September 10, 2014
As we discussed a few weeks ago, the Electronic Medical Record (EMR) and other clinical systems are just that — clinical systems. To successfully tweak, update, adjust, or in severe cases completely redesign the systems, the process must be clinically-driven. IT has a role in knowing what is possible — after all, the system is a big, highly customized database. However, IT does not always have the required understanding of the details of clinical needs, workflows, and documentation requirements.
It is critical to a clinical systems optimization and indeed to the ongoing success of the clinical systems that a clinical team drives the efforts to design, implement, and refine systems. With that requirement in mind, let’s talk about the players who should be on the EMR optimization team.
The Chief Medical Information Officer – or if that role doesn’t exist in the organization, one or more physician leaders should be involved. Physicians are the most highly skilled and most highly paid members of the health care systems. In addition, as is it is incumbent upon the physician to take a lead role in documenting the patient’s condition, treatment plan, and specific orders, they are most impacted by the transition to the EMR. Hospital users will also recognize that physician compliance is a major issue in many organizations, and a strong physician leadership presence on the team will assist in user buy-in.
The Chief Nursing Informatics Officer – or again, if that role doesn’t exist in the organization, one or more nursing leaders. Nurses represent the user group that spends the most time in the EMR, documenting patient condition, patient care, and receiving and documenting the delivery of patient orders such as the administration of drugs. Small issues in EMR design, multiplied by dozens or hundreds of nurses, multiple times per shift, can quickly become major issues that the clinical optimization must address.
Nurses (more than one). It is tempting to imagine that nursing leadership can effectively represent the interests of the end-user nurse, but that is not an appropriate assumption to make. When is the last time the CNO discharged a patient, or documented during a cardiac arrest? The best clinicians for the job are those users with the ear of their colleagues, and this can include the system’s biggest fans as well as the biggest detractors. Being included on the design team for the system can make the loudest detractors into the loudest supporters, or at least reassure them that their interests are being considered. To do this, include nurses from multiple areas. Consider one example – ICU and ED nurses will have significant user needs because of the patient acuities, but neither is likely to perform an inpatient discharge.
Other clinical experts will need to be included from time to time during the optimization process. Allied health personnel, including representatives from respiratory therapy, clinical therapy, radiology, and the laboratory will be needed as part of the design process when their areas are impacted.
IT expert(s) in the affected systems – these are the analysts that normally define and implement the desired changes, and who best understand how a potential change may affect other parts of the system, and its functionality. If you are seeking to optimize a new system, you may not have the complete resources available on your team. If you don’t have all the staff you need, consider adding a consultant to your team who has experience implementing and optimizing clinical functionality.
Meaningful Use / MIPS expert – the changes in a clinical system optimization will likely impact current and future Meaningful Use / MIPS compliance efforts. Your Meaningful Use / MIPS expert should have a seat at the table to vet the impact of proposed changes.
Revenue cycle experts – the EMR and the other clinical systems stand in the center of the revenue continuum. Registration is involved to some extent in clinical processes through their role in admissions, discharges, and transfers (ADT) and the business office to a much greater extent. The business office will be significantly impacted by changes to clinical systems because of the potential impacts on downstream charge flow.
Quality reporting expert – the potential changes to nursing and physician documentation can have major impacts on quality reporting, particularly now that quality reporting will be extracted directly from the EMR under stage 2 of Meaningful Use / MIPS.
Clinical optimization expert – if your experts above don’t have experience managing a clinical optimization process, consider bringing one in from the outside. When you consider the cost of all the resources already on this list, the cost of a resource to guide the process and guide you away from pitfalls is slight compared to the potential cost of time wasted as a result of an ineffective optimization.
Phoenix can guide you through the tricky process of a successful clinical optimization effort. Our experts work to ensure that clients realize the full cost savings and quality improvement they expect.