EHR Value Realization Sales Deck
How to Achieve Your Multi-Million Dollar Value from Your EHR Investment February 17, 2014 Learning Objectives Participants will: Discuss industry challenges in realizing value from IT investments 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. ingenuity | intensity | integrity Page 2 Results of CIO Prioritization Exercise (October 2012 CHIME Fall Forum) Votes: 0 Population Health/ACO/New Models of Care/PCMH Leveraging Information and Big Data Achieving Meaningful Use “Optimizing Current Systems / EHR Value Realization Completing ICD-10 Ability to Exchange Data Cloud-First/Bring Your Own Device Data Governance Implement New Systems and New Sites M&A/Affiliation (IT Implications) Patient-Centric Solutions (including Self-Service) eVisits/Tele-Health/mHealth Interoperability (including Bedside Medical Devices) Outreach (Hospital and Provider) Workforce Management Ambulatory Systems Contact Centers Focus on Clinical Systems Health Information Exchange IT Service Management Research Support Cost Reduction Genomics/Personalized Medicine IT Governance Process Improvement Securing Patient Information ingenuity | intensity | integrity 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? Page 3 Realize the Full Benefit of the EHR What 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 ingenuity | intensity | integrity Page 4 Value Realization Key Drivers Physician engagement/ satisfaction Population Health Accountable care Brand/reputation Data driven culture Meaningful Use ICD-10 Shift from volume-based care to value-based care Experience of Care ingenuity | intensity | integrity Per Capita Cost Page 5 Value Realization (VR) Framework ingenuity | intensity | integrity Page 6 Value Realization: What is it? Realize increased value from your EHR investment 1. Optimize 3. Realize Optimize the user experience (physicians, staff and patients/ consumers) 2. Measure Measure associated benefit metrics ingenuity | intensity | integrity Page 7 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. ingenuity | intensity | integrity Page 8 Value Realization: Competency Definitions 1. User Experience: Optimize the process and supporting systems to enhance the overall user experience (both clinicians and patients/consumers). 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. 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. ingenuity | intensity | integrity Page 9 Value Realization Maturity Model Level 1: Structures and priorities remain implementationfocused; 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 4: Level 3: Multi-disciplinary governance structure; priority of changes aligned to goals and benefit realization Value is measured and realized; continuous improvement Value is expected and outcomes are achieved Quality and efficiency maximized Leaders held accountable for outcomes Centrally chartered performance improvement projects Training addresses needs Productivity and process efficiency is low Benefit metrics owned, tracked and actively managed Satisfaction and adoption is increasing Pockets of proficiency Change control board and process established User groups are leveraged Analytics capabilities enhanced Processes are established to manage and measure metrics and KPIs Large backlog of requests Limited benefit metrics Low adoption and user satisfaction FOUNDATIONAL ASPIRATIONAL PROFICIENT TRANSFORMED PEOPLE, POLICIES, TECHNOLOGY ADOPTION ingenuity | intensity | integrity Page 10 EHR Value Realization Framework Maturity Levels Level 1: Competencies 1. User Experience 2. Governance 3. Change Leadership 4. Performance Improvement 5. Training and Education 6. IT Services Structures and priorities remain implementationfocused; 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; continuous Improvement People Process FOUNDATIONAL ASPIRATIONAL Technology PROFICIENT TRANSFORMED BENEFITS FRAMEWORK ingenuity | intensity | integrity Page 11 Steps in the EHR VR Methodology “Call to Action” 1. Shared framework and goals 2. Project Kickoff ingenuity | intensity | integrity “Assess the Current State” “Define the Vision” “Plan and Execute” 1. Evaluate experiences, perceptions and beliefs 2. Analyze current system configuration / opportunities 3. Document influencing factors 1. Facilitate group visioning 2. Develop guiding principles 1. Implement quick wins (intense short-term effort; big benefit 2. Develop roadmap Page 12 Benefits Framework ingenuity | intensity | integrity Page 13 How Do You Know When You Have Achieved Value from Your EMR? Quality Cost VALUE Patient Experience Safety Benefits must be measured and managed to achieve value. ingenuity | intensity | integrity Page 14 Benefits Framework Process 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 ingenuity | intensity | integrity Page 15 Example Metrics Goal: Improve Coding Efficiency Category Quality Physician Satisfaction Revenue Cost X Benefit Objective Measurement Tools Ensure that documentation justifies the intensity of services actually rendered to assign proper DRG. Measure # of CDI queries before and after documentation changes. Provide clinical, quality, coding and regulatory requirements, with standards, to streamline documentation to support clinical facts of the case/appropriate intensity of care. ingenuity | intensity | integrity Focus on top 5 coding related denials and reduce those denials. Ease of Measure Actionable Baseline Available June 2013 Yes Yes Measure charges coded per hour before and after documentation changes. Page 16 Industry Examples The potential to realize significant benefits from your EHR is high when you manage your initiatives using a Benefits Framework. Allina Health Clinical resource use - $12.4 mm Adverse drug events - $4.8 mm Duplicate testing - $800,000 Drug utilization/cost - $600,000 Documentation workload - $1.7 mm Order proc. workload - $1.2 mm HIM workload - $2.5 mm Accounts rec. reduction - $2.4 mm Denial reduction - $15.5 mm Data quality improvement - $7.8 mm Net revenue increases - $5.1 mm Revenue cycle FTEs - $800,000 Total: $55.6 million Across 11 hospitals Texas Health Resources Evidence-based care - > $50 mm Medication safety - $8-15 mm Complications reduction - NQ Order turnaround time - 1-2 hrs Increase efficiency - NQ Patient throughput - ED LOS cut Reduce paper forms - $1 mm Reduce denials - NQ Optimize medication use Charge capture - $ 2-3 mm Total: $60-69 million Across 13 hospitals Sentara Healthcare Nursing OT, retention - $5.2 mm IT maintenance - $4.2 mm Medical rec./transcript. - $4.1 mm Increased O/P services - $3.2 mm Reduced length of stay - $3.1 mm Reduced ADEs - $2.9 mm Reduced paper/storage - $2.4 mm Other improvements - $4.9 mm Total: $30 million Across 11 hospitals Source: HIMSS Davies Award Applications ingenuity | intensity | integrity Page 17 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 ingenuity | intensity | integrity Page 18 Q&A ingenuity | intensity | integrity Page 19
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