More than one-third of hospital chief information officers say they plan to make EHR investments over the next three years.
Healthcare providers have invested millions of dollars in electronic health records (EHRs) during the past decade, fueled by the Health Information Technology for Economic and Clinical Health (HITECH) Act’s $29 billion in provider incentives to adopt EHRs, meaningful use requirements, and adoption of ICD-10.
Their investments will continue, according to recent studies. A January 2017 survey of College of Healthcare Information Management Executives (CHIME) members by KPMG found that 38 percent of members will make EHR optimization their top choice for investing capital over the next three years. The survey also found that only 20 percent of CIOs expect a decrease in their IT operating budgets, which is about the same as capital budgets. The electronic health record market is estimated to be $28 billion, according to Kalorama Information.
Of course, with that level of investment, many organizations are examining whether they are meeting the goals in quality, patient engagement, satisfaction, and cost of care that they wanted to achieve or plan to achieve from implementing these systems. Data show that they are not.
In the past, many healthcare organizations tried to do too much at once, creating difficulties on various fronts and frustrating clinicians, senior management, and other healthcare leaders.
Key among these difficulties are disrupted workflows—clinicians do not like to take time away from face-to-face contact with patients to type information into the computer. In fact, a report by the ECRI Institute cited information management in EHRs as the biggest patient safety challenge ahead of unrecognized patient deterioration, test result reporting, antimicrobial stewardship, and opioid administration in acute care, among other conditions.
The key to avoiding such problems is a road map to address the best use of EHRs that engages both clinicians and business leaders and aligns them with broader clinical and financial objectives.
ECRI’s report highlighted the need for a holistic approach in EHR implementation that includes involvement of health information management professionals, IT professionals, and clinical engineers. When those individuals are involved in the creation of an implementation road map, success is more likely. The following steps can be included in developing the road map.
Establish strong program and project management. Understand the program/project environment from all perspectives and layers, and establish the right level of project leadership structure: too much and it’s seen as bureaucratic and a hindrance to progress, too little and there is little visibility or control. Include both client and vendor resources, and leverage cross-functional perspectives so that all the right resources are engaged as appropriate and focused on the right thing at the right time.
Manage budgets. Establish budget and financial performance metrics that include cost controls and accountability. The project’s scope, quality, time, and cost requirements should be carefully evaluated and included in the overall project budget to achieve timely and proper completion of deliverables and the overall achievement of the project’s objectives.
Measure progress. Conduct a baseline measurement, assess clinician satisfaction and productivity, establish benchmarks, and provide incentives to obtain results. Determine current system utilization, system requirements, end-user knowledge, and system deficiencies. Monitor, measure, and report data, including patient satisfaction and clinical outcomes. Data needs to be turned into actionable insights for clinicians and business leaders to improve quality and drive a population health management program. The data must be collected in templates that include standardized capture fields so the information can be aggregated and analyzed.
Consider the future. Determine the EHR’s ability to support future strategic initiatives. How can EHR modules be modified to more closely align with intended business processes?
Perform a value-chain focused review. A top-down look at the delivery system value chain determines opportunities to optimize applications. These priorities drive the system and infrastructure optimization roadmap.
Conduct focused reviews of patient and clinician journeys. Identify friction points that are impeding desired behaviors. This will drive optimized and holistic requirements; reduce the risk of non-adoption and workflow incompatibility; and increase efficiency, effectiveness, and engagement.
Identify improvement efforts. Perform a current state assessment on the installed EHR platform, covering the current environment, including opportunities, constraints, and data quality issues. Develop a “gap analysis” and draft a high-level needs document.
Deliver effective training. Enable the adoption of optimized systems as well as new processes and tools by equipping users with the know-how to be successful.
Implement a strong communication and change management approach. Convey project information; support change in behavior; build organizational awareness, understanding, and commitment to the program; and help ensure all stakeholders understand the project and their roles within it. This is essential to maximize lasting adoption, minimize disruption, build buy in, and achieve lasting results.
Case Study: Road Map Leads to Efficiency
A mid-size hospital system that saw more than 200,000 patients annually was facing challenges that prevented it from establishing a successful revenue cycle in line with industry benchmarks and support of a high-quality patient experience. Patient calls for scheduling were being abandoned 50 percent of the time. Paper-based processes for scheduling, preregistration, benefits, and admissions dampened efficiency and showed a lack of process around billing and admissions. Internal IT expertise was not sufficient to meet financial objectives.
Consultants examined the hospital’s workflows, determined where technology could be applied, and developed solutions to improve revenue processes. The solutions deployed were not purely technological, because processes had to be repaired as well. The hospital system and the consultants created a road map detailing workflows and policies and plotted where functions could be automated and connected with the EHR. The organization conducted a cost-benefit analysis for upgrading its EHR system to one that would meet regulatory mandates and patient care needs and support long-term growth.
The EHR and processes were positioned to support one another, creating more transparency to see where and how patients were engaged from registration through treatment. The consulting team acted as an interim health information management director to guide strategy and provide project leadership, allowing existing staff to focus on hospital operations. Part of that team’s role was to document current and future IT requirements to achieve long-term goals. The scheduling department reorganized to focus on its mission and assigned other tasks, such as registering lab specimens, to appropriate departments.
The project team positioned the healthcare system for long-term growth by enhancing the front-end of the revenue cycle and improving the patient experience. After following this program, the hospital system recovered lost revenue through an enhanced pre-registration and insurance verification system. Patient call abandonment dropped after an improved automated phone system was installed. And the improved EHR and realignment of workflows led to the removal of duplicated claims and insurance data, eliminating more than 400 duplicate entries to ensure correct billing to third parties.
EHRs and Market Demands
The EHR is seen as a catalyst to reduce healthcare costs and improve quality by reducing redundancy in care, catching errors, and streamlining processes. However, the implementation of EHRs has run into barriers. The creation of a clear road map, especially when it includes business and clinical leaders, can improve the implementation of an EHR system, and deliver the efficiency and improvements in patient care that the market demands.