While more than 95 percent of hospitals have implemented electronic health records (EHRs), according to data from the Office of the National Coordinator for Health IT (ONC), many of these organizations have not been able to optimize their EHR systems to realize the value of the technology. To this point, healthcare CIOs plan to invest heavily over the next three years to improve how they are used, according to a recent survey of College of Healthcare Information Management Executives (CHIME) members conducted by KPMG LLP, the U.S. audit, tax and advisory firm.
In a survey of 128 CHIME members about healthcare IT investment priorities, 38 percent of respondents ranked EMR system optimization as their top priority for capital investment over the next year.
The KPMG survey, which was conducted through January 2017, found CIOs plan the majority of capital investment over the next three years to be (figures rounded):
- EMR system optimization (38 percent)
- Accountable care/population health technology (21 percent)
- Consumer/clinical and operational analytics (16 percent)
- Virtual/telehealth technology enhancements (13 percent)
- Revenue cycle systems/replacement (7 percent)
- ERP systems / replacement (6 percent).
“Meaningful Use, HITECH and new payment models have encouraged healthcare providers to invest in EHRs, but some didn’t mesh with how doctors and nurses work,” Ralph Fargnoli, Advisory managing director at KPMG and author of a report, Beyond Implementation: Optimizing EHRs to Maximize Results, said in a prepared statement. “A majority of doctors are dissatisfied with EHRs. We need to make these systems secure, easier to use, and interoperable across the continuum of care to effectively treat patients and uncover where quality and efficiency can be improved.”
According to Fargnoli, the investment priorities correlate with some of the biggest healthcare IT challenges that executives face. The survey found that improving clinical/business processes topped the list of challenges, closely followed improving operating efficiency and delivering business intelligence/analytics.
These spending plans are likely to remain the same among 63 percent of respondents for the next 12 months and for 44 percent during the next two years, the survey found. For the next 12 months, 18 percent of respondents expect higher spending. Further, 36 percent of respondents expect an increase in operating budgets during the next two years.
Approximately one quarter of all respondents said their organizations were implementing or investing in cloud computing infrastructure (servers, storage and data centers) and 18 percent said their investments were in enterprise resource planning (ERP) solutions. Other key functions for the cloud among the respondents include electronic health records (10 percent), enterprise systems solutions (10 percent) and disaster recovery (8 percent). The biggest challenges and concerns with cloud computing were regarding data loss/privacy, applications not being fully optimized with the cloud and integration with existing architecture, according to Fargnoli.
In the report, Fargnoli, offered an analysis of EHR optimization strategies. He wrote, “Many of these ‘out-of-the-box’ EHR implementations, which were often fast-tracked in an effort to meet meaningful use requirements, typically restricted providers from realizing a clear return on investments (ROI). In such cases, organizations often shifted to a reactionary mode—patching together teams to resolve issues that arose after going live with their EHRs. However, these organizations didn’t establish an organized plan to move forward. As a result, they often tried to do too much at once—and the attempt to remediate backfired. The length of time to resolve the issues increased and frustrations mounted as clinical, senior management, IT and human resources staff found themselves spinning their wheels.”
Further, Fargnoli offers recommendations for effective EHR post-implementation strategies. “Organizations should assemble a cross-functional team that comprises technology professionals as well as clinical and business leaders to focus on executing an EHR post-implementation strategy and aligning it with organizational goals,” he wrote.
First, healthcare organizations should conduct a baseline measurement, set top benchmarks and incentivize leadership to obtain results, he wrote. And, during this stage, healthcare leaders should identify pain points and the most urgent business priorities. Second, organizations should determine how best to improve the installed EHR by reviewing goals or expectations that were set when making the initial investment and then evaluate the progress. Third, organizations should monitor, measure repeatedly and report data. “Data and analytics are the key to providing insight into performance. By analyzing key performance indicators (KPI) related to service lines, productivity, decision-support and supply chain issues, organizations can understand the cost of care, profitability of medical service lines, patient satisfaction and quality measures,” Fargnoli wrote.