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How to Define, Influence and Drive an EHR Value
Realization Agenda to Support Your Organizations
Joanne SunquistHealthEast Care SystemSenior Vice President and CIO
Myra AubuchonThe Chartis GroupPartner
Page 2August 2016 2016 The Chartis Group, LLC. All Rights Reserved.
Define EHR value realization
Discuss perspectives on how to achieve EHR value realization
Describe the organizational core competencies necessary to be
successful with value realization
Describe how to define, influence and drive a value realization
agenda to support your organizations strategic objectives
Page 3August 2016 2016 The Chartis Group, LLC. All Rights Reserved.
The Promise of EHRs: Tremendous Value PotentialWhen leveraged, the EHR should be integral to achieving your organizations strategic and operational goals. Real clinical and
operational opportunities can be associated with focused efforts to realize value from EHR investments.
Improve physician and staff
Support safe and successful transitions of care between
Enable adoption of Evidence
denials and improve revenue collection
Improve communicationamongst the care team and between the care team and
Support an efficient and
Increase efficiency of ambulatory
Increase adherence to
clinical standards and
access to care services
Reduce preventableclinical errors
Improve physician &
Page 4August 2016 2016 The Chartis Group, LLC. All Rights Reserved.
Live with Your EHR
Our revenue is back to baseline, but I expected to exceed that!
Wasnt this EHR supposed to
streamline care and open up some
We still cant seem to identify and manage our sickest patients. I thought that was
our primary objective for this investment.
With MACRA on the horizon, have we built this
system to capture and send the required data?
Our physicians are frustrated that it
takes longer to see their patients now.
Page 5August 2016 2016 The Chartis Group, LLC. All Rights Reserved.
What is EHR Value Realization?
Leveraging the EHR to achieve the next level of efficiency, cost management, quality, or experience through quantifiable clinical, financial and operational improvements.
Optimizing the technology alone will not bring significant value. Value is achieved when technical and operational performance teams share the value agenda.
Comprehensive EHR systems are significant investments with a great deal of promise to add value, improve clinical quality, and enrich the care experience.
Organizations are looking for a comprehensive, renewable and sustainable approach to value realization.
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Optimization vs. Value RealizationExample: an at Capacity ENT Group Practice
Chief complaint drop-down list refined to mirror patient
Specialty-compatible documentation note templates
Physician-specific, drop-in text (smart text)
Improved data-carry-forward functionality
Hot links to frequently used documentation tools
Physician-led development of documentation standards
Physician, peer-based audit and feedback loop established to maintain and improve documentation standards
Scribe policies, workflows, and training plans implemented
Patient check-in and check-out staff roles expanded to include tablet-based pre-visit questionnaires and distribution/review of after-visit summaries
Improved efficiency by modifying technology build and functionality in support of current clinical workflows
Changes to care team roles and responsibilities and clinical workflows to achieve additional improvements in efficiency and patient experience
Improvements to system build and configuration
An Optimization approach focuses on EHR system build
A Value Realization approach focuses on improving clinical and operational workflows in
tandem with EHR system build and configuration
Benefit ImpactStreamlined documentation reduced visit times by 2.25 minutes, resulting in 750 additional patient visits per year contributing to significant downstream perioperative, ancillary and other system revenue.
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Your EHR: An Underperforming Organizational Asset
Technologies to support care delivery are no different that
any organizational asset, they require leadership
commitment to both maintain and expand; otherwise they
face stagnation and underperformance
Unlike fixed assets that increase volume, improve quality
and reduce capacity constraints, EHR technology, as a value-
generating investment is not always easy to track
Deriving value from technology depends on operational
ownership and a planned approach; quantified benefits must
be identified, built into process / system design and
Although operational and clinical leadership accepts accountability to drive value from costly organizational assets; those same
leaders often do not exhibit the requisite accountability for their EHR, even though the magnitude of that investment supersedes
build an EHR Value
a strategic and balanced
portfolio of qualified
projects producing tangible
economic benefit which can
be re-invested to grow this
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Value Realization Agenda
Comprehensive, long-term and renewable
Aligned with organizational strategies to
maximize organizational value
Targeted, qualified and measurable clinical
and financial outcomes
Balanced short- and long-term returns; total
portfolio value calculated and tracked
Funds functional operating and capital costs
Funds growth and renewal year-after-year
Ownership and oversight by multi-disciplinary
clinical, financial and operational leadership
Clinical Quality &
Reporting and Regulatory
Peer-Review and Audit
Optimized Content and Data Visualization
Service line Redesign
Extending EHR to newly acquired partners
MU 3 CMS MACRA Payors
Sunsetting Legacy Systems
Service Line Planning
Care Management Clinician
Date 2016 The Chartis Group, LLC. All Rights Reserved. Page 9
HealthEasts Value Realization Agenda
Page 10August 2016 2016 The Chartis Group, LLC. All Rights Reserved.
The Starting Line or the Finish Line?Total Cost of Ownership for decision-making on EHR investments clearly identify areas of planned savings and cost avoidance. ROI
on the initial investment is critical. Value realization is the next step in the journey.
In addition to cost avoidance and savings, EHR value realization is a broader definition that includes both qualitative and
quantitative outcomes tied to organizational strategies. Revenue generation, cost avoidance and risk mitigation all are key results
that can be achieved.
Page 11August 2016 2016 The Chartis Group, LLC. All Rights Reserved.
EHR Sample ROI Analysis (7 Year)
EHR Cost Benefit Analysis (7 Year) PROJECTED ACTUALTotal Total
Clinical Staff Utilization - reduced nursing overtime 222,000 -
NonStaff Clinical Utilization 3,036,000 -
Unnecessary Radiology Tests 2,278,000 2,426,691
Unnecessary Laboratory Tests 1,498,000 -
Document Imaging 2,377,450 2,018,631
HIM Staffing 5,718,700 8,908,224
Off site Record Storage/Recall 3,014,000 3,789,271
Reduction in Transcription 9,073,000 8,805,453
Charge/Order Entry Staffing- HUC 2,085,000 1,216,788
Redundant Prescriptions 1,082,000 -
Order Entry Pharmacy Staff Reduction 657,000 -
Therapeutic Substitution 390,000 -
APC Improvement 1,531,000 845,000
Scheduling Productivity 905,000 -
Clinic Revenue 4,249,700 4,149,115
Consulting Outsource Cost Avoidance 938,000 2,077,047
Denials/POS Collection 36,130,100 27,033,356
SUBTOTAL BENEFITS 75,184,950 61,269,576
OPERATING COST AVOIDANCE
Legacy Billing System 5,762,282 4,811,648
IT Salary 14,171,769 13,825,499
Mainframe 14,017,948 19,037,246
ADE's 2,241,000 21,758
CDR 2,461,000 2,481,756
Unnecessary Laboratory Tests 1,846,000 -
Charge/Order Entry Staffing 1,437,000 1,256,000
Chart Tracking system 170,000 175,