how to achieve your multi-million dollar value from your ehr investment february 17, 2014
TRANSCRIPT
How to Achieve Your Multi-Million Dollar Value from Your EHR Investment
February 17, 2014
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Discuss industry challenges in realizing value from IT investments
Learning ObjectivesParticipants will:
Review a practical framework for evaluating your organization’s capability to realize value.
Learn key tactics for getting your organization focused on benefits and ROI.
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Results of CIO Prioritization Exercise(October 2012 CHIME Fall Forum)
Population Health/ACO/New Models of Care/PCMHLeveraging Information and Big Data
Achieving Meaningful Use“Optimizing Current Systems / EHR Value Realization
Completing ICD-10Ability to Exchange Data
Cloud-First/Bring Your Own DeviceData Governance
Implement New Systems and New SitesM&A/Affiliation (IT Implications)
Patient-Centric Solutions (including Self-Service)eVisits/Tele-Health/mHealth
Interoperability (including Bedside Medical Devices)Outreach (Hospital and Provider)
Workforce ManagementAmbulatory Systems
Contact CentersFocus on Clinical Systems
Health Information ExchangeIT Service Management
Research SupportCost Reduction
Genomics/Personalized MedicineIT Governance
Process ImprovementSecuring Patient Information
0 2 4 6 8 10 12
Actual funded priorities over the next 2 years
What else in an ideal world would you focus on in the next 2 years?
Votes:
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Realize the Full Benefit of the EHRWhat are stakeholders saying?
“Our system just doesn’t seem to work well, and I have heard from colleagues that there is a better EHR out there – let’s buy that new system!”
“Documentation is full of too much extra stuff, and I can’t find the information I need to take care of my patients – how do we fix this?”
“We spent lots of time and dollars to put in this system and have been working with it for 4 years but we still haven’t seen any improvements in our coding and revenue.”
There are many symptoms of EHRs that are under-performing Dissatisfied clinicians, staff and patients/customers Low adoption rates Multiple workarounds Promised benefits (clinical and revenue) unrealized
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PopulationHealth
Experience of Care Per Capita Cost
Physician engagement/ satisfaction
Accountable care
Brand/reputation
Data driven culture
Meaningful Use
ICD-10
Shift from volume-based care to value-based care
Value Realization Key Drivers
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Value Realization (VR) Framework
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Value Realization: What is it?
Optimize the user experience (physicians, staff and patients/ consumers)
1.Optimize
2.Measure
3.Realize
Measureassociated benefit metrics
Realize increased value from your EHR
investment
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Value Realization: Core Competencies
In order to maximize the value of an Electronic Health Record (EHR), it is critical to develop a roadmap that addresses many core competencies, all in support of an optimized user experience and continuous value realization.
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Value Realization: Competency Definitions
2. Governance: focus on value, accountability, alignment and mitigation of risks.
3. Change Leadership: Create a culture and a framework to make changes faster, smarter and more effective.
1. User Experience: Optimize the process and supporting systems to enhance the overall user experience (both clinicians and patients/consumers).
4. Performance Improvement: Measure the output of a particular process or procedure, then modify it to increase the output, increase efficiency and effectiveness.
5. Training and Education: Offer learning methods that match the time constraints and learning styles of end users to introduce new functionality and improved ways of interacting with the system.
6. IT Services: Align business and IT objectives to ensure delivery of value to the organization while mitigating risks and maximizing user satisfaction.
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Value Realization Maturity ModelLevel 1:
Structures and priorities remain implementation-focused; KPIs and supporting metrics are not defined or understood
Level 2:A roadmap for value realization is developed; change control and prioritization become a priority
Level 3:Multi-disciplinary governance structure; priority of changes aligned to goals and benefit realization
Level 4:Value is measured and realized; continuousimprovement
FOUNDATIONAL ASPIRATIONAL PROFICIENT TRANSFORMED
Processes are established to manage and measure metrics and KPIs
Analytics capabilities enhanced
Pockets of proficiency
Change control board and process established
Training addresses needs
Centrally chartered performance improvement projects
Leaders held accountable for outcomes
Satisfaction and adoption is increasing
Benefit metrics owned, tracked and actively managed
Quality and efficiency maximized
Value is expected and outcomes are achieved
User groups are leveraged
PEOPLE, POLICIES, TECHNOLOGY ADOPTION
Limited benefit metricsLarge backlog of requests
Productivity and process efficiency is low
Low adoption and user satisfaction
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EHR Value Realization Framework
Level 1:Structures and priorities remain implementation-focused; KPIs and supporting metrics are not defined or understood
Level 2:A roadmap for value realization is developed; change control and prioritization become a priority
Level 3:Multi-disciplinary governance structure; priority of changes aligned to goals and benefit realization
Level 4:Value is measured and realized; continuousImprovement
FOUNDATIONAL ASPIRATIONAL PROFICIENT TRANSFORMED
1. User Experience
2. Governance
3. Change Leadership
4. Performance Improvement
5. Training and Education
6. IT Services
Competencies
Maturity Levels
BENEFITS FRAMEWORK
People
Process Technology
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Steps in the EHR VR Methodology
“Call to Action”
1. Shared framework and goals
2. Project Kickoff
“Assess the Current State”
1. Evaluate experiences, perceptions and beliefs
2. Analyze current system configuration / opportunities
3. Document influencing factors
“Define the Vision”
1. Facilitate group visioning
2. Develop guiding principles
“Plan and Execute”
1. Implement quick wins (intense short-term effort; big benefit
2. Develop roadmap
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Benefits Framework
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How Do You Know When You Have Achieved Value from Your EMR?
Benefits must be measured and managed to achieve value.
Quality
PatientExperience
Safety
Cost VALUE
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Benefits FrameworkProcess to Identify, Track and Manage Benefits
Develop short-list of strategic benefit objectives with named owners Secure executive agreement Describe and communicate each benefit objective including:
– Benefit statement – what will be achieved?– Selected metric(s) – how it will be tracked?– Expected outcome – what is the target?– Timeframe to realize outcome – when will the target be achieved?– Required technology change – what design/configuration will support this?– Required process change – what process/staffing will support this?
Establish governance group to oversee benefit metric progress and address any barriers
Develop tool to track the status of the functional build and process changes required to achieve expected benefit outcome
Develop tool to track the status of benefit metrics based on expected timeline to goal
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Example MetricsGoal: Improve Coding Efficiency
Category Benefit Objective Measurement ToolsEase of
Measure Actionable
Baseline Available June 2013
Quality Ensure that documentation justifies the intensity of services actually rendered to assign proper DRG.
Provide clinical, quality, coding and regulatory requirements, with standards, to streamline documentation to support clinical facts of the case/appropriate intensity of care.
Measure # of CDI queries before and after documentation changes.
Focus on top 5 coding related denials and reduce those denials.
Measure charges coded per hour before and after documentation changes.
Yes
Yes
Physician SatisfactionRevenue X
Cost
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The potential to realize significant benefits from your EHR is high when you manage your initiatives using a Benefits Framework.
Industry Examples
Allina Health Clinical resource use - $12.4 mmAdverse drug events - $4.8 mmDuplicate testing - $800,000Drug utilization/cost - $600,000Documentation workload - $1.7 mmOrder proc. workload - $1.2 mmHIM workload - $2.5 mmAccounts rec. reduction - $2.4 mmDenial reduction - $15.5 mmData quality improvement - $7.8 mmNet revenue increases - $5.1 mmRevenue cycle FTEs - $800,000
Texas Health Resources
Evidence-based care - > $50 mmMedication safety - $8-15 mmComplications reduction - NQOrder turnaround time - 1-2 hrsIncrease efficiency - NQPatient throughput - ED LOS cutReduce paper forms - $1 mmReduce denials - NQOptimize medication useCharge capture - $ 2-3 mm
Sentara Healthcare
Nursing OT, retention - $5.2 mmIT maintenance - $4.2 mmMedical rec./transcript. - $4.1 mmIncreased O/P services - $3.2 mmReduced length of stay - $3.1 mmReduced ADEs - $2.9 mmReduced paper/storage - $2.4 mmOther improvements - $4.9 mm
Total: $60-69 millionAcross 13 hospitals
Total: $55.6 millionAcross 11 hospitals
Total: $30 millionAcross 11 hospitals
Source: HIMSS Davies Award Applications
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Key Takeaways
Engagement is required from all parts of the organization; this is not an IT initiative
Value realization is a multi-dimensional effort; need to consider organizational structures, behaviors and processes
Benefits must be measured and managed to achieve value There are no quick fixes to achieve sustained value It is critical to understand where you are starting from across all
competency areas before you can develop a plan to improve and achieve your vision
Strive to develop a balanced plan that facilitates quick wins and aligns to the strategies of the organization
Change leadership is required to establish a culture where value is expected and achieved
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Q&A