Section 1.2 Adopt – Plan
HIT Goal Setting
An important step in health information technology (HIT) strategic planning is to establish specific,
measurable goals that are communicated to all. Specific goals play an important part of many of the
aspects of planning, selecting, implementing, and realizing benefits of HIT.
Momentum is building for acquiring HIT—especially electronic health record (EHR) systems—
under the federal stimulus legislation (American Recovery and Reinvestment Act of 2009/Health
Information Technology for Economic and Clinical Health (HITECH)). Some chiropractic offices
anticipate acquiring an EHR in a short period of time, possibly without thorough planning. If
decisions are made hastily, they may not align with the office’s culture or readiness. Establish a
realistic timeline and goals for each phase of acquiring HIT to assure thoughtful decision-making and
progress.
HIT Goals . . .
Copyright © 2009, Margret\A Consulting, LLC
Objectives
EHRs are not new, and the need to use EHRs to achieve value is as critical today as ever. The
Institute of Medicine, in its first study on improving patient records in light of new technology (The
Computer-based Patient Record: An Essential Technology for Health Care, National Academy
Press, 1991), identified several broad objectives for EHR systems:
• Access data
• Improve quality of care
• Enhance patient safety
Section 1.2 Adopt – Plan – HIT Goal Setting - 1
•
•
Support health maintenance, preventive care, and wellness
Increase productivity
•
•
•
Reduce hassle factors and improve satisfaction for chiropractors, consumers, and caregivers
Support revenue enhancement
Support predictive modeling and contribute to the development of evidence-based health care
guidance
Maintain patient confidentiality and exchange data securely among all stakeholders
•
These are laudable statements, but they do not help in distinguishing between products, and they
cannot be used to test for success. Each organization must evaluate what it wants out of HIT, and
define its own goals.
Writing Goals
Writing effective goals is not easy. Many organizations recognize the importance of SMART goals,
described below:
Specific. Goals should identify who, what, where, when, and why. They should be well defined
and clear to anyone who has a basic knowledge of the way your office works. Goals not only
need to be Significant enough to make the investment in achieving the goal, but they need to be
Stretching so the office can push itself to continuously strive for improvement.
Measurable. “If you can’t measure it, you can’t Manage it.” Goals should answer the questions,
how much and how many, so you can determine when a goal has been accomplished. To be
measurable, goals must contain specific Metrics, be Meaningful, and Motivational.
Attainable and Agreed Upon. In addition to the need to develop attitudes, abilities, skills, and
the financial capacity to reach the goals being set, gaining consensus on Acceptable goals and
commitment to Achieving the goals is critical as well. Goals need to be Action-oriented if they
are going to guide your office to success.
Realistic, Relevant, Reasonable, Rewarding, and Result-oriented. Goals must reflect the
availability of resources, knowledge, and time so they can be achieved. Set the bar high enough
to be meaningful in light of the investment made to Reach the results, yet not so far afield that
you become frustrated in attempting to achieve them.
Timely, Time-based, Tangible, and Trackable. Allow enough time for staff to learn to use HIT
in support of achieving goals. Applying milestones to each goal helps make their achievement
more realistic. However, allotting too much time to attain goal achievement may suggest that the
goal is not important or meaningful for your organization. Specific metrics make the goal
tangible and enable your organization to track its accomplishments. If a goal is achieved within
the timeframe established, celebrate it. If it is not accomplished, analyze why it has not been
achieved. If your office is planning to earn federal incentives for making meaningful use of
certified EHR technology, align your goals with the specific criteria in the incentive program.
Following is an example of a well-stated SMART goal for a transcription scenario:
Utilize structured data collection templates to reduce transcription expense by 30 percent
within three months of adopting an EHR system, 60 percent within six months, and 85
percent within one year in order to support clinical decision alerts and reminders.
Goal setting for the EHR should not focus on general objectives for the project. Acquiring an easyto-learn system or implementing it by the end of the year are goals for the project, not for the EHR.
Consider specific, measurable goals, such as the following examples:
Section 1.2 Adopt – Plan – HIT Goal Setting - 2
 Improved productivity: every chiropractor will have completed charting by the end of the
day and will go home on time each day after two months of using the EHR
 Enhanced quality of care: the EHR patient recall function will improve regularity of
treatments and patient reports of lowered pain measured by standard instruments by 20
percent improvement after one year of using the EHR
 Assured patient safety: health information exchange capabilities will enhance sharing of
radiographic studies resulting in a 10 percent reduction in repeat studies after one year of
using the EHR
 Reduced hassle factors: every returning patient will be seen with a complete health record
after two weeks of using the EHR
 Increased revenue: improved scheduling and wait time management will enable open access
appointments and generate increased business through word-of-mouth after six months of
using the EHR
These examples may not all apply to your office, the type of EHR you acquire, or your own
interests. Focus your goal setting on what your office wants to achieve with the EHR once it is
implemented and learned.
When broad goals are proposed that are not measurable, rewrite them as specific actionable goals.
For example, the EHR steering committee at one office identified improved productivity as a goal.
When asked what this meant specifically, they identified reduced transcription expense. When asked
by how much, they suggested by 80 percent. When asked if they expected all users to start using
templates for at least 80 percent of their notes, they understood the connection between using
templates and no more dictation. After recognizing this connection, the merits of templating to
achieve structured data for use in clinical decision support and external reporting were discussed.
They then recognized that considerable upfront work would be required in skills building and
initiating the use of practice guidelines. The group suggested that paper-based charts start to
incorporate templates so chiropractors could become accustomed to using structured data forms.
Template for Writing and Tracking Goals
Don’t be concerned about writing SMART goals because you do not have baseline data, or because
you fear results will be difficult to achieve. These issues are actually a part of the problem. The adage
“you can’t manage what you can’t measure” is true in health care organizations and reflects one of
the main reasons pay-for-performance and other incentives are being adopted. If baseline data are not
available, now is the time to start collecting data for the most important functions. Baseline data are
essential for setting realistic goals. For example, if a recent coding audit revealed you could increase
revenues by three percent with better coding, do not expect to achieve 10 percent improvement with
an EHR.
Even for a difficult measure, you can estimate baseline data or create scenarios. Cultivating a culture
of quality measurement, reporting, and improvement is vital to achieving positive results from HIT.
Engaging end users in setting expectations, providing the commitment and support to achieving
expectations, then measuring, reporting, and celebrating success is essential. Monitor goal
achievement and make adjustments in training, workflows, the application, and goals as needed.
Use the template below to help write your goal statements. Start out with a general statement, such as
the example in the objective column. As you dissect the goal to determine how HIT and EHR can
help you achieve it, you will be describing the intended action. Identify the sources of data and which
application will enable you to make improvements. Define the metrics so you have a clear
understanding what data to collect. Record your current baseline data. Then set your goal by
Section 1.2 Adopt – Plan – HIT Goal Setting - 3
summarizing the improvement you think can be made within a realistic timeframe using the new HIT
or EHR application. Record the rationale for setting the goal and any obstacles to achieving it that
you see. An example of an obstacle may be the imaging center you work with is not yet using digital
images (i.e., picture archiving and communication system [PACS]), so you may not be able to fully
achieve a specific goal until they adopt the technology. Finally, use a table like the one below to
periodically record results until the target date for achieving your goal is reached. If you wait until
the targeted time, you will not know whether you are on course to meet the goal and you will not be
able to implement corrective action to meet your deadline. While the deadlines are self-imposed,
timeliness is a key motivator.
In some cases, the goal may be set for you by regulation or contract. Describing the rationale and
obstacles may help you communicate the importance of the goal and find ways to overcome the
obstacles. Record the results regularly.
Template with Samples for Writing Goals
Objective
Improve
revenue
through
better
E&M
coding*
Intended
Action
Prompts
for
appropriate
E&M code
assignment
Source of Application Metrics Baseline
Data
Structured EHR visit
data
note
collected
via
templates
# of
outliers
on
coding
audit
3% of
visits are
coded
too low
Goal
Rationale/
Obstacles
Results
Use
structured
data entry
templates
to record
visit info &
improve
E&M
coding so
100% of
visits
coded at
right level
Recent
coding audit/
Potential for
medical
necessity
questions
1% outliers,
including
one case
exceeding
medical
necessity,
at three
months
post go live.
Check that
LMRP
guidance is
part of E&M
coding
support
* Evaluation and management (E&M) coding
Resources for Goals
Identifying all the goals for a given HIT project may take some time. To help structure your goals,
consider the major functions your organization performs. The following table lists many of these
functions in ambulatory care, hospitals, and health information exchanges (HIE). Knowing how the
hospital captures information gives you a better understanding of how information may be shared
with your office through HIE, and supports the continuum of care. Add to or delete as your
functional descriptions vary. Focus on the functions that need HIT support.
HIT Related Functions
Ambulatory Care Functions
Pre-visit patient registration,
appointment scheduling, patient
identification/ registration, insurance
verification, chart preparation
Health maintenance/preventive
services reminders, chronic care
registry alerts, and call-back lists
Section 1.2 Adopt – Plan – HIT Goal Setting - 4
Hospital Functions
Patient identification, record location
(MPI), admission/discharge/transfer,
patient access, utilization review,
insurance verification
HIE Functions
Patient identification,
record location
Ambulatory Care Functions
Hospital Functions
HIE Functions
Automated self-history by patient or
caregiver, personal health record
information retrieval, standing orders
for advance diagnostic studies
Automated self-history by patient or
caregiver, personal health record
information retrieval, pre-admission
testing
Personal health records
Consent management
Consent management
Manage workflow and wait times
Nurse staffing, triage, bed control, census
Patient intake (reason for visit, vital
signs)
Nursing assessment and clinical
pathways
Validate patient history, physical
examination, diagnostic studies review,
previous visits review, referring
physician and patient-supplied
information review
History and physical examination,
diagnostic studies review, previous
admission review, referring physician
information review
Problem list management
Problem list management
Medication reconciliation
Medication reconciliation
Care planning, clinical decision
making, clinical practice guidelines,
documentation at the point of care,
level of service (E&M) coding
Care planning, clinical decision making,
clinical practice guidelines, documentation
at the point of care
Data mining
Provider order entry for internal office
tasking, diagnostic studies, surgery,
referrals, admissions; prescription
writing
Provider order entry for nursing services,
medications, procedures, therapies,
diagnostic studies, consultations
Data transmission
Data collection
Diagnostic studies operations: anatomical
pathology, blood bank, lab, microbiology,
radiology and other imaging (picture
archiving and communication system
[PACS])
Diagnostic studies results retrieval and
management
Diagnostic studies results retrieval and
management
Medication administration
Operating room management
Patient monitoring and care charting
Medical devices information capture
and display
Medical devices information capture and
display
Care coordination and scheduling
across sites of care: hospital
admission, long term care, home care,
referrals to specialists
Care coordination and scheduling across
sites of care: triage, ED, ICU, surgery,
recovery, step down, specialty areas, long
term care, behavioral health care, home
care, assisted living, migrant care
Care communication, continuity of
care, medication instructions, health
education
Care communication, continuity of care,
discharge instructions, health education
Release of information,
health education
Charge capture
Charge capture/coding
Purchasing, pay-forperformance
Section 1.2 Adopt – Plan – HIT Goal Setting - 5
Ambulatory Care Functions
Quality measurement, reporting, and
improvement; revenue cycle
management; productivity; general
accounting; supplies management;
human resources
Hospital Functions
Quality measurement, reporting, and
improvement; revenue cycle
management; general accounting; supply
chain management; human resources
HIE Functions
Quality improvement,
public health reporting,
population health, biosurveillance
Patient follow up and prescription refills
Health information management and
document archiving; release of
information; privacy and security,
including data breach notification
Health information management and
document archiving; release of
information; privacy and security,
including data breach notification
Setting Goals
The process of setting goals helps individuals understand the capabilities of HIT and builds interest.
Once written, the goals form the basis for a performance-based request for proposal (RFP). The RFP
is written to ensure that the application has all the functions needed to achieve the goals. In the
example of improving revenue through better evaluation and management (E&M) coding, the office
seeks prompts for appropriate E&M code assignment.
During the selection process, evaluate whether products truly can help achieve your goals. Ask your
references and staff at site visits how well the HIT has accomplished the outcomes that interest you.
If a product is generally supportive of your goals but lacks one function, identify that function in the
contract as something that must be provided by a certain date. Once you start the implementation
process, your goals serve as the starting point for training and testing scenarios. Ultimately, your
goals will guide your users to optimizing their use of the technology.
Copyright © 2011 Stratis Health. Funded by Chiropractic Care of Minnesota, Inc. (ChiroCare), www.chirocare.com
Adapted from Stratis Health’s Doctor’s Office Quality – Information Technology Toolkit, © 2005, developed by Margret\A Consulting,
LLC. and produced under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of
Health and Human Services.
For support using the toolkit
Stratis Health  Health Information Technology Services
952-854-3306  info@stratishealth.org
www.stratishealth.org
Section 1.2 Adopt – Plan – HIT Goal Setting - 6