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Electronic health record (EHR) optimization

EHR optimization

Electronic health records optimization: What is it and what’s in it for you?

Kevin McNamara | April 17, 2015

Electronic health records (EHR) systems promise a host of benefits, chiefly supporting better patient care, efficiencies, and cost savings.

Healthcare organizations (hospitals and health systems) have invested heavily in EHR implementations to support patient care (real-time access to patient information such as progress notes, medications, allergies, and test results at the point of care and clinical decision support) and business requirements driven by changes in the regulatory and reimbursement landscapes (such asmeaningful use and payment reform).

However, now that these systems are in place, organizations have experienced varying levels of success. The programs put in place to maintain these systems are not producing the results intended or desired—either because they’re targeted to specific audiences or lack a holistic view of what the system actually needs. Many are confronting end-user dissatisfaction, ranging from workflow issues and documentation and change management needs to insufficient communication and (lack of) provider engagement. Sound familiar?

EHR optimization has been held up as an answer to those challenges, but it lacks definition.

EHR optimization defined

Optimization should be a strategy that makes real the driving vision behind EHR: a high-performing system that delivers on all stakeholder needs in support of optimal patient care.

In order to define EHR optimization, let’s start with what it isn’t. It is not occasional IT support ticket purges to clear the decks, such as documentation improvement. It is not incremental changes in software configuration to stay current with system updates and code changes. It is not implementing new forms of documentation to capture additional data needed for reporting.

Optimization means different things to different people.

For providers and clinicians, it may mean better tools and functionality that assist in providing efficient and effective patient care. This audience is especially concerned with timely access to information, tools that help them work more efficiently, training that helps them make the most of those tools, and a help desk that’s truly helpful with a responsive change-management and communication process.

For those in administration, it could mean providers and clinicians using the system in the provision of excellent care, and in doing so, capturing the data the organization requires to stay ahead of the regulatory curve and continue to receive reimbursement.

For those in IT, it may mean staying up-to-date on code changes and updates, installing new functionality or technology, upgrading hardware, and managing IT help desk support tickets, while keeping downtimes to a minimum.

While all of these are elements of optimization, they fail to capture what should be a holistic approach.

A holistic approach to an ongoing process

Optimization should be an ongoing process that adapts along with the organization. Here’s how to get started.

A thorough assessment of your current environment—its people, processes, technology, and business drivers—will help you understand your system and its issues. Identify the key areas of dissatisfaction and barriers to EHR adoption and success. Take a look at how the system is being used and how it’s delivering (or not) on the goals of your stakeholders. The output of that assessment is your starting point.

If you’re like most organizations, you likely have (or had) a governance organization managing the system implementation. It may even still be functioning but in maintenance mode. Because this group would be charged with reviewing the assessment, understanding its current governance processes may inform your approach.

For example, if the governance group has appropriate representation from all stakeholder groups, you could reinvigorate the group to drive your optimization efforts. The group would then be charged with ensuring that their structure is representative and responsive to the entire organization. If changes are needed, then those should be implemented to address concerns.

This group would then need to review the initial vision of the EHR system and, informed by their current understanding of the EHR environment, develop a clear vision for how the system should function and what changes are required. This vision is key to developing a strategy that addresses:

  • How to set priorities and weigh competing stakeholder needs
  • Which projects can serve as quick wins, communicating to the stakeholders the organization’s commitment to improving the system
  • Which projects will have the most impact and drive improvements in patient care
  • How the optimization efforts will be communicated to the larger organization

Each of these are formidable tasks, but doing nothing is not an option. Regulatory pressures will continue to drive changes in how the EHR is essential to supporting meaningful use, reimbursement, quality, patient outcomes, and satisfaction measures, along with a myriad of other requirements.

And remember: at the center of all of this is the foundational goal of providing better patient care.

So, what’s in it for you and your stakeholders?

Done right, optimization will unite stakeholders around a common vision on how best to support the EHR through its lifespan.

For providers (and, ideally, nursing staff and clinicians), hopefully this leads to a forum where their challenges are recognized and addressed, resulting in improved tools and workflows, less interruption in the flow of patient care, and greater satisfaction and engagement in the overall process.

For the organization, it will ideally result in more consistent patient care, thanks to increased efficiency and effectiveness, and resulting in more consistent capture of the data that’s necessary for business processes.

For IT, it could represent a new paradigm of collaboration with the other stakeholders, with the ability to respond to their needs while being mindful of the challenges they face.

To realize the benefits of your EHR system, you must incorporate optimization into its normal care and feeding. It should enable providers to deliver the best and safest care possible in a framework that aligns clinical and IT priorities with the organization’s greater goals.

Kevin McNamara is no longer with Slalom.


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