October 8, 2014
In our series that addresses maximizing ROI through the use healthcare information technology, we’ve focused a lot of the discussion on clinical systems. There are a variety of clinical systems, but we’ve talked primarily about the electronic medical record (EMR). The reason for this is the central role the EMR plays in the clinical systems infrastructure. An EMR is the system that is most directly involved in patient quality and patient safety and the easiest place to capture a large and quick return on your optimization efforts. Therefore, we find it to be the lowest hanging fruit when it comes to realizing the benefits of optimization. So, how do you approach an EMR optimization? We’re so glad you asked…
If you’ve followed the other posts in the optimization series, you’ve gathered your multi-disciplinary team, led by clinicians, and you are ready to get started. Now what?
We recommend that one of the key activities in the initial meeting of the clinical systems optimization team is education. It’s important to make sure that the team understands the importance of the effort to the organization, and to the everyday activities of the members of the patient care and revenue cycle teams.
We also suggest that the initial meeting be used to set expectations about how the members of the optimization team should approach the project. The team should establish guidelines that address the following areas:
The first task in a systems optimization is identifying the opportunities and their relative values to the organization. Often, the larger team will break up into smaller teams, with each subgroup addressing a set of concerns.
Key steps in the identification of opportunities include:
Data gathering – this starts with a series of brainstorming sessions, and requires members of the team to answer questions about their interactions with the system. These questions might include:
Research – Once ideas have been identified, research is required. The team presenting the opportunity to the group should be ready to describe:
This portion of the data process needs to focus on observable and measurable facts. There is a big difference between the statement, “This is happening a LOT” and the actual measurement, “An audit of the last six months shows two examples with a total lost revenue value of $125.”
An example from a recent project demonstrates the level of understanding required:
The identified problem is that items are being placed on the problem list as a resolved problem that can’t be changed to a current problem. Further investigation showed that when problems are added in the past medical history, the problems are set as resolved, but not when added as current problems, or in the review of systems. This causes items to be on the problem list as resolved, which requires the nursing staff to enter the problem again as a current item to produce a correct problem list. This happens on every patient. The system is working as designed – this is the way the system was configured by the vendor, but the nursing staff was not educated on it. Options include changing the behavior of the system or educating the workforce. It may be advisable to allow problems to be “re-activated” from the resolved status if they are placed there in error.
Ranking and prioritization – It is true in healthcare IT in general and certainly in the optimization process in particular that not everyone is going to get everything they want. By using a ranking process, the healthcare system can insure that the issues that get attention are the ones that benefit the patients and the organization the most. Some priorities, like direct financial gain, can be easily measured, with the high-dollar items obviously bubbling to the top of the list. There are other priorities, however, that still should be relatively important in determining the ranking of opportunities to be addressed, including:
One area that merits special attention is patient safety. In many organizations, “This is a patient safety issue” is the hot-button phrase that is used to move anything remotely clinical up on the list. More properly, each potential patient safety issue has to be assessed from a risk perspective. In this case, the following questions make sense to ask:
In future installments of this series, we will discuss other considerations in the decision making process, look at what activities the team should undertake during the implementation of changes, and discuss ways you can adapt this optimization decision framework to ongoing IT operations to support ongoing ROI based decisions.
The assessment of clinical systems and processes as they interact is complex. Phoenix consultants can help in setting up the structure for a clinical optimization process and guiding the process to completion. If you’re interested in talking to one of our experts, let us know.