A METHODOLOGY FOR Benefits-Driven EHR Implementation and OptimizationIn our companion paper, EHR Benefits: Unlocking the Secrets of Successful Organizations, we outlined the key practices used by organizations that have achieved substantial benefits from their EHRs. These practices (the “what”) are illustrated in Figure 1, along with supportive principles that help individuals throughout the organization understand, agree upon and support the changes required to achieve lasting benefits (the “how”).

A benefits-driven EHR approach to implementation and optimization uses these leading practices to drive substantial improvements in clinical quality, patient safety and/or operational and clinical efficiency.

A step-by-step methodology to deliver a benefits-driven EHR approach is illustrated in Figure 2 and described on the following pages. Example change management tactics are highlighted as part of each step.

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List of Strategic Benefits

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Defined BenefitMechanisms

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FIGURE 1: A BENEFITS-DRIVEN EHR IMPLEMENTATION & OPTIMIZATION APPROACH

FIGURE 2: BENEFITS-DRIVEN EHR IMPLEMENTATION & OPTIMIZATION METHODOLOGY

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Validate BenefitsRealizationApproach

Agree on a ShortList of Strategic

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Deploy PDSA CyclesUntil BenefitsAre Achieved

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Sustainability Plan

Transition toEHR-SupportedImprovement

Approach

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PHASE II: PLANNING

PHASE III: EXECUTION

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A Methodology for Benefits-Driven EHR Implementation and Optimization

PHASE I: ORGANIZATION—MONTHS 1–2

Validate Benefits Realization Approach. Establish executive sponsor(s) for the benefits realization effort. Appropriate sponsors may include the Chief Operating Officer, Chief Medical Officer or hospital CEO in a multi-hospital health system. With the sponsors’ help, reach agreement with key stakeholders, including hospital/system executives, clinical leaders and department/functional leaders on the approach and methodology.

CHANGE MANAGEMENT TACTIC: Leadership Message: Harnessing and Reinvesting Benefits (reinforcing the discipline of achieving benefits to fuel future initiatives, published on project home page)

Agree on a Short List of Strategic Benefits. Educate key stakeholders on EHR benefits commonly reported by successful organizations and ask stakeholders to identify their most important desired/expected outcomes of the EHR effort. Prioritize those benefits that are large in magnitude, consistent with organizational strategy, measurable and clearly related to EHR functionality. Then facilitate a process to gain agreement on a short list of strategic benefits. Assign benefit owners to each benefit on the short list.

CHANGE MANAGEMENT TACTIC: Benefits Prioritization Survey (soliciting leadership voice through mid-management level)

Establish Organization and Governance. Establish a committee focused on benefits realization including benefit owners and experts who understand process analysis and improvement, change management, data collection and measurement, etc. This group should report to the executive steering committee providing oversight for EHR implementation or optimization, members of which may be called upon to reduce process barriers that could potentially impact the ability to achieve the targeted benefits. The benefits realization committee should be focused on achieving the benefits over at least a one- to two-year timeframe post go-live.

CHANGE MANAGEMENT TACTIC: Governance Structure and Membership (introducing on project home page, publishing structure, naming leaders and inviting stakeholders to contact leaders with questions/comments)

Define Benefit Mechanisms and KPIs. Work with clinicians and operations/business leaders to define the mechanisms by which the desired outcomes will be achieved. For their assigned benefit area, benefit owners write “benefit sentences”—brief statements in a standard format outlining the EHR functionality, process changes, expected outcomes and time to achieve those outcomes. Benefit owners identify KPIs including primary outcome metric(s) and a few process and system use metrics to help guide the benefit realization effort.

CHANGE MANAGEMENT TACTIC: Benefit Visioning and Design Sessions (scheduling in-depth discussions with clinical and operational managers/frontline staff to dissect the “lifecycle of a benefit” and identifying key workflow and system configuration to support achievement)

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Phase II: Planning—Months 3–5Develop Measurement Plan. Specify how data for the KPIs described above are collected and how KPIs are calculated and reported. Ensure at least one of the benefits committee members has measurement expertise to ensure data is accurate and meaningful. Include trended outcome, process and system use metrics in high-level monthly dashboards; produce more detailed reports for operational use by benefit owners. Designate a “business expert” who understands current state operations and data and can support validation of baseline and ongoing KPI values.

CHANGE MANAGEMENT TACTIC: Benefit Measurement Review Meetings (creating a dialogue with clinical and operational managers/frontline staff to review and receiving input on plans for extracting and publishing operations data)

Establish Baselines. Establish baseline values for performance metrics prior to EHR go-live. Although it may be possible to use historical data to calculate baseline values later, in some cases historical data are not available (e.g., new time studies).

CHANGE MANAGEMENT TACTIC: Benefit Measurement Review Meetings (creating a dialogue with clinical and operational managers/frontline staff to review and receiving input on baseline data)

Create Benefit Models. Create benefit models to understand at a detailed level how benefits will be achieved (the benefit mechanisms) and guide and focus the benefits realization effort. Combine patient volumes and performance metrics with a deep understanding of local culture, structure, strengths and weaknesses, and what is known from the literature to generate targets for benefit achievement. Targets must be credible, easily explained and achievable.

CHANGE MANAGEMENT TACTIC: Benefit Measurement Review Meetings (creating dialogue with clinical and operational managers/frontline staff to review and receiving input on proposed targets)

Develop Benefit Realization/Communication Plans. Ensure that benefit owners develop plans to achieve individual benefits. Combine the individual plans into an overall benefits realization plan for the organization. Follow a similar process and format for each plan, and take advantage of common organizational resources including experts on dashboard and detailed metrics, process analysis and design, change management, statistical and other analytical methods, etc. Describe how the benefit owner will work with clinicians and others to measure, understand and modify existing processes and tools, including EHR content and functionality, with the agreed-upon outcomes as the goal. Define milestones and contingencies, roles and responsibilities, expected risks and challenges, and plans to overcome them. Define how benefit realization methods and outcomes will be communicated, not only to leadership, but throughout the organization.

CHANGE MANAGEMENT TACTIC: Leadership Message: Summary of the Multi-Year Benefits Plan (introducing and endorsing the full plan, published on project home page)

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Phase III: Execution—Months 6–30 Execute Benefit Realization/Communication Plans. Deploy the program, with benefit owners leading execution of individual benefit plans and the benefits committee (and the benefits lead, if one has been assigned) responsible for the realization of the entire short list of strategic benefits within expected timeframes. Make process changes that can be accomplished before EHR go-live date, reducing the amount of change required during the go-live period. Review benefit realization plans and results to date during monthly benefits realization committee meetings and collaborate on approaches across benefit areas.

CHANGE MANAGEMENT TACTIC: Benefit Spotlight: “What If?” (quarterly web-based articles to tie benefit measure to visible improvements in various areas; published on project home page)

Deploy PDSA Cycles Until Benefits Are Achieved. Review progress toward desired outcomes monthly and identify the root causes of lack of progress toward desired outcomes using a PDSA (plan, do, study, act) approach. Assess and leverage organizational capabilities to complete PDSA projects. Engage the steering committee to overcome barriers and maintain focus on outcome goals.

CHANGE MANAGEMENT TACTIC: Benefit Remediation Sessions (convening operational managers/frontline staff to diagnose barriers and design/endorse remediation plans)

Develop and Execute Sustainability Plan. Continue to review and communicate results to the executive steering committee. Alternatively, identify another existing organizational committee that will assume responsibility for ongoing oversight of benefit goals. Establish short- and long-term goals coordinated with organizational plans. Communicate the plan for ongoing monitoring and achievement of benefits clearly to all users. Benefit owners, the benefits committee, the benefits lead (if present) and the executive steering committee are responsible for ensuring the sustainability plan is executed.

CHANGE MANAGEMENT TACTIC: Leadership Message: Results Spotlight (highlighting and celebrating one or two achievements for the identified benefits, telling the story of how those benefits will be monitored for the long run)

Transition to EHR-Supported Improvement Approach. Once the initial EHR-centric improvement effort has achieved its outcomes and the organization has learned how to use the EHR to drive measurable results, embed these learnings in the organization’s ongoing patient-focused or outcomes-centered performance improvement approach, with the EHR as an important tool. Transition the benefits oversight framework and targeted benefits to existing operational and quality improvement committees.

CHANGE MANAGEMENT TACTIC: Leadership Message: Benefits Monitoring and Permanent Structure (describing the transition of benefits monitoring and oversight to a permanent structure which leverages organizational resources for continuous improvement; publish article in organization-wide communication vehicles (ex: weekly CEO message)

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About the Authors

Douglas ThompsonPrincipal, Informatics & Technology602.690.6964dthompson@chartis.com

Douglas Thompson is a Principal with The Chartis Group. He is a leading national expert in planning, defining and measuring the value of healthcare information technologies and translating these technologies into operations improvements and strategic advantage. His consulting and research experience includes health IT and consumerism, IT benefits realization and measurement, IT systems implementation and optimization, the development of performance measurement and improvement systems, and the role of technology in reducing unwarranted care variation. He is the founder and former Chair of the HIMSS Clinical Information Systems Benefits Task Force and a current member of the HIMSS Innovation Committee. Prior to joining The Chartis Group, Mr. Thompson was a senior researcher for The Advisory Board, and as a consultant for Navigant, CSC, First Consulting and Ernst and Young, and as an independent practitioner, he advised hundreds of leading health systems.

Tonya Edwards, MDPrincipal and Clinical Informatics & Technology Practice Leader864.430.6227tedwards@chartis.com

Tonya Edwards, MD is a Principal with The Chartis Group and Practice Leader for the Clinical Informatics and Technology Practice. Dr. Edwards has over 25 years of experience in healthcare as a family physician, physician executive and consultant. For much of her career Dr. Edwards served in dual roles as a Family Practice board certified, practicing clinician and operational leader in diverse environments from private practice to large integrated delivery networks before transitioning into full-time clinical informatics leadership roles. Dr. Edwards has extensive experience in clinical operations. She is certified in Clinical Informatics, Lean Six Sigma and has led numerous performance improvement projects. Dr. Edwards’ recent work has focused on clinical IT governance, physician engagement and change leadership, clinical process improvement and technology enablement and clinical informatics strategies, particularly related to the role of clinical informatics in driving value. Prior to joining The Chartis Group, Dr. Edwards served as Medical Director of Informatics for Bon Secours Health System. Dr. Edwards received her medical degree from Eastern Virginia Medical School and completed her Master of Medical Management degree from Carnegie Mellon University and is a Certified Physician Executive. She is board certified in Family Practice through the American Board of Family Medicine and in Clinical Informatics through the American Board of Preventive Medicine.

© 2019 The Chartis Group, LLC. All rights reserved. This content draws on the research and experience of Chartis consultants and other sources. It is for general information purposes only and should not be used as a substitute for consultation with professional advisors.

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