- An EHR implementation is a costly and resource intensive endeavor that is transformative for healthcare organizations. Adding to the challenge of implementing an EHR is the increasing complexity of provider organizations across numerous care settings, geographical locations, and type of facility.
Despite near ubiquitous EHR adoption across the United States, health systems, hospitals, and physician groups still struggle to get the most out of their EHR technology and realize expected value. What steps can organizations take to achieve a real and meaningful return on investment?
With the intensity of resources, time, and focus needed to effectively go-live on an EHR, many times organizations are uncertain how to effectively advance, manage, and support their care team needs after the EHR is in use. Day 1 of the new EHR system marks the beginning of a multiyear journey that requires continued maintenance and investment.
EHR systems are not static technologies and organizations are struggling to understand how to ensure optimal use of the EHR. Currently, EHR optimization efforts garner none of the attention that large EHR rollouts do, but they are no less critical to achieving an actual return on a seven-figure investment in technology.
“By and large, EHR implementation focus is on clinical workflows that meet the needs of the top 50 to 60 percent of physicians, which are primary care physicians. There's less effort and focus on the specialties, especially when it comes to having the appropriate configuration, optimal workflows, and tools that they need. The specialties do not have the tools they need to use the EHR effectively,” says Nuance Communications Executive Director and CMIO Bret Shillingstad, MD, himself a general surgeon by training.
“Once live, you’re at your peak in terms of resources, but then the project team and IT budgets get smaller. It's difficult to keep up with upgrades, new features, and emerging technologies to deliver the most efficient and best experience to all physicians.”
An unsuccessful EHR implementation can negatively impact clinical productivity and organizational efficiency, so it follows that many resources are dedicated to the success of go-live. However, reaping the full benefits of EHR adoption requires a sustained focus, clinical workflow knowledge, and investment in skilled resources to achieve continual advancement and meet the needs of the physicians.
“Optimization is something that can start within four to six weeks after go-live,” Shillingstad observes. “But certainly after you get to stabilization, you should start analyzing the data available from EHR and other technologies physicians use to understand better which areas have the greatest pain points, which areas that got cut during the implementation and are needed by physicians, or subspecialties you just couldn't build out and enable properly because of budget and staffing at the time of go-live.”
The process of EHR optimization begins with an analysis of data from the EHR, surveys, and additional technologies physicians use in their daily workflows. Through useful analysis of the data organizations can take a dedicated look at the pain points, and problems physicians are encountering with their technology systems in the field.
The focus should then turn to review that problem list with project teams and leaders and developing a roadmap for mitigation. EHR optimization can even dovetail with efforts to address provider burnout by better tailoring the system to clinical workflows and ensuring support for enablement and the ‘how to’ questions is readily available to all members of the care team.
Well adopted EHR technology allows for the collection of high-quality data to improve the health of a single patient as well as inform clinical decision-making around specific patient populations. The EHR is the foundation element in the process of transforming data into information. However, organizations must first get providers to use the systems effectively and efficiently.
The build of the EHR that rolls out at the point of go-live will need to evolve and mature to suit the needs of its end-users. Specialties are one area ripe for optimization given their tendency to focus on a limited set of conditions. Configuring the EHR system to manage the 20 to 30 conditions that account for 90 to 95 percent of all specialist work is likely to meet with success.
“One of the areas that most organizations look at are the procedural ones,” Shillingstad reveals. “Those tend to have different workflows than your 50 to 60 percent of physicians that are primary care, and that's where you see the biggest ROI. The addition of one to two consults per day can translate into $80,000 more per year per physician in procedural revenues.”
Many times, however, organizations do not have the depth and breadth of knowledge and number of resources needed to effectively complete and focus on activities required to deliver on timely optimization action items. Adding to the challenge is the need to have resources working on necessary upgrades, enhancements, additional technology projects, and merger and acquisition activities. Given these factors, many are likely to miss out on taking advantage of all functionality available in the upgrades and enhancements to their EHR systems that address obvious paint points at their organizations.
“The teams are strapped. They're extending to other organizations through acquisitions and contracts, and they don't have much bandwidth,” says Shillingstad.
Experts in EHR adoption and optimization are fortunately available to assist in these processes as a service. Having clinical experience and knowledge of the EHR to build EHR systems and support physician adoption effectively is critical.
“Having eyes and clinical leadership that has seen this at numerous sites is a benefit over a project team that may have only seen an EHR used at one or two places ever,” Shillingstad notes.
From Shillingstad’s vantage point, the path to successful EHR adoption comes from coupling the right software build with the right kind of training.
“You're only going to gain so much improvement in the use of the EHR by training alone,” he argues. “Training alone will get you some improvement, no doubt. But if you can combine that with build and training, that's where you see the biggest wins.”
With providers becoming increasingly concerned with the quality of care they provide to patients and ensuring the care they provide is accurately reimbursed, they are looking to extract more value from their EHR data. There is no question of how organizations begin to execute effective EHR optimization plans is a crucial factor in achieving the value they seek from their substantial IT investment.