Over the last 10 years, health systems and physicians have invested heavily in the current generation of electronic health records. With three out of four hospitals having at least a basic EHR in place, it is safe to say implementing a system has become a foundational requirement for being in the business of healthcare delivery.
The opportunities EHR offer for improvements in care delivery are promising—they include efficient care team communication, improved clinical outcomes through embedded decision support and standard use of evidence-based protocols, immediate access to patients’ clinical information, increased patient engagement and enhanced revenue cycle. However, achieving improvement has remained elusive.
Countless hours and billions of dollars have been spent by providers to create a streamlined and integrated clinical environment capable of decreasing operating costs, improving clinical quality and qualifying for incentives. These efforts, however, are typically pursued from a “project first” perspective, focusing on the implementation cycle and its metrics—system selection, launch and functionality—as the markers for EHR value realization. Instead of a well integrated, streamlined EHR system that drives and enables process improvements in care delivery, providers end up with an EHR that does a great job automating existing processes, whether they support improvements in care or not.
As providers attempt to move beyond implementation, they are faced with a critical inflection point. The approach that most have taken to successfully get the system in is not the same as the approach needed to realize its promise and value.
- Common barriers to full value realization include the following:
- Useful data and information cannot be easily extracted from the EHR.
- Systems are not integrated across the full care continuum.
- Caregivers say they believe the EHR interferes with their ability to effectively care for patients, yet clinical teams have not been given the authority or responsibility to engage in wholesale workflow, process or role redesign.
- Expected benefits of the EHR are unknown or unclear to stakeholders and end users.
- Prioritization of EHR enhancements or investments is not aligned with strategic or operational goals.
Healthcare organizations need to move beyond the “project first” mindset to understanding and enhancing the powerful role technology plays in transforming care delivery through a “care first” approach.
A new mindset is necessary to achieve full EHR value realization. This can only be done by integrating clinical, operational and technology performance improvement efforts in a manner that is fundamentally different than healthcare organizations have ever had the need or opportunity to do in the past. Technology can and should play a key role in achieving superior levels of care delivery performance across all dimensions of cost, quality, outcomes, and patient, physician and staff satisfaction.
To achieve full benefits, organizations need an entirely new set of starting points for achieving value with EHRs.
Organizational strategies. Whether you aspire to manage the care and outcomes for designated populations of patients or you strive to gain efficiencies to reduce escalating care costs, your approach to EHR value realization should drive toward your organizational imperatives.
Voice of the clinicians. A “care first” approach must begin with the clinicians and the work that they value—caring for, communicating with and helping patients gain and maintain their health. Elevate the voice of the care team members, and keep the clinicians in charge of designing optimal care processes in which technology plays an essential but secondary role.
Patient and family perspective. A “care first” approach also must incorporate the perspective of the patient and their family members, and the experience they value—ease of communication; seamless, friendly processes; collaboration; and engagement and empowerment. Avoid the temptation of assuming that you know what this most important individual in the care process wants and ask directly.
Systems of care. The EHR is the central nervous system for systems of care. EHR optimization efforts should be intrinsically connected to clinical and operational performance improvement efforts, allowing technology to do what it does best—serve as the clinician’s partner to enhance knowledge and experience.
Organizational core competencies. An organization’s core competencies around governance, change management, analytics, continuous improvement, leadership and supporting IT infrastructure must be in place and functioning effectively to drive value from EHR investments and transform care.
Also contributing to this article for Chartis were Myra Aubuchon, principal; Jodi Capistrant, associate principal; and Stephanie Hines, practice manager.
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