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  • CHIME College LIVE

    How to Define, Influence and Drive an EHR Value

    Realization Agenda to Support Your Organizations

    Strategic Objectives


    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.

    Achievable Benefits

    Improve physician and staff


    Support safe and successful transitions of care between


    Enable adoption of Evidence

    Based Medicine

    Reduce clinical

    denials and improve revenue collection

    Improve communicationamongst the care team and between the care team and


    Support an efficient and

    effective discharge


    Increase efficiency of ambulatory


    Increase adherence to

    clinical standards and


    Enable virtual

    access to care services

    and information

    Reduce preventableclinical errors

    and readmissions

    Improve physician &

    staff productivity

  • 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?

    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.

  • Page 6August 2016 2016 The Chartis Group, LLC. All Rights Reserved.

    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

    and configuration

    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.

  • Page 7August 2016 2016 The Chartis Group, LLC. All Rights Reserved.

    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

    most others.

    Organizations must

    build an EHR Value

    Realization Agenda

    a strategic and balanced

    portfolio of qualified

    projects producing tangible

    economic benefit which can

    be re-invested to grow this

    strategic asset.

  • Page 8August 2016 2016 The Chartis Group, LLC. All Rights Reserved.

    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 &


    Provider Engagement

    & Satisfaction

    Clinical &OperationalEfficiencies

    Organizational Growth

    Reporting and Regulatory



    Physician Documentation

    EHR ValueRealization


    Documentation Standards

    Peer-Review and Audit

    Streamlined workflows

    Optimized Content and Data Visualization

    Ambulatory Throughput

    Service line Redesign

    Physician Productivity

    Connected Community

    Extending EHR to newly acquired partners

    MU 3 CMS MACRA Payors

    CDI Centralized

    Access Pre-Admission


    Vendor Selection

    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


    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,