Chapter 5
EHR Goal Setting and Impact
on Quality of Care
1
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EHR and Quality of Care
• Despite not a lot of scientific evidence, there is
strong belief that EHRs:
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Improve productivity
Save time; reduce cost
Reduce hassles
Improve patient safety
Improve quality of care
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Difficulty Proving Value
• Not a lot of “complete” EHRs
• Definition of “complete” is elusive
• EHRs are increasingly becoming more
sophisticated, so landscape is changing
• Too few organizations have the ability to conduct
scientific studies to prove value
• But, once an EHR is implemented, few
organizations want to turn back!
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Quantitative Vs. Qualitative Benefits
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“Pure Research” is Difficult
• Confounding values
– Multiple factors can contribute to benefits
• Evaluating processes before implementing EHR leads to
benefits
– EHRs take a long time to implement, so many other
factors may take place during that time
– Strictly controlled studies are very difficult to
conduct
– Even act of studying benefits of EHR may contribute
to improvements
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Vs.
• Meta-analysis that integrates findings from many similar
organizations using similar systems may improve the value of
anecdotal results
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Cost-Benefit Feasibility Study
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Done before a decision to acquire EHR is made
Determines if initiative is appropriate at this time
Highlights broken processes to be repaired
Measures the costs of acquisition of hardware and software,
installation, implementation, and ongoing maintenance against
anticipated financial benefits
– Estimates return on investment
• May be estimated and not detailed; or based on process
assessment and detailed
• Success factors include:
– Clear vision
– Management support
– Realistic expectations
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Goal Setting for EHR Benefits
• Goals help achieve the intended result of a
strategy
• Goals must be
Specific
Measurable
Attainable
Realistic
Timely
Within six months of acquiring an
EHR, we will achieve 90%
compliance with cervical cancer
screening guidelines through a
patient-specific reminder
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What does Goal Setting do?
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Goal Setting and Education
• Stakeholders must understand what an EHR can
do and what is feasible in order to set appropriate
goals
– Too moderate goals will not yield sufficient benefit to
return investment
– Too great expectations will result in disappointment
• Education is needed to set realistic goals
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Goal Setting and Change Management
• Identifying goals can lead to stakeholder buy-in
• Goal setting is a part of change management
– It must allow participation to achieve goal ownership
• It allows for anticipation of change
• Goals must be expressed as benefits that are real
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Benefits Requirements
• Nature of benefits must relate to type of
organization
• Should support organization’s strategic goals and
objectives
• Must reflect vision and migration path of EHR
defined by organization
• Need to be proposed within context – perceptions
or formal study
• Need to be supported by resources and
commitment of senior management
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Benefits Vary Along Migration Path
• Access to data
• Interaction with data
• Documentation
• Decision support
• Data outreach
• Continuum of care
• Longitudinal data
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Operational improvements
Cost savings
Basic patient safety
Improve service and
productivity
• Improved outcomes and
quality
• Quality of care and
biosurveillance
• Quality of life; economic
benefits
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Economic Benefits
• Cost savings
– Example: reduction in forms production
• Cost avoidance
– Example: avoiding staff recruitment costs
• Revenue increases
– Example: Accurate E&M coding
• Contribution to profit
– Example: Reduce complications from adverse drug events
• Productivity improvements
– Example: See two more patients in a day
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Clinical Benefits
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Better access to clinical information
Improvement in clinical decision-making
Improvement in disease management
Enhanced documentation and accuracy
More patient education tailored to the patient’s needs
More physician and nursing time with patients
Improved overall care and outcomes
Improved quality of life
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Quantifying Clinical Benefits
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Benefits Realization Study
• Done both before a decision to implement an EHR and after
EHR implementation
• To determine if anticipated benefits are realized
• Before, may highlight processes to be fixed and contribute to
system build; after, will identify areas not meeting expected
benefits in order to take corrective action
• Needed success factors are:
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Clear vision
Management support
Realistic expectations
Valid metrics
Process assessment skills
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Benefits Realization Study Steps
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Commit to study upfront
Identify potential benefits
Decide on study design
Create metrics for measurement
Measure base line data before implementation
Measure after implementation
Take appropriate action(s)
– Celebrate
– Correct course
– Adjust metrics and re-measure
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Creating Metrics
• Metrics must truly measure what they are intended to
measure
• The same metric must be used both before and after
• Obtain agreement as to a metric’s applicability and the
processes involved in their use
• Include representatives who would be affected by the
metrics
• Test the metrics
• Implement the metrics
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Evaluating the Measurements
• The final step in the benefits realization study is
to analyze the results
• The same metric must be used before and after
the study
• Before measuring the benefit, it is important to
describe the level of improvement or benefit
desired
– Anticipate time period in which improvements are
desired
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Conclusion
• Benefits from EHR should be celebrated,
– Along the various milestones in an implementation
project
– Along the migration path
• Setting goals and conducting benefits realization
studies are often more difficult to do than
implementing an EHR,
– But help recognize the value of EHR
– Provides motivation for continued improvement in
adoption
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