CHIME College LIVE - The Chartis Group€¦ · CHIME College LIVE How to Define ......
Transcript of CHIME College LIVE - The Chartis Group€¦ · CHIME College LIVE How to Define ......
CHIME College LIVE
How to Define, Influence and Drive an EHR Value
Realization Agenda to Support Your Organization’s
Strategic Objectives
Presenters:
Joanne SunquistHealthEast Care SystemSenior Vice President and CIO
Myra AubuchonThe Chartis GroupPartner
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Objectives
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 organization’s strategic objectives
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The Promise of EHRs: Tremendous Value PotentialWhen leveraged, the EHR should be integral to achieving your organization’s 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
satisfaction
Support safe and successful transitions of care between
settings
Enable adoption of Evidence
Based Medicine
Reduce clinical
denials and improve revenue collection
Improve communicationamongst the care team and between the care team and
patient
Support an efficient and
effective discharge
process
Increase efficiency of ambulatory
visits
Increase adherence to
clinical standards and
protocols
Enable virtual
access to care services
and information
Reduce preventableclinical errors
and readmissions
Improve physician &
staff productivity
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“Live” with Your EHR
NowWhat?
Our revenue is back to baseline, but I expected to exceed that!
Wasn’t this EHR supposed to
streamline care and open up some
capacity?
We still can’t 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.
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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.
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Optimization vs. Value RealizationExample: an “at Capacity” ENT Group Practice
Chief complaint drop-down list refined to mirror patient
mix
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.
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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
monitored
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.
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Value Realization Agenda
Comprehensive, long-term and renewable
agenda
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
year-after-year
Funds growth and renewal year-after-year
Ownership and oversight by multi-disciplinary
clinical, financial and operational leadership
Clinical Quality &
Effectiveness
Provider Engagement
& Satisfaction
Clinical &OperationalEfficiencies
Organizational Growth
Reporting and Regulatory
ImprovedRevenue
ApplicationRationalization
Physician Documentation
EHR ValueRealization
Agenda
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
Testing
Vendor Selection
Sunsetting Legacy Systems
Service Line Planning
Care Management Clinician
Communications
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HealthEast’s Value Realization Agenda
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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.
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EHR Sample ROI Analysis (7 Year)
EHR Cost Benefit Analysis (7 Year) PROJECTED ACTUALTotal Total
REVENUE SAVINGS
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 170,000 175,747
Pharmacy 796,000 281,491
Rad System 626,000 445,134
OR System 370,000 173,635
ED System 1,132,000 698,159
Surg Nav - 224,936
SUBTOTAL OPERATING COST AVOIDANCE 45,030,999 43,433,010
INTEREST INCOME
A/R Reduction (interest income) 1,009,000 414,000
DNFB Reduction (interest income) 932,000 383,000
SUBTOTAL INTEREST INCOME 1,941,000 404,000
TOTAL EHR BENEFITS 122,156,949 105,106,586
Capital Costs 68,057,023 61,189,298
Ongoing Operational Costs 43,392,470 49,266,186
TOTAL COSTS 111,449,493 110,455,484
NET SAVINGS 10,707,456 (5,348,899)
The Majority of EHR Value Realization Occurs After
Implementation
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Create a Value Realization Agenda Starting with Organizational Priorities
HealthEast’s Vision: Optimal health and well-being for our patients, our communities and ourselves.
HealthEastStrategic Themes
Operational Goals Success Drivers
------- ------- -------
Leading Practices
Re-Imagine & Grow Primary Care
Clinically Integrated Network Development
QuantifiedBenefits Effort
------- ------- -------
------- ------- -------
------- ------- -------
Growth in Net Revenue and Cash
Neighborhood Integration
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Strategy Linked to Value RealizationSample EHR Value Realization Projects
Implementation of Care Management
Functionality (Registries, Workflow)
Risk Bearing Analytics
Establish Care Management Capabilities
Neighborhood Integration
Re-Imagine & GrowPrimary Care
Clinically Integrated Network Development
EHR Enhancements to Support Access
EHR Integration with Contact CenterRedesign Primary Care Delivery Model
Elimination of Legacy Systems Costs
Revenue Cycle System EnhancementsDevelop “Medicare Break Even” Model
Growth in Net Revenue and Cash
Patient Portal, Virtual StrategyDesign and Launch Neighborhood Initiative
Strategic Themes Strategic Initiatives EHR Value Realization
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Example: Re-Imagine and Grow Primary Care
Primary Care
Workstreams Initiatives
Care Management Integrated care management model including populations of intervention with care guidelines and protocols
Care Team Care Team re-design and implementation of supporting tools, training, technology
Leadership visual controls
Access Standards for provider time away
Provider time and capacity – normalized expectations for FTE and hours; standardization of contact hours
Template re-design
Care Connection (Contact Center)
Provider and Patient profiles (i.e., improve scheduling accuracy and ease)
Care Connection/Clinic Partnership Council; local-level decision-making body
Communications between Care Connections and primary care clinics
Re-Imagine & GrowPrimary Care
Redesign Primary Care Delivery Model
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An Integrated ApproachThe true integration of clinical and operational performance improvement with EHR value realization is a powerful accelerant for
moving provider organizations along the benefit curve.
Two Dimensions to this Work:
Governance
Clinical &Operational Leadership
ChangeManagement
Informatics & ContinuousImprovement
IT Services
Reporting &Analytics
High ImpactOpportunitiesPerformance
Improvement
EHR Redesign
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Prioritize through a Strong Governance StructureOperational ownership is key; it is essential to have a governance model that delivers the structures, processes and feedback loop
needed for organizations to make the effective decisions at the appropriate levels by the people most informed to make those
decisions.
PIC CLICClinical Councils
Rev CycleBusiness Systems
Analytics
ELT
ISBGB
EAC
HIC
OSOC
CSS Group
NIC
Others
Sched/Reg
HIM
Board for Intake Review (BIR) + Resource Board (RAB) + Security & Architecture Review Board (SARB)
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Sample Optimization/Project WorkflowIntegration with Service Management System Important for Tracking
Governing body
assesses request
Governing body
assesses request
ANALYTICS
Governing body assesses/
ranks request
BIR /SARB /RAB define preliminary
scope
ISBGB reviews and prioritizes
Work request submitted
Governing body informed
OPTIMIZATIONS
PROJECTS
BIR validates request and distributes request to appropriate
governing body
Denied
Project into Intake Process
Complete requirements,
design, reviews
Active Project
Project completed
Project On Hold
Project Withdrawn
Approved
PROJECTSINTAKES/REQUESTS
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Re-Imagine and Grow Primary Care Planned Outcomes
Metrics Definition Goal
Lives served Number of unique lives seen in 18 months 350,000
Financial health Operating margin (net margin/cFTE) At or above top quartile
% visit requests are seen on day requested
Number of patients who request care on same day (or next day after 5pm) and are seen that day
90% of requests
Avg. panel size per physician (right sizing)
Total number of unique MRNs by provider within 18 months (normalized to 1.0 FTE)
>3,500
Likelihood of recommending practice
% of patients who responded in the top box to the “likelihood to recommend” question
At or above 95th percentile
Staff and provider satisfaction
Staff and provider voluntary turnover <8%
Positioned for MACRA bonus# of quality metrics in the top quartile of CMS performance
MACRA metrics in the top quartile
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How do you define and influence your organization’s definition of EHR value realization and build and execute upon a value agenda?
1. Assess strategic priorities and understand how you can
leverage your EHR to support the strategies
2. Develop a value realization agenda, a portfolio of
projects that are approved, monitored and operationally
led
3. Quantify and deliver on those opportunities; earmark
returns for ongoing EHR investment
4. Tell your story and showcase successes in initial
paybacks and the year-over-year value realization
agenda
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Contact Us
Joanne Sunquist [email protected]
Myra [email protected]