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Road MapHow to Save Your EHR: 6 Steps to Holistic Optimization

ROAD MAP

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How to Save Your EHR: 6 Steps to Holistic Optimization

Electronic health record (EHR) adoption has skyrocketed thanks to the numerous recent incentive programs. Unfortunately, accompanying this automation has been a sense of dissatisfac-tion in the trenches because of unmet expectations, poor workflows, and feature underutilization. If you’re experiencing these issues, you may be considering replacing your system. But before jumping ship on your current EHR, it’s worth considering a holistic system optimization program.

Optimization goals generally include improving patient care, increasing staff satisfaction, streamlining processes, and leveraging existing technology. Your optimization plan should look beyond a single system and consider how all systems work together. Reviewing data is a good start, but a holistic approach includes exploring workflows, processes, policies, and organizational goals and climate.

The timing of your optimization project is critical to its success. You need to be past the implementation stage to the point where users have accepted the EHR. Once they start asking for shortcuts, customizations, and training for advanced features, you’ve hit the sweet spot for beginning the optimization process.

Solid planning is the key to success of your project. This six-phased approach will help you best organize your initiative and may save you the pain of converting to a new system.

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Get Organized1

Project Manager. As the optimization project builds momentum, priorities can become confused without clear direction. A disciplined project manager will keep the project on track and initiatives in scope and help guide the organization through the difficult change management process.

Application/Systems Expert. Your system expert can offer valuable perspectives gleaned from exposure to various offices’ configurations.

Revenue/Financial Team Lead. A revenue cycle resource will provide valuable insight into the financial impact of your initiative.

Clinical Team Lead. Someone from the clinical staff will not only provide knowledge critical to the initiative, but they can also have a huge impact on peer influence and adoption.

Super Users. Enthusiastic staff members provide front line perspective, are good at working through issues that occur during the project, and tend to spread the positivity like wildfire.

Internal IT Resource. An internal IT resource will know how all the systems and applications in your organization fit together and can act as a liaison with vendors during the optimization process.

Optimizer. An optimizer acts as an intermediary between several departments, vendors, and committees and can be a resource for line staff to report problems or communicate issues. Your optimizer should be someone who knows your workflows, has an interest in process improvement, and who has potential to master the technical, clinical, and financial components of your organization.

Define Project Scope and Deliverables. Now that your governance structure is in place, define your project scope and deliverables. Discuss and document assumptions, determine internal resource bandwidth, assign teams and task ownership, and set timelines and deadlines for deliverables. The goals and focus should center on your reasons for optimizing. Are you preparing to participate in or want to increase efficiency in programs such as meaningful use, patient centered medical home, or another inter-nal initiative? Will you focus more on revenue cycle or clinical perspectives?

Develop a Communication and Marketing Plan. Finally, develop your communication and marketing plan. This is a prime opportunity to set clear expectations, communicate priorities, and gain buy-in. Use newsletters, email, and other internal resources to promote messages.

Holistic optimization is a group effort and does not belong to the IT department alone. Your optimization team should contain representatives from all areas of the organization and should include these key players:

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Discover & Collect Data

Begin by gathering information through interviews, observations, system review, and data mining.

People. Reach out to staff for pain points and wish lists. Through staff observation, look for opportunities to eliminate redundant tasks, workflow variations to policy, security threats, and areas for training opportunities. Also note workflows and processes that are working effectively.

Primary Software and Add-on Applications. Review all applications for new ways to take advantage of existing functionality. Find ways that paper processes can be converted into electronic workflows. Look for manual data entry points and research where items can be defaulted instead.

Physical Environment. Finally, review physical layout and its impact on workflows. Note patient flow through the office, check-in or registration areas, and views of patients in the waiting room. Do patients have to pass the checkout desk before they leave your office or can they slip out before their visit is closed? Are the provider desks/offices within sight inviting constant interruptions?

Once all data collection and observations have been completed, develop a gap analysis between current state and desired future state. Itemize each issue, workflow, best practice, and recommendation and list the benefits of implementing each. It’s critical to include the input from everyone on the team because each has a different perspective based on roles and assumptions.

Do not set the optimization project on the shelf at this halfway point. Too many times all the hard work and meticulous documentation can end up collecting dust because the project came to a halt as other priorities took precedence. The bulk of the work has been completed and now it’s time to design a plan for action.

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Compile, Analyze, Document & Understand Findings3

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Design an Action Plan then Build, Test, and Validate

The implementation phase involves these key steps:

Prioritize. Categorize items by ranking them based on perceived level of impact, complexity, effort, or cost. Choose a few “quick win” items that are low effort but high impact.

Gain Consensus. Gain buy-in and address concerns. If the core team is not on board, it will be difficult to implement in the global rollout.

Redefine Scope and Deliverables. Compare the findings from what the Phase 2 expectations and realign as necessary. Assign responsibility for building, testing, and validating the recommendations. Document a timeline and deadlines for deliverables.

Keep in Scope. Allocate hours and timeline for each initiative. Use a “parking lot model” to place ideas that come up after the fact to ensure they are accounted for and addressed where appropriate. Plan for items to come up and set aside time to address unforeseen issues that may occur.

Define Metrics. Decide how each recommendation will be measured. Metrics demonstrate the effectiveness of the investment in time, money, and people before, during, and after an optimization.

Stretch Your Dollar. Leverage your quarterly vendor support fee. The fee is the same whether you ask one question or fifty questions per month and support is often unused by staff because either they don’t know about it, don’t have the contact information, or simply neglect to use it. Vendors may be an invaluable resource for many of the recommendations on the list.

Identify simple but time consuming work that can be done by internal staff, students, or interns who may have downtime throughout the day rather than outsourcing at a high hourly rate. Build, Test, Validate. When appropriate, use a test database and have multiple people run through various workflows to eliminate major issues.

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PRIORITIZE

GAIN CONSENSUS

REDEFINE SCOPE AND DELIVERABLES

KEEP IN SCOPE

DEFINE METRICS

STRETCH YOUR DOLLAR

7 BUILD, TEST, VALIDATE

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Communicate. Communicate. Communicate. Communicate before, during and after go-live. Provide staff updates, explain the reason for changes, and how it benefits the organization. Set expectations on upcoming changes and give opportunities for staff feedback.

Negative Neds and Nellies. Change is not always welcome with open arms. Negative verbal and non-verbal signals from office managers, physicians, and staff can be a major obstacle to the initiative. It’s important to ask for input and feedback, listen and address concerns, and provide opportunities to help resolve issues. Expect Go-live Issues. Even with proper planning and testing, it is likely you may encounter an unforeseen hiccup during implementation. Be prepared with an action plan to triage issues, rework, and reengineer ad-hoc. Timing is Everything. Consider a tiered approach and go-live with a pilot site if possible. Consider the daily schedules and pick the “slow” day or time that works best for them. Factor in other projects currently in progress. Training. Provide plenty of opportunities for hands-on learning close to and during go-live. Prepare a variety of learning materials, training aids, and learning sessions and circle back to include any missed staff or new employees.

Global Rollout5

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Maintain a plan for support as issues arise. Communicate positive impacts, celebrate wins, and show appreciation for staff efforts. Monitor the changes for any workflow variations and follow up on any new issues, problems or concerns.

True optimization never ends. The optimization process requires a continual cycle of review, reevaluation, and reconfiguration to maximize the use of systems, people and processes. The whirlwind of internal and external change in healthcare IT will continue so it’s crucial that organizations continue to evolve. In the end, holistic optimization may be a better alternative than moving to a new system.

Support, Follow Up, Measure Outcomes6

Hayes Management ConsultingHayes Management Consulting is a leading, national healthcare consulting firm that partners with healthcare organizations to streamline operations, improve revenue and enhance technology to drive success in an evolving healthcare landscape. To learn how Hayes Management Consulting can help you with your clinical optimization, call 617-559-0404 or [email protected].

www.hayesmanagement.com

1320 Centre Street, Suite 402 | Newton Center, MA 02459Phone: 617-559-0404 | Fax: 617-559-0415www.hayesmanagement.com | [email protected]