Part one in a two-part series
By: Tim Dobkins, Managing Director, Huron
If you or other leaders in your organization are struggling to find the value in a comprehensive electronic health records (EHR) conversion relative to the disruption that can accompany them, you’re not alone. Ideally, an EHR improves care coordination, yet the implementation of a new EHR system may have the opposite effect if not executed well. Many medical groups believe simply purchasing a new system will alleviate their EHR challenges. The problem with this logic is that, without proper pre-conversion planning, those challenges will exist no matter the system.
Leveraging the EHR to optimize patient access to care is key to realizing the value of the initial spend. EHR conversions can offer new functionality to improve service to patients, but certain foundational “must-dos” should be done pre-conversion to improve the patient’s access experience now.
The list below outlines several recommended prerequisites to any successful EHR implementation.
Pre-EHR Conversion “Must-Do” Items
1. Identify your organizational goals for the new software.
When identifying the right goal, ask yourself: What are you trying to accomplish with this large investment?
- Goal example: Achieve 90 percent participation rate for EHR template utilization.
2. Harvest baseline performance data.
In addition to current performance metrics, you should include lists of data that are not currently available and catalogue future data needs for long-term technology optimization.
For example, many organizations struggle to accurately baseline physician and resource template utilization due to limitations or variability in current scheduling system functionality. However, this understanding is critical to ensure the new EHR is not negatively impacting a physician’s capacity to care for patients.
3. Invest heavily upfront in workflow documentation and identify gaps/opportunities learned from desired leading practices.
Your new EHR will only provide improved operational performance if you build it to achieve effective operational workflows. Examples for designing effective workflows include the following:
- Understand existing referral/order management workflows. As computerized physician order entry (CPOE) continues to expand, many organizations are leveraging these improvements to expand their ability to track and monitor the capture of referrals as well as conversion to appointments.
- Review scheduling protocols including the following actions:
- Review existing physician preferences and clinical requirements to ensure buy-in.
- Define variability among like providers and discuss feasibility to improve consistency.
- Leverage EHR functionality to automate provider preferences into decision trees or questionnaires to aid schedulers in selecting the right appointment with the right provider, in the right location, and for the correct duration.
4. Hardwire access guidelines.
Several policies/procedures exist that can and should be built into the EHR's functionality to ensure sustainability over time. Below are a few impactful guidelines that often get overlooked during the pre-conversion planning phase:
- Scheduling template management
- Block/hold release approaches
- Over-booking strategy
- Provider cancellations (i.e., “Bumps”)
5. Establish collaboration and accountability forums.
To hardwire the desired change, accountability forums should be established to review clearly defined lists of performance metrics. These forums should be a mix of physician champions and service line leaders as well as information technology stakeholders. Forums should also display a bias to action to remedy performance metrics that are not meeting goals.
6. Implement targeted service recovery strategies.
Even the most thoughtful planning won’t eliminate cancellations and no-shows from occurring - this is simply part of the scheduling process (plans change). Based on this fact it is critical to establish a process for defining work drivers to follow up with patients who miss out on their care to ensure they are rescheduled as appropriate. Additionally, these cancellations and no-shows create gaps in schedules which need to be filled to ensure physicians can care for as many patients as possible in their busy schedules.
EHR implementation can be daunting and take years to successfully execute. Regardless of the vendor selected, organizations are required to invest significant resources to support the design, planning, building, testing and training efforts. And, in the end, there is often a moment when leaders don’t feel the tool is delivering the level of desired results relative to the investments in time and finances. Following the suggested pre-planning steps above can help to prevent this frustration. In part two of this Insight series, we’ll focus on the importance of effective post-planning to ensure full optimization and minimize any underutilized functionality of the product.
Tim Dobkins is a managing director at Huron and works with health systems and medical groups across the country to improve their financial and patient access performance through operational enhancement and performance accountability. Tim helps providers optimize and/or build new centralized call center operations for multiple access functions including scheduling, authorization procurement, insurance review, financial counseling, preregistration, pre-service patient interaction, and POS Collections.