how to achieve your multi-million dollar value from your ehr investment february 17, 2014

How to Achieve Your Multi-Million Dollar Value from Your EHR Investment

February 17, 2014

ingenuity | intensity | integrity

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.


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:


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


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


Value Realization (VR) Framework


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


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.


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.


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


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


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


Benefits Framework


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


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


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


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


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


Q&A

how to achieve your multi-million dollar value from your ehr investment february 17, 2014

Documents

increased value

delivery of value

dollar value

continuous value realization

ehr investment slide

revenue unrealized slide

optimized user experience

overall user experience