So much of the focus of an EHR implementation is on the go-live and plenty of hustle and bustle precedes a practice's launch of a new EHR technology. However, the digital journey has only just begun at that point and what follows to sustain EHR adoption and use is known as EHR optimization.
Simply put, EHR optimization is the process of refining an install of EHR software to serve a practice's own needs and which tends to focus on clinical productivity and efficiency.
Most recently, the push for value-based care and reimbursement has raised new needs for EHR optimization among physicians. A recent Black Book survey indicated that most practices are demanding more integrated and useable EHR, practice management programs, and revenue cycle management system as a result.
About 76 percent of physician practices with 25 or more clinicians reported that they are eager to apply EHR enhancements in value-based payment innovation as well as functionality and service by the second quarter of 2016.
“The nature of integrated EHR functionality and practice management is also changing, given that Medicare and commercial payers are endeavoring on the shift away from pay-per-procedure billing to paying for value incentives for providing better care efficiently,” said Doug Brown, Managing Partner of Black Book. “Notably, leading-edge EHR are supporting large group medical practices with multiple specialties and multiple locations real-time insights and flexible technology to help drive successful accountable care organizations.”
Earlier this year, PricewaterhouseCoopers reported that healthcare organizations having completed the EHR implementation process were turning their attentions to EHR optimization initiatives.
"But now that the dust has settled and many providers have successfully hurdled their initial implementations, those providers are objectively assessing their EHR systems and identifying areas that may not have delivered the value they had hoped for," the report stated. "It is a prudent approach, because there are typically opportunities to enhance EHR systems at any stage of an implementation — with the ultimate goal of improving outcomes."
With EHR optimization expected to move from the back to front burner, here's a look at the factors contributing to a successful EHR optimization initiative.
Value of EHR assessments
Before an EHR optimization can be considered, EHR adopters must first learn the basics of their current EHR technology and take the time to adjust to its nuances. But once this adjustment period has passed, then the conversation can turn to EHR optimization opportunities.
"Even if we'd had 18 to 24 months, you're going to discover some things — whether it's enhanced functionality or a misinterpretation. But what you really strive to do is implement it as successfully as possible and with limited fallout, and then your optimization after that is making it feel like a tailored suit," Beebe Healthcare Vice President and CIO Michael Maksymow, Jr., told EHRIntelligence.com.
His organization undertook an aggressive system-wide EHR implementation and as a result that decision went in knowing full well that EHR optimization projects would have to follow. "It's about right sizing the scope, setting those expectations, carving out some things you'll be able to provide your attention to later, and making sure you have the capital and human resource funding to support this project," he added.
"The technology like many things does amazing things, but it’s just a tool. You have to learn how to use it just like everything else."
These sentiments are shared by others in the field, such as Emory Healthcare CMIO Julie Hollberg, MD.
"The technology like many things does amazing things, but it’s just a tool. You have to learn how to use it just like everything else. We have coupled this with required training so that people have a skeleton from which to hang new knowledge from the coaches when they are in clinic," she explained.
A fair and objective assessment of current EHR technology will highlights its proficiencies and deficiencies, the latter of which serve as the target of EHR optimization efforts.
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Importance of working with EHR vendors
First and foremost, EHR optimization is a collaborative effort, both internally and externally. A critical step for many practices is connecting with their EHR vendors to start the ball rolling.
At Memorial Hospital of Gulfport, David Northington, MD, began the process of reducing physician burnout through EHR optimization by reaching out to the organizaton's EHR vendor, Cerner Corporation.
"As this has been a budding problem, I went back to our Cerner partner and said we need to partner up on this because not only is it good for your organization and company but we would be happy to help lead the way on getting efficiency return on investment," he recounted.
"And what does efficiency mean?" he continued. "It means that the chart is done on time so that the patient-centric view for the poor soul who ends up in the emergency room that night has the information in the chart and not in a saved document that's coming out two weeks later. It also means improved A/R time, improve revenue cycle time. It improves throughout the whole stream of the hospital by getting these documents done on time and in real time where most of the information is probably better than looking at it two weeks later after you can't remember all of what took place."
As the process of optimizing an EHR system requires changes to software, who better than its creator to partner with in modifying its components.
"Your partner will get you so far. Your IT team will get you so far. Your other stakeholders will get you so far. But your physician engagement is critical to the use of that EHR."
Another form of partnership centers of physician engagement.
"At Beebe, we're fortunate to have a chief medical officer who got that and worked with me as a partner internally to garner that interest and engagement," said Maksymow. "That governance team still meets today and talks about relevant issues in optimization, improvement, and driving our use and adoption of the EHR. That is key for any organization that wants a successful implementation. Your partner will get you so far. Your IT team will get you so far. Your other stakeholders will get you so far. But your physician engagement is critical to the use of that EHR."
Memorial Hospital of Gulfport took a similar approach.
"We have created an EHR governance team to evaluate some of our pain points," explained Northington. "As the chart matures the governance structure will evolve with our physicians and patient’s needs. We realized we wanted to improve and evolve the current efficiencies within our organization to see the benefits of our investments. Cerner partnered with us to continue this growth and we are working together to evolve the next generation of the EHR."
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Opportunities for EHR optimization
EHR optimization opportunities will vary based on practice and can range from simple to complex. However, one obvious one is reducing the number of clicks — a widespread complaint of physician EHR users across the country.
"Healthcare providers do not want to worry about where or how they put the data in the system — their focus is getting it in there as efficiently as possible. As developers and builders of the application, the focus should be on making the data entry easier for the end-user with the ability to easily extract that data out of the system," writes health IT consultant Jerri Cowper.
"Healthcare providers do not want to worry about where or how they put the data in the system — their focus is getting it in there as efficiently as possible."
At Memorial Hospital of Gulfport, a program is in place to track mouse movement and clicks to identify inefficiencies in physician EHR use.
We're doing this nine-step program using the Cerner Advance piece to evaluate our individual physicians and practices," described Northington. "We're looking at everywhere from mouse miles to clicks to get our physicians to be able to flow efficiently through the chart and finish it as they finish with the patient in real time with the metrics to get them home on time."