A recent survey from the American Hospital Association (AHA) conducted between November 2013 and February 2014 found that hospital adoption of electronic health record (EHR) systems has increased more than five-fold over the last five years. Specifically, 93 percent of hospitals in 2013 reported being "in possession" of an EHR system that received meaningful use certification, according to the survey’s data.
However, while the overwhelming majority of healthcare organizations across the country have implemented EHRs, it’s the work that is done post-implementation that will have a greater impact on how a health system succeeds. Indeed, organizations are faced with increasing pressure to deliver clinical and financial results demonstrating the benefits of their implemented EHRs. As such, using the technology to achieve health and efficiency goals—such as attesting to meaningful use, and then population health and care management—should be a high priority at patient care facilities.
Fran Turisco, a principal with the Denver-based Aspen Advisors—a healthcare consulting firm that helps organizations streamline operations through the strategic and effective use of technology— recently spoke with Healthcare Informatics Assistant Editor Rajiv Leventhal about strategies for EHR optimization, what organizations are currently doing wrong, and the direction the industry is going in terms of post-EHR implementation. Below are excerpts of that interview.
Now that so many organizations have their EHRs implemented, what are the next steps?
What putting the EHRs in did was provide the foundation in terms of functionality and data. Now organizations have a lot more data, so they are working on initiatives—call it data analytics or clinical analytics—to take the data and do interpretation and measurements so you can assess your quality and risks, and see what your care outcomes are. That’s really the whole emphasis behind meaningful use Stages 1, 2, and 3, and part of Stage 3 is outcomes-driven. So they have the data, and a lot of organizations are focusing on understanding where they are by using the data to come up with meaningful metrics and dashboards to monitor how things are going. Another area where we are seeing activity, after getting the basics in and meeting meaningful use, is customizing the EHR so it has alerts that they think are important; evidence- based protocols that they want to follow; and advanced alerts for patient safety issues. And they’re also creating more and refining their order sets.
After implementation, do organizations try to mimic all their old paper processes and workflow? Is this smart?
It depends how long they’ve had the EHR in. We always tell organizations that this is a great opportunity to look at your new technology, but also your processes. Some do, but some feel that they have to get the system in by a deadline. Afterwards, many go through what is almost like a process improvement care redesign. We just recently finished with a client that had difficulties with standardization of where data is, as well as physician documentation and medication reconciliation, so they created this whole program and had a “tiger team.” We did five different initiatives and measured the before and after to show improvement, and not only does it help the organization, we saw that it really got physicians jazzed up. So it was a win-win, and now we see a number of organizations looking at things like that, determining what works versus what won’t work now that the technology is there.
On that note, how important is physician adoption to the optimization process?
I would say clinician adoption varies based on the level of involvement and decision making during implementation. If there is a lot of involvement—and if physicians want to be involved—then you get great adoption. At other places, they see it as an IT initiative, and it becomes a “we have to do it because we won’t get paid for it otherwise” situation. They might do what they need to do, but it’s checking boxes as opposed to looking at the underlying reason for why it’s being done in the long run. Some don’t see that [this technology] is capturing data for metrics, research, and education.
What are organizations doing wrong when it comes to post-implementation? Is poor planning a big issue?
In the long run, yes, planning is of course critical to success. There are two organizations I am working with right now. One multi-hospital system implemented its EHR [almost two years ago], and the other one is a hospital that implemented last August. The one that has been up and running for [almost two years] is now customizing for the particulars of the different hospitals. The other organization that just installed it is still dealing with a lot of basic issues. I don’t believe that there is any way to optimize the processes and technologies before you get it in; you’re lucky if you get 80 percent there. Organizations expect that there will be some level of optimization, whether they feel like it’s a great opportunity to change their workflows and fine tune their systems, or their workflows are fine but their system needs to be enhanced, standardized, and optimized to get more out of it. It really depends on the organization.
The other thing we’re seeing is that [optimization] allows organizations to play in the health information exchange (HIE) sandbox. So with the hospital that has been up and running for [almost two years], I talked to the CIO recently, and he said, “We’re connected using Epic, and we have exchanged 2,500 records. Isn’t that wonderful? Someone in Boston could travel to Denver and if something happens, we have their information.” He was truly amazed. I think that’s another area—as organizations are starting to embrace value-based care, accountable care, and collaborative care—that they need these systems in place for, or there’s no way they can exchange and share data. It’s part of the entry into the accountable care world.
A lot of organizations are starting out as “view only,” but are moving into shared protocols and shared care delivery. Time is preventing them from getting from one phase to the other, but also it is new to them and is a culture shock. They’re not used to sharing and they don’t want to share. And they’re also not quite sure how they will operate in an accountable care environment. Over a year ago, one organization asked us to build a technology roadmap for its new accountable care organization (ACO), and at the time, it hadn’t even figured out how it was going to conduct business. So we’re asking, “What quality measures do you need and what do we need to set up for care protocols?” And their response was, “We’re working on that.” So folks are dipping their toes into data sharing and data collaboration. It’s still very early in the process, you need to remember that.
What else do you see on the horizon for organizations deploying their EHR strategies post-implementation?
Another thing that is important now is that if you pass Stage 2, there is this whole patient engagement concept with patient portals. We are seeing organizations using the patient portal part of the EHRs to not only engage the patients, but also the family members. Even with things such as appointment reminders and simple things like health assessments and educational information, you’re fitting in contact with the patient, which is really important. You’re allowing the patient to use the portal to communicate with the provider. We’re seeing that a lot.
The reality of healthcare reform is that we now need to manage populations—we are now responsible for that. And they will find new and innovative ways to care for patients rather than seeing them in person. So we’re getting there, but slowly. It’s both exhausting and exciting, but really, I think the fun is just beginning in terms of technology.