaptability may not represent the broader user base. For example, a recent study by MedStar Health found that placing an imaging order took users at one site an average of 25 seconds but more than a minute at another site. Users at the first site clicked eight times to complete the order, but it took users at the other site 31 clicks. Of course, a limited user scope leads to repeated order errors and wasted staff time. The study shows that vital cross-organizational input is necessary in the vendor implementation development process and that thorough user training must be consistently deployed and documented across all facilities.

To combat a costly knowledge gap across a health system, early in the process assess the EHR end users’ level of comfort and performance across the entire organization to identify where additional training is necessary. Do not assume, for example, that effective performance by the flagship site’s employees represents EHR-use aptitude for the entire organization. Another benefit of conducting a user assessment is determining that the workflows are efficient; over-customization of the EHR system will hinder overall end-user efficiency.

Patient Portal Education and Outreach

Overburdened by competing tasks and data entry, providers often forget to remind patients to access the portal for information, communication, and bill payment. A promotional poster in the waiting room is not enough. Staff should remind visiting patients at check-in and departure to utilize portal access. Patients should be provided with their private login credentials with short, clear, and digestible instructions. Consistent portal access and automated outreach notifications help keep patients with chronic conditions adherent to their care plans while saving staff time. For collections, offer direct payment options through the portal to reduce business office follow-up time and days in accounts receivable (A/R). Simplified portal solutions and patient engagement leads to efficiency all around, simplifying the care experience.

Data Conversion

Whether transitioning to a new EHR system or undergoing a merger and acquisition standardization, EHR data conversion and integration is vital. Without up-to-date, timely, and complete patient data in the updated system, clinical visit decision-making is hindered, impeding patient safety and negatively impacting claims and cost containment.

To complete a successful and accurate data conversion and promote patient safety as well as prevent claims and cost containment issues, follow these steps:

  • Clean and align data among the multiple systems as a unified organization.
  • Combine communication among the legacy system, the new or takeover system, and conversion teams to identify data requirements, file transfer locations, and naming conventions.
  • Simplify data extraction and entry, when possible, by using the Continuity of Care Document (CCD) load from the legacy system. A CCD is an electronic document exchange standard for sharing patient summary information.
  • Audit data, following the best practice of reviewing 10 percent of patient files by provider at random. 

Industry Initiatives

Industry groups are working around the clock to represent providers’ best interests. For example, in coordination with major EHR vendors and medical professional societies, the American Medical Association is actively working on its Integrated Health Model Initiative (IHMI) to help the industry better organize and capture the right data beyond current standards. From patients’ goals to health statuses, the updated, holistic data capture is based on IHMI’s clinically validated content, tools, and guidance to support providers’ meaningful outcomes analysis. Healthcare financial leaders can join the project’s current collaborative communities to voice feedback for improving data processes. It’s important for provider organizations to actively engage in initiatives or professional groups such as the College of Healthcare Information Management Executives and others, to accurately represent provider pain points.   

In the competitive healthcare landscape, strategic utilization of an EHR and other emerging technology systems is key. By implementing the five tactics, from pre-implementation through post go live, healthcare financial leaders can enable streamlined clinical-financial collaboration for a shared vision of health system success.


Dan O’Connor is vice president of client relations for Stoltenberg Consulting, Inc., Bethel Park, Pa.

Publication Date: Monday, March 18, 2019