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.
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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
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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
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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
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Per Capita Cost
Page 5
Value Realization (VR) Framework
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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
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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.
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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.
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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
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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
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Page 11
Steps in the EHR VR Methodology
“Call
to Action”
1. Shared
framework and
goals
2. Project Kickoff
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“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
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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.
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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
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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.
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 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
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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
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Page 18
Q&A
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Page 19