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Chapter 5

EHR Goal Setting and Impact on Quality of Care

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EHR and Quality of Care

• Despite not a lot of scientific evidence, there is strong belief that EHRs:– Improve productivity– Save time; reduce cost– Reduce hassles– Improve patient safety– Improve quality of care

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Difficulty Proving Value

• Not a lot of “complete” EHRs

• Definition of “complete” is elusive

• EHRs are increasingly becoming more sophisticated, so landscape is changing

• Too few organizations have the ability to conduct scientific studies to prove value

• But, once an EHR is implemented, few organizations want to turn back!

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Quantitative Vs. Qualitative Benefits

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“Pure Research” is Difficult• Confounding values

– Multiple factors can contribute to benefits• Evaluating processes before implementing EHR leads to

benefits

– EHRs take a long time to implement, so many other factors may take place during that time

– Strictly controlled studies are very difficult to conduct– Even act of studying benefits of EHR may contribute to

improvements

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• Meta-analysis that integrates findings from many similar organizations using similar systems may improve the value of anecdotal results

Vs.

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Cost-Benefit Feasibility Study• Done before a decision to acquire EHR is made

• Determines if initiative is appropriate at this time

• Highlights broken processes to be repaired

• Measures the costs of acquisition of hardware and software, installation, implementation, and ongoing maintenance against anticipated financial benefits– Estimates return on investment

• May be estimated and not detailed; or based on process assessment and detailed

• Success factors include:– Clear vision

– Management support

– Realistic expectations

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Goal Setting for EHR Benefits

• Goals help achieve the intended result of a strategy

• Goals must be

Specific

Measurable

Attainable

Realistic

Timely

Within six months of acquiring an EHR, we will achieve 90% compliance with cervical cancer screening guidelines through a patient-specific reminder

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What does Goal Setting do?

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Goal Setting and Education

• Stakeholders must understand what an EHR can do and what is feasible in order to set appropriate goals– Too moderate goals will not yield sufficient benefit to

return investment– Too great expectations will result in disappointment

• Education is needed to set realistic goals

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Goal Setting and Change Management

• Identifying goals can lead to stakeholder buy-in

• Goal setting is a part of change management– It must allow participation to achieve goal ownership

• It allows for anticipation of change

• Goals must be expressed as benefits that are real

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Benefits Requirements• Nature of benefits must relate to type of organization• Should support organization’s strategic goals and

objectives• Must reflect vision and migration path of EHR

defined by organization• Need to be proposed within context – perceptions or

formal study• Need to be supported by resources and commitment

of senior management

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Benefits Vary Along Migration Path• Access to data

• Interaction with data

• Documentation

• Decision support

• Data outreach

• Continuum of care

• Longitudinal data

• Operational improvements• Cost savings• Basic patient safety• Improve service and

productivity• Improved outcomes and quality• Quality of care and

biosurveillance• Quality of life; economic

benefits

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Economic Benefits• Cost savings

– Example: reduction in forms production

• Cost avoidance– Example: avoiding staff recruitment costs

• Revenue increases– Example: Accurate E&M coding

• Contribution to profit– Example: Reduce complications from adverse drug events

• Productivity improvements– Example: See two more patients in a day

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Clinical Benefits• Better access to clinical information• Improvement in clinical decision-making • Improvement in disease management• Enhanced documentation and accuracy• More patient education tailored to the patient’s needs• More physician and nursing time with patients• Improved overall care and outcomes• Improved quality of life

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Quantifying Clinical Benefits

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Benefits Realization Study• Done both before a decision to implement an EHR and after

EHR implementation

• To determine if anticipated benefits are realized

• Before, may highlight processes to be fixed and contribute to system build; after, will identify areas not meeting expected benefits in order to take corrective action

• Needed success factors are:– Clear vision

– Management support

– Realistic expectations

– Valid metrics

– Process assessment skills

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Benefits Realization Study Steps• Commit to study upfront• Identify potential benefits• Decide on study design• Create metrics for measurement• Measure base line data before implementation• Measure after implementation• Take appropriate action(s)

– Celebrate– Correct course– Adjust metrics and re-measure

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Creating Metrics

• Metrics must truly measure what they are intended to measure

• The same metric must be used both before and after• Obtain agreement as to a metric’s applicability and the

processes involved in their use• Include representatives who would be affected by the

metrics• Test the metrics• Implement the metrics

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Evaluating the Measurements

• The final step in the benefits realization study is to analyze the results

• The same metric must be used before and after the study

• Before measuring the benefit, it is important to describe the level of improvement or benefit desired– Anticipate time period in which improvements are

desired

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Conclusion• Benefits from EHR should be celebrated,

– Along the various milestones in an implementation project – Along the migration path

• Setting goals and conducting benefits realization studies are often more difficult to do than implementing an EHR,– But help recognize the value of EHR – Provides motivation for continued improvement in

adoption