“As difficult as it is to scale Mount Everest, coming back down from the world’s tallest peak is far more deadly…. Among climbers who died after scaling higher than … 26,246 feet above sea level, 56 percent succumbed on their descent.” (Scientific American, December 2008)
You’ve gone live with your shiny new EHR after months and months of planning, configuring, testing, and training. It’s been a long climb to the top, but you’ve finally arrived. It wasn’t perfect, but patients are being seen, notes are being documented, orders are being sent, and claims are going out the door. And odds are good that they’ll even be paid. It’s time to breathe a sigh of relief and pat yourself on the back. The hard part is over … right?
Not even close.
EHR optimization—every health system and provider organization is either doing it or plans to. A poll of College of Healthcare Information Management Executives (CHIME) members published earlier this year indicated that 38% expected to spend time and money on EHR optimization. Organizations not actively replacing their EHRs understand that optimization is critical to maximizing the benefit of current systems, and those that are trudging through an implementation increasingly recognize that it’s never too soon to start planning for optimization.
Following an EHR implementation, there are three optimization phases an organization should go through that are key to achieving high performance. An organization must regain stability after a disruptive go-live before attempting to become proficient using the new system. Once proficiency has been achieved, the organization should strive for continuous cycles of performance improvement going forward. Below is an example of the three phases of EHR optimization defined within the context of a physician group.
|Phase One: Stabilization||Phase Two: Proficiency||Phase Three: Performance Improvement|
• Practices/providers are able to return to pre–go-live levels of productivity.|
• High- and medium-priority issues from go-live (and shortly after) are resolved.
• The majority of users have demonstrated basic system competency.
|• Items identified during implementation but deferred to optimization are addressed.
• All practices have adopted and are maintaining intended work flows.
• All users have demonstrated functional and operational proficiency.
|• Training and support is designed based on specific performance goals and driven by related metrics.|
• Goals are likely to include targets that surpass pre–go-live performance of practic-es/providers.
• Performance improvement is characterized as an ongoing effort.
Let’s further define stabilization, because the characteristics of stability must be established so that the physician group can determine when a practice is prepared to benefit from support in order to achieve proficiency.
- Productivity: Providers have returned to pre–go-live productivity levels, taking into account seasonality, vacations, planned FTE adjustments, etc. Office staff can schedule appointments and perform registration, intake, and checkout as well as other key work flows at approximately the same rate as before. Key revenue cycle metrics are not declining but rather starting to improve and trending toward pre–go-live values.
- Issues Resolution: People, process, and technology issues with significant impact to quality, safety, and/or efficiency, or issues that are less significant but pervasive across the medical group, are adequately resolved.
- Competency: Role-based competency checklists are administered to ensure users have a basic understanding of system functionality in order to perform their jobs. Re-training is deployed until minimum competency is achieved by most. Some users may be put on targeted improve-ment/support plans.
Although the time required to achieve stability will vary between practices, it’s important to remember that beginning proficiency support prior to stabilization will not produce positive results.
In part two of this series, we will expand on the second and third phases of optimization.