Transcript Maximizing your EHR Investment for Improved Data Analystics

Maximizing Your EHR Investment
David Reitzel
Partner
Grant Thornton
Jamie Morisco
Manager
Grant Thornton
Table of Contents
•
•
Health IT Market
– Defining Health IT
– Health IT Market
EHR Introduction
– Key Fact and Trends
– Regulatory and Spending
Considerations
– Interoperability
– Challenges
•
•
•
•
EHR Implementation
– Analytics vs Informatics
– Leveraging Informatics
– Improve Physician Performance
– Data Governance
– Using IT Services to Maximize ROI
Key Activities
Implementation vs. Adoption
IT Management
1
Defining Health IT
Maintaining day-to-day IT operations and deliver patient care, it is critical for individuals and
organization to better understand how technology is leveraged and integrated into day-to-day
patient care and business
Organizational
Strategy and Alignment
Strategic
Planning
IT
Value
Project & Delivery
Management
Emerging
Technologies
Business Continuity Planning
Fiscal
Management
Staffing
IT
Organization
Organizational
Strategy and Governance
Data
Management
Governance &
Policies
Principles &
Practices
User
Outlook
Application Architecture &
Infrastructure
Mobility
Infrastructure & Data Center
Operations
Application
Management
CyberSecurity
Service
Levels
TECHNOLOGY
ORGANIZATION
Portfolio Spend
Standards
Network
Improvements
2
Health IT Market
The growth of the health IT market will continue to be a challenged due to the high costs of
healthcare IT solutions, high maintenance, interoperability challenges, shortage of healthcare IT
professionals and poor standards and protocols
Includes:
• Software
• Infrastructure
• Mobile Health
• Cybersecurity
• Professional
Services
CARS AVE: 7.4%
CN: 7.7%
US: 7.2%
Note:
Published by
Healthcare IT
News
Canada
USA
North America
3
Questions
•
What is the average annual spend of hospital IT?
– What are the components?
•
What is the cost of implementing a new IT system?
– Does it require new hardware? New Interfaces? What are the compatibility
issues?
•
Is it a challenge finding qualified candidates to staff a hospital IT department?
4
EHR Introduction
•
A digital way to document health information on a patient
– An electronic version of a paper chart
– Demographic data, medical history, medications, test results, etc
•
Facts:
– 97% of hospitals have a certified EHR system in 2014, up from 71% in 2011.
– Only 34% of hospitals have a Comprehensive EHR
• all med orders, image viewing, decision support, advanced directives
– There is no 'standard' solution for EHR
• Disparity among vendor technology limits communication between hospitals and
physicians across healthcare networks
• Lack of interoperability and protocol standards
– Most physicians report
• 85% - 90% of all clinical documentation has errors
Source: ONC and HIMSS
5
EHR Statistics
6
Top 20 IT Capital Budgets
•
•
•
Hospitals are now investing into a "Post-EHR era"
by expanding their IT infrastructure
Investing in products including big data analytics,
patient engagement, and cybersecurity
IDC Health Insights conducted a survey of around
200 hospital IT decision makers
• 37% stated their increased spending was
focused on big data analytics
• 32% recognized the need for patient
engagement
• 29% begun to focus on cybersecurity
• According to Definitive Healthcare,
over 350 hospitals and health systems
have experienced a data breach in the
past
7
US EMR Adoption Model
8
Question
•
Where are the challenges in having so much disparity in vendors?
•
Why is the IT portfolio so complicated?
•
Why has the US been slow in adopting this technology?
Healthcare Reform Objectives & Key Provisions
Affordable Care Act (“ACA”)
Provisions
▪ Commercial and Medicaid eligibility expansion
▪ Value-based purchasing for hospitals and
physicians
▪ Penalties for readmissions and hospital-acquired
conditions
▪ Lower Medicaid reimbursements per encounter
▪ Accountable Care Organizations and alternative
payment methods established
▪ Subsidies for IT investment to support care
Reform Objectives –
Better health at lower cost
▪
▪
▪
▪
▪
Decrease number of uninsured
Better prevention and improved outcomes
Lower cost of care
Incentives for higher quality/lower cost
Incentives for collaboration – hospital/physician/
provider /payor partnerships
▪ Better use of technology
▪ The right care at the right time in the right setting
management
"Healthcare reform continues to evolve. Our advisers, who are on the ground in Washington,
are monitoring and analyzing legislation daily and communicating this information to our firm.
This way, we can provide solid, accurate and prompt advice to our clients."
- Anne McGeorge, National Managing Partner, Health Care practice
10
EHR Regulatory Programs/Initiatives Promote Adoption
•
Specific initiatives include ways to standardize documentation, incentivize effective
use of technology, or penalize for not reporting critical values to public health
agencies:
– Meaningful Use
– HL7
– PQRS
– ICD-10
– HIPAA
– Cybersecurity
– Data Warehouse / Informatics
•
These are all individual initiatives and cannot be performed under one umbrella
11
Interoperability
•
Athenahealth, Epic, eClinicalWorks, NextGen Healthcare and Surescripts signed on to be the
first to implement Carequality’s framework for interoperability and data sharing principles
–
–
•
Key benefits of interoperability
–
–
–
–
–
•
Focus on query-based exchange of clinical documents
Eventual expansion to other cases
Allows physicians to focus on patients and less on coordinating care
Increasing patient safety, security, and well-being
Decreasing costs associated with legacy non-integrated healthcare systems
Increasing employee productivity
Improved patient experience
Major issue of Interoperability
–
–
–
Amount of time and resources require to go live
Outlining process, testing, legal review
Successful installation by both parties
12
EHR Technology Challenges
Two surveys show that physicians see challenges when adopting/using EHR technology
13
Critical IT Management Capabilities
Program Value Management focuses on accomplishments, not activities, and success is measured by the benefits
organizations realize. To maximize the likelihood that large IT-driven business initiatives will deliver expected
value on time and within budget, focus on four key capabilities
Health IT Initiative(s):
Project Value Realization
1
3
2
program strategy & secure
stakeholder support
• align initiative with strategy
and stakeholders
• establish clear vision of
initiative benefits/value
• build robust business case,
focus on objectives
• engage leaders to align
business and IT solutions
• define and maintain
initiative scope stability
deliver proven solutions that
serve the business
• employ standardized,
proven, IT solutions
• engage business and endusers to shape solution
• use frequent feedback to
progressively elaborate
• align release plans with
business priorities
• use Lean to deliver the
greatest business value
• access benefits/value
realized and adjust
build effective teams and align
efforts business need
• establish common vision,
high-performance culture
• engage teams with proven
ability to execute
• deploy leveraged SMEs who
understand IT & VOC
• engender IT and business
SME collaboration
• facilitate stakeholder and
team communication
• use Kaizen to improve
incrementally
4
excel at core delivery
management practices
• ensure common scope
understanding, up front
• establish short cycle-times
for value delivery
• establish disciplined,
standard mgmt. practices
• establish rigorous QA/QC
processes and procedures
• improve quality through
process standardization
• establish performance
standards and measure
14
Analytics vs. Informatics
Analytics is the discovery and communication of meaningful patterns in data.
Informatics uses this data, linking financial, quality and clinical data to make
health care decisions improving the overall quality and cost of care.
•
Health Care Analytics
–
–
–
–
extracting, collecting and storing
discrete data in an Enterprise Data
Warehouse (EDW)
data mapping; the determination of how
data is identified and stored
Metadata – data that describes other
data, it summarizes basic information
about the data
Analysis reporting in a single
dimension. i.e. looking at only clinical
data or only financial data
•
Health Care Informatics
–
–
–
–
–
using analytical data to identify patterns in
clinical, financial, quality data, etc.
algorithms for analyzing large amounts of
data generated in public health, clinical
research, or genomics/proteomics
data gathered in the clinical research
process that can inform clinical decisions
analyzing Big Data – data sets so large or
complex that traditional data processing
applications are inadequate
Analysis reporting in multiple dimensions.
i.e. looking at data across functions such as
clinical and financial
15
Leveraging Informatics as Core Evolution to Maximizing Investment
• Acquire and implement a business intelligence/data warehouse
environment as soon as possible if one does not exist
– This will be instrumental in helping to measure the clinical metrics
identified for tracking and calculating ROI.
– Maximize the use of the reporting tools inside your EMRs - these tools
are effective if just clinical data is needed or if immediate production of
data reporting is needed.
• Utilize a data warehouse and dashboards to track operational
metrics
– Track results on a daily basis and trend them over time
– Tracking can become annual after a tangible ROI has been achieved
16
Capitalize on EMR Capabilities to Monitor and Improve Physician
Performance
• Monitor RVU's and compare to national and local averages
• Monitor coding & documentation for accuracy
– This includes ensuring that physicians are appropriately documenting
the services provided (under 30 min discharge vs over 30 min discharge
code) as well as using the correct codes to support the documentation
• Track physician encounter closing rates
• Have physicians create a problem list from which tip sheets,
optimizations, and additional trainings can be developed
17
The Right Amount of Control
Too Much Control
Too Little Control
•
•
•
•
Possible breaches and misuse
Low quality data
Reports are not useful for decision making
Non-users have access to restricted data
•
•
•
•
Redundancies and inefficient data processing
Clinicians/users restricted from information and cannot
turn reports around quickly
Inefficient use of data
Not enough literacy throughout organization
18
Healthcare Data Governance Competencies
The core competencies for successful Data
Governance are similar to any other business unit
or business process improvement initiatives with a
lean towards data performance. Attaining these
competencies, improving upon them, and
reengineering theses processes towards Data
Governance goals will determine whether or not
Data Governance 'sticks.'
6 Benefits of Strong Data Governance
1. Improved business process efficiency
2. Increased business user productivity
3. Improved confidence in reports and analytics
4. Reduced cost of compliance with clear traceability
5. Better risk management, transparency and control
6. Support for growth and enterprise change
19
Delivering Healthcare Value Through Data Governance
The Value of Data
Data governance is the first step towards managing information as a key asset of a healthcare organization. The shift towards value demands
compliance with more stringent governance standards.
Alignment with Business Strategy
Data governance objectives should align with business strategic planning to ensure that funds are made available for Data Governance initiatives.
Once planners have defined the organization's Data Governance strategy, they can seek support from executive leadership.
20
Key Activities to Help Maximize ROI
•
Establish a baseline for measuring improvements
–
–
–
–
•
•
•
Any time span from a couple of weeks to a year before the EHR goes live
Metrics must be able to be measured at current state and future state
Revisit metrics at go-live and after optimization
Examples metrics include AR days, cash posting, elimination of paper char process,
nursing efficiency, staff retention
Determine key areas of focus for each department that can aid in maximizing ROI
– Example: Reducing LOS, streamline record completion (HIM)
Continue to drive EHR adoption to achieve higher stages of EHR capabilities
Set the right attitude to ensure buy-in from clinical staff and departments as well as
IT
– Establish an ROI task force with the above stakeholders to drive the evaluation process
21
Implementation vs. Adoption
"Implementation happens when the application is installed and
live; an important milestone from a technology perspective, but
only a small step toward adoption. Adoption is the continuous
process of keeping users informed and engaged, providing
innovative ways for them to become proficient in new tasks
quickly, measuring changes in critical outcomes, and striving to
sustain that level of performance long-term. Adoption is not a
snapshot at a single point in time; it is a motion picture"
Source: Beyond Implementation: A Prescription for Lasting EMR Adoption
22
Achieving Adoption
• A successful go-live does not translate to end users embracing the
technology
– Singular focus
• Negative feedback is good
– Shows users are in the system finding issue for optimization and making an
effort to adopt new workflows
•
•
•
•
•
IT not being the primary owner of the EHR project
Engaged leadership
Clinician involvement
Engaged and educated end users on EHR capabilities
Focus on post go-live workflow optimizations, continuing end user
education, and metrics
23
Reducing risk and maximizing ROI from IT
Our Health IT services offering helps clients achieve the value of their IT investment while
addressing the business issues they continue to struggle against
IT Strategic Services
Health IT systems
Grant Thornton uses a tested methodology to help
clients develop an IT strategy that addresses the
key elements impacting IT performance:
A collaborative approach to planning, developing and
implementing health IT systems drives willing
adoption of new technology and ensures ROI. Areas
include:
• Organizational strategy • IT organizations and
& alignment
governance
• Application architecture • IT portfolio spend
& infrastructure
• Revenue cycle
• Operational systems (Lawson,
Oracle, & PeopleSoft)
• ICD-10, 5010 and HIPAA
• Clinical information
systems
• Informatics (Oracle,
Allscripts and McKesson)
Health Informatics
CyberSecurity
Grant Thornton understands that providers need to
be able to securely share information across the
care domain and we are prepared to assist:
Grant Thornton has expertise in Security and
Privacy assessments and program development
designed to meet requirements of NIST, HITECH
and AT601. Our teams can help:
• Extend existing Clinical Information Systems (CIS)
• Implement an existing 3rd party solution
• Internally develop a customized solution A3 and
RxIQ
Revenue enhancement
Operational
transformation
•
•
•
Assess readiness
Implement a privacy and security program
Ensure sustainability of the program
Physician solutions
IT services
Finance and strategy
24