EHR Implementation & Optimization: Keeping Your Eye on the Prize
The financial incentives for achieving meaningful use of Electronic Health Records (EHRs) coupled with the broader need to better coordinate patient care have generated a flurry of IT activity among physician practices. In our work with provider organizations, we have repeatedly seen problems arise when the stated goal of the organization is to “implement an EHR.” When implementation itself becomes the goal, progress is generally slow, there can be extensive rework of failed attempts, and the frustration levels run high among both providers and managers. To avoid such frustration, implementation goals and associated metrics focus on improving patient care, the real “prize” of a successful EHR.
This Executive Briefing describes specific methods to ensure that providing better and more efficient care drives decision making as you implement your EHR. We also discuss the key to success: involving physicians in all aspects of EHR implementation or optimization.
- Meaningful use Stage 2 criteria require increased physician interaction with the EHR and patients, as well as with other providers, entities, and care teams.
- Eligible professionals can follow steps to help define and plan for Stage 2 requirements and ensure that the appropriate processes are in place to meet the criteria while continuing to deliver efficient and high-quality care.
Focus on Explicit Clinical and Operational Goals
While everyone may recognize the importance of establishing meaningful clinical and operational goals for an EHR, most often organizations either have no explicit goals or settle for goals that focus on the process of EHR implementation, rather than on desired outcomes. Goals such as attaining 80 percent utilization by providers within 6 months may seem laudable but can be achieved without any change in coordination, quality, or cost of care. Rather than evaluating success in terms of project milestones, we recommend that measuring progress toward strategic priorities is the appropriate benchmark. Examples of clinical and operational goals that can provide substance and direction for the EHR include:
- Fully support conversion to clinical management by service line.
- Facilitate disease management.
- Enable the implementation of a PCMH.
- Ensure clinical coordination for managing a population of 50,000.
- Increase patient satisfaction utilizing operational improvements.
After identifying clinical and operational goals for the EHR, the next step is to build a work plan around those goals. Regardless of what work plan methodology is used, specific tasks, timelines, and accountabilities should be developed for each goal. For instance, if facilitating disease management is a goal, the first practices to go live should include primary care, endocrinology, and cardiology. If the goal is supporting service line development, then orthopedics, neurology, and cardiology may be the logical first users.
The final component to ensuring that the EHR meets your goals is to measure the progress and success of the EHR by clinical and operational metrics. If disease management is a priority, measures could include:
- Increase the rate of retinopathy screening among diabetics to 90 percent.
- Reduce mean low-density lipoprotein (LDL) values among heart disease patients by 20 percent.
- Attain 80 percent participation in post-infarct patient education program.
If patient satisfaction is selected as a goal, evaluation metrics could include:
- Increase the rate of primary care appointment completion within 48 hours of request to 70 percent.
- Reduce patient waiting time by 20 percent in specialty clinics.
- Complete 80 percent of prescription refills within 24 hours of request.
The important point in these examples is that the EHR is a tool to improve the patient experience in terms of outcomes, cost, and satisfaction. Therefore, the best way to evaluate the success of your EHR is to set goals and measure improvements in the patient experience, rather than treating installation of the EHR as an end in itself.
If there is a sincere commitment to patient care goals when implementing an EHR, physicians must have a major role in every step of the process.Too often, EHR plans are developed by IT staff working with the system vendor, consultants, and a loosely formed advisory group of clinical and administrative representatives.An IT manager is assigned the role of EHR project manager.Not surprisingly, physicians then perceive that the EHR implementation as an administration-run IT project, and they behave accordingly.
The favored alternative is to place providers at the center of all EHR activities.First, identify a practicing clinician with both the interest and ability to direct the process.He/she can be compensated for time lost from practice and should be empowered with the needed authority and responsibility.Given the scarcity of qualified clinician candidates, a viable alternative is to create a leadership “dyad” by pairing a senior administrator, such as the chief medical officer or chief operating officer, with the best qualified clinician who will also be using the EHR.
Second, create a multidisciplinary task force with responsibilities that include meeting EHR clinical and operational goals, ensuring timely implementation and provider satisfaction, and establishing a solid foundation for future EHR and practice improvement initiatives.If yours is a large organization, form a team for each clinical specialty or geographic region.Membership on the governing task force and teams should include physician users along with representation from clinical support staff, administration, and IT.The important point is that the membership must match the goals (i.e., the people who most directly affect improvement in clinical outcomes and efficiency).
A task force structure guided by clinicians has significant benefits, including:
- Ensures that clinical goals remain the priority.
- Significantly increases physician acceptance and participation.
- Enhances communication and coordination among stakeholders.
- Takes into account work flow changes.
- Broadens systems knowledge among clinical staff.
- Increases IT’s understanding of the clinical environment/needs.
Working in the Real World
We recognize the importance of the technical component of getting an EHR in place and functioning smoothly.It is absolutely true that the nuts and bolts of a timely EHR implementation or optimization initiative need attention.Timelines for data conversion, hardware installation, system configuration, and training are important, and most everyone understands these parts of the process.It is not as well understood that while an EHR is necessary for improving patient care and efficiency, the EHR will not result in any improvement without a collaborative effort and physician leadership.Keeping your eye on the prize (better and more efficient care) requires that organizational strategy drive all aspects of EHR adoption and that clinicians take ownership of planning and implementation.