What Measures are Useful?
This weeks discussion centered on how to assess the value of a HIT project. Value for this type of project does not just boil down to dollars and cents, it looks to the tangible and intangible values that make a HIT project successful...or not. When you measure value, one must look at the increase revenue collected by an organization after the successful implementation of an EHR. According to a study in the Journal of the American Medical Informatics Association, EHR implementation may lead to a dip in patient volume but can boost revenue in the long term.
Intangible value is very difficult to measure. However, the are value added to the organization. Improved decision making imparts immense value because EHRs allow care providers the ability to see the whole picture when reviewing a patients chart and determining the best course of care. The ability to collaborate with other care providers to offer comprehensive care to a patient is hard to measure in terms of dollars yet its intangible value is understood through the improvement of care.
http://www.beckershospitalreview.com/healthcare-information-technology/study-ehrs-decrease-number-of-patients-seen-but-increase-revenue.html
How do we determine what success will look like for a given initiative?
One aspect of an IT proposal that can often be overlooked is answering “what will success for the project look like?” This question may seem as if it does not need to be addressed until implementation but the earlier the question is asked the easier it will be to answer. It is possible that part of an initiative may be set up in such a way that it is impossible to gain meaningful data and that a small change would rectify this problem. The only way to make this change before it is too late is if the project is properly planned. During this chapter we will look at a hypothetical IT initiative, in this case the implementation of a telemedicine program between urban specialists and rural primary care, and examine how to effectively manage the data which the program will provide.
The first step in determining success is to figure out what the objective is trying to achieve. By having a clear picture of what the ideal end state will be it will allow administrators to create meaningful metrics. In the case of the telemedicine setup there are several objectives which contribute to success. If everything works to perfection on the clinic’s side it means that rural patients will be able to get instant access to specialists who normally would require a day’s travel and a week’s wait for an appointment. Additionally, they would have increased patient satisfaction and a better relationship with those patients. From the specialist’s perspective, an ideal initiative would mean a better relationship with rural providers and an increased likelihood that they will refer their patients to the medical center in the future. Now that we have an idea of what success looks like we can attempt to come up with ways to measure and sustain that success.
http://site.ebrary.com.offcampus.lib.washington.edu/lib/uwash/reader.action?docID=10734602
Can we use the data to make actionable decisions?
The data and evaluations of the overall value that a health IT investment generates should provide the very basis upon which healthcare leaders make actionable decisions. As business value of health IT can be measured through outcome metrics such as cost reductions, time savings, workflow efficiency, utilization reduction, physician satisfaction, patient satisfaction, it is important for healthcare leaders to also recognize that health IT can generate social value. When weighing decisions on what types of health IT investments should be made, we must always keep our organization’s mission, vision, and values in mind as we move forward with formulating strategy and, specifically, health IT strategy that should be aligned with the organization’s overall aims. Viewing health IT as a key strategic asset instead of merely a tool to cut costs and improve patient care quality, healthcare leaders will see the need to make smart investments that are aligned with their strategic goals.
Chief Information Officers should be acutely aware of current and upcoming trends, news, and best practices in newly available health IT products and services, the latest health IT investment decisions of other healthcare organizations, health IT strategy, as well as new ways to leverage health IT and data analytics. CIOs are responsible for collecting this information, bringing it back to the organization, and using his business acumen, expertise, and knowledge to make recommendations to the rest of the senior leaders that will need to be on-board with expensive health IT investments. Other senior leaders, including the CEO and CFO, will assert significant influence over whether or not a health IT investment will be made, based on space in the budget for IT, competing organizational priorities, and their assessment of organizational readiness.
http://www.modernhealthcare.com/article/20150411/MAGAZINE/304119976
http://www.ajmc.com/journals/issue/2014/2014-11-vol20-sp/the-value-of-health-information-technology-filling-the-knowledge-gap/P-1
Is doing an ROI a waste of time?
Electronic Health Records are increasingly in popularity for a number of justifiable reasons. However, as of recent, the passage of MACRA has made the reporting of data and quality metrics a financially rewarded, or punitive if not reported, factor for physician reimbursement. This was the federal government’s way of mandating that all physician practices implement EHRs. Many may ask themselves then, if this is something that I have to purchase and implement, is there any point to conducting an ROI for the EHR? In the traditional sense of an ROI the answer would be no. Often times, ROIs are used to justify an investment and in many cases are the means through which the investment was approved. However, with EHRs being mandated by the federal physician reimbursement system there is no longer the need to justify the purchase, the justification has become explicit. With this understanding, it is important to realize that there are other benefits to an ROI that still validate the effort to facilitating one. These benefits and the reasons to continue the practice of ROIs will be explored a little further in the following section.
When it comes to an EHR, there is no easy way to conduct an ROI as many of the benefits are difficult to quantify such as enhanced patient satisfaction, better quality of care, and improved security over prescribed medication. Yet, that does not mean that the need for an ROI has become obsolete. Even when ROIs are not used to justify a project, there is still value in them as a tool to measure performance and make changes incrementally if the technology is not meeting expectations. In the business setting, ROIs are understood and although the reasoning behind needing to do them has changed, they should still be done as they contribute value and clarity to the implementation process.
http://medcitynews.com/2013/10/ehr-roi-vs-ehr-implementation-costs/?rf=1
http://www.acog.org/About-ACOG/ACOG-Departments/Health-Information-Technology/Electronic-Medical-Records--Return-on-Investment
http://bok.ahima.org/doc?oid=101607#.WCHpsIWcHIU
How would you perform your evaluation?
When making post-evaluations of your EHR implementation, it is important to revisit the expectations and proposals made initially when the project was being formulated. First and foremost is to see if the implementation meets the anticipated deadline. Once go-live begins, it is good for any organization to review where it is in terms of progress. Second, all EHR implementations run over budget and even with the best intention and best planning, it is difficult for many organizations to budget precise costs. An evaluation of the financial standing and assessing the budget will highlight which areas to focus on to stop financial leakage. Third, workflows should be evaluated. Checking to see whether staff are able to work efficiently and effectively with this new technology will help identify training needs, system interface issues, and vendor issues. Although this may be a requirement during post-implementation, this should be woven throughout the planning and launch process. Since EHR implementations are very costly, this gives opportunity to report back to vendors what is not working for the organization. Last and most importantly, staff should be evaluated. People are the best resources in many capacities in health care, but they are often overlooked by more appealing and innovative technologies. Surveying whether staff have easily acclimated to the new system and made the new system a part of the organization’s culture is valuable. As you can see, evaluating EHR implementations is not simply a financial review. It requires leadership to evaluate the connections the organization has with its vendors and its staff and to make sure valuable resources are utilized to the best of its ability.
http://site.ebrary.com.offcampus.lib.washington.edu/lib/uwash/reader.action?docID=10734602&ppg=593
https://www.healthit.gov/providers-professionals/faqs/how-do-i-conduct-post-implementation-evaluation
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