Why do we implement Electronic Health Records (EHRs)? It’s not just to capture data. It’s to have the data so you can use it to make decisions to help your organization deliver better clinical care, meet compliance standards, increase margins, reduce inefficiency, and grow in a constantly changing environment.
In each of the examples below, our projects began with an implementation of an EHR. As we worked with these organizations through the implementation effort, we helped prepare them for ways to increase system adoption and effectiveness post Go Live. In the midst of an EHR implementation, it can be difficult to be proactive in creating plans and workflows to ensure that everything will run smoothly after the system goes live because much of the project team is busy getting the system ready to use. But this is an extremely important step that will help you optimize your organization’s clinical and financial outcomes while ensuring that you don’t run into major roadblocks once the system is in use.
When a new EHR goes live, there are bound to be some issues in the data based on system configuration issues or gaps in the staff workflow. These problems will cause some frustration and anxiety with staff, but it also has the potential to cause serious issues with your ability to maintain a smooth revenue cycle process. If there are data points that aren’t being captured properly you can begin to see much higher rejection rates on services or services that can’t even go out the door.
We ran into this situation when we went live with a large CMH that was transitioning from an old EHR to a new platform. After the Go Live cutover, they began to have a large volume of services that were being documented without the proper diagnosis information. We had previously identified this as a potential issue, though, so we proactively created reports to show staff who was missing information so they could get the bills out the door. We also used this data to identify specific programs, locations, and staff that was having issues, and then targeted them with messaging and training to ensure that we modified their workflow moving forward. Without this reporting and feedback mechanism, there would have likely been hundreds of thousands to millions of dollars that would have backed up in the system. By proactively defining this process, though, we were able to minimize the problem and the impact that it had on the organization’s cash flow post Go Live.
A major initiative when an EHR goes live is ensuring that the adoption rate amongst users is high, and also monitoring what updates are needed to forms or reports to ensure that the staff is properly supported. The hard part of this process is that it is usually based on anecdotal evidence from staff, and that isn’t always going to be complete and accurate during the chaos of an EHR Go Live.
During one of our implementations, we reviewed the volume of some of our client’s commonly used forms to create an estimate of how many should be completed each day based on assumed post-live service levels. We then created reports in the new system to monitor which forms were being used and when so we could easily identify if people were using the clinical documents as expected. When we identified outliers, we immediately created targeted messaging to team leaders and staff to make the necessary adjustments to processes.
Similarly, IT teams and leadership usually get inundated with report requests once a system goes live, and they all tend to be needed immediately. We had a process in place to prioritize and rollout new reports, but we also created a single report to illustrate how many staff were accessing the standard and custom reports in the system. So, when we built an “emergency” report and subsequently found that no one was actually using it, we were able to identify the issue (or culprit) and could start a conversation to change the prioritization and development process.
Another powerful way that you can use the data from an EHR is to ensure alignment between your organizational goals and the staff incentives that will help to realize those goals. In one instance, we helped to develop reports and statistics to assist in developing a bonus program for Prescribers that was aimed to increase productivity across a large Prescriber population.
After the dust of their EHR Implementation settled, we worked with our client to design reports to measure Prescriber productivity by the day, month, and year. To ensure we were comparing apples to apples, though, we made sure to break down the data by procedure type so that variables like service duration and reimbursement could be taken into account. Based on that information, our client was able to determine an average threshold that they thought was a reasonable “high efficiency” productivity target and offered financial incentives for anyone that exceeded that target.
In the first year, less than 50% of the Prescribers met this threshold, but the initiative is helping to drive behavior that aligns with organizational goals. The Prescribers that aren’t hitting the target are able to receive support, training, and ongoing assistance to become more productive, and with the incentive for a significant end of year bonus, most of the Prescribers have bought into trying to get themselves up to that level.
All Thought Leadership