- Now that it's December, healthcare organizations and providers are able to reflect on a rather busy year.
Coming into 2015, many had concerns about meaningful use requirements such as a full-year reporting period for Stage 2. However, modifications to the EHR Incentive Programs allayed most of those.
Even still, the imbroglio surrounding the ICD-10 implementation finally came to an end with little more than a whimper after October 1 past and most providers proved capable of rising to the challenge.
With the calendar about to bid goodbye to 2015, the attention now turns to 2016 and the opportunities next year holds for providers without a major federal mandate or otherwise hanging over their heads. So is now then the time for these health systems, hospitals, and physician practices to spend time improving inefficiencies internally?
EHRIntelligence.com posed this and similar questions to the Physician Executive of Impact Advisors. According to Tonya Edwards, MD, MMM, the coming year is most likely to be one whose focus for providers is on EHR optimization.
In this one-on-one, Edwards shares the goals and resources necessary for succeeding at EHR optimization projects as well as the type of approach that could hamper these improvement initiatives.
EHRIntelligence.com: Where is EHR optimization likely to focus in the coming year?
Tonya Edwards: I see it as three buckets. There's the usability/efficiency bucket of keeping our providers and our end-users happy and more efficient and productive. Then there's the bucket of cost avoidance — let's improve workflows to increase utilization and decrease variability. Then there's the bucket of let's try to increase revenue because we have not made this big transition from volume to value yet. We're in the midst of it, so we still have got to drive volume.
EHRIntelligence.com: Will the EHR optimization project fall mostly to vendors or providers?
TE: It's a little bit of both. Definitely, there is vendor involvement as far as improving usability. But there's a lot that's involved just from an individual organization standpoint.
For instance, take a vendor like Epic. Epic comes in with a foundation system and there is a lot that Epic has done to try to improve usability, but there is just tremendous amount of flexibility in the product and each health system has an individual build. You can choose to build 300 or 400 BPAs [best practice advisories] that are going to pop up for all providers or you can choose to streamline and try to minimize the number of popups you might have and use every other kind of clinical decision support to get the same result but not have impeded the workflow for providers. By the same token, you can streamline who sees that — is it only the attending physician or does every provider that touches that patient see it?
There is a lot that health systems can do themselves as far as usability, taking a look at what those workflows really are. Sometimes, that involves looking at the clinical workflow, streamlining it, and then having IT support that. But sometimes it's really just inside IT and how you choose to build within the product.
EHRIntelligence.com: Are EHR optimization projects more likely for mature EHR adopters?
TE: That's definitely true, but it can be done for organizations just going through implementation. You have to put those key usability principles in front of the people who are helping to design your system and try to weigh your decisions against those principles. It can be done while you're going through your initial build — it's harder. There are other things, simple things, like clinical documentation improvement in trying to standardize frameworks for docs so that all of the key elements are capture as automatically as possible so that you're capturing those things that are required for reporting out to governmental or commercial insurance companies as well as for coding and revenue.
EHRIntelligence.com: Who comprises the team in successful EHR optimization project, for instance?
TE: It is a multi-disciplinary team that needs to be operationally-led because it is the people doing the work who understand the work. They understand why things need to be done in a certain order. They understand what the barriers are. Once those workflows are developed, then it's up to IT to come in and try to support that.
EHRIntelligence.com: Will providers have to turn to outside resources to complete EHR optimization work?
TE: It depends on whether or not you have a mature process improvement team that is used to doing projects in a multi-disciplinary fashion. Certainly it can be done internally. But another problem starts to fall on the IT side. Once you're through the implementation, now you're working on optimization, but you may not be appropriately staffed. You may have just enough staff to do a quick fix or maintenance, but then you end up a couple years into an EHR implementation project and there are 700 items on an enhancement list because no one has time to work them or prioritize them for that matter.
It becomes resources, skill set, and culture. The culture has to be that we're moving away from this being IT-led, that we're moving away from it being purely operationally-led and instead multi-disciplinary a team looking at this. Not every healthcare organization is at that point in their culture that they're ready to do that.
EHRIntelligence.com: Will the lack of a serious federal mandate in 2016 help providers focus on these EHR optimization efforts?
TE: I certainly hope so. I don't know a major topic coming up that should be an impediment. Obviously, we now need to be compliant with Stage 3 Meaningful Use. We have gone through all of ICD-10 and it really wasn't as much of an event as many feared it would be or at least not for most health systems. It seems like we may have an opportunity in the next year to have a breather, be able to focus a little bit more on being able to optimize these systems, and really try to get the value out of the millions and millions of dollars that we have put in.