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EHR Implementation Accomplished – What’s Next?

Posted on April 12, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When you look at the world of hospital and health system EHR implementations, it’s fair to say that we can say Mission Accomplished. Depending on which numbers you use, they are all in the range of about 90% EHR adoption in hospitals. That’s a big shift from even 5-10 years ago when it comes to EHR adoption in hospitals. It’s amazing how quickly it shifted.

While it’s easy to sit back and think “Mission Accomplished” the reality is that we still have a LONG way to go when it comes to how we use the EHR. Yes, it’s “Mission Accomplished” as far as getting EHRs implemented. However, it’s just the start of the mission to make EHRs useful. I’d suggest that this is the task that will take up CIOs time the most over the next 5 years.

I think that most people looking at their EHR think about next steps in two large baskets:EHR Optimization and Extracting Value from EHR Data.

EHR Optimization
Most EHR software was slammed in so quickly that it left the users’ heads spinning. Hospitals were chasing the government money and so there was no time to think how the EHR was implemented and the best way to implement the EHR. We’re paying the price for these rushed EHR implementations now.

What’s most shocking to me is how many little things can be done for EHR end users to make their lives better. Many EHR users are suffering from poor training, lack of training, or at least an ignorance to what’s possible with the EHR. I’ve seen this first hand in the EHR implementations I’ve done. I know very clearly that a feature of the EHR was introduced and the users were shown how to do it and 6 months later when you show that feature to them they ask “Why didn’t you teach us this earlier?” Although, they then usually sheepishly say, “Did you teach us this before? I don’t remember it.” At this point it’s not about who we blame, but is about ensuring that every user is trained to the highest degree possible.

The other EHR optimization that many need is an evaluation of their EHR workflow. In most EHR implementations the organization replicates the paper processes. This is often not ideal. Now that the EHR is implemented, it’s a great time to think about why a process was done a certain way and see if there is a different workflow that makes more sense in the digital world. It’s amazing the efficiency you will find.

Extracting Value from EHR Data
As I just suggested, most EHR implementations end up being paper processes replicated electronically. This is not a bad thing, but it can often miss out on the potential value an EHR can provide. This is particularly true when it comes to how you use your EHR data. Most hospitals are still using EHR data the way they did in the paper world. We need to change our thinking if we want to extract the value from the EHR data.

I’ve always looked at EHR data like it was discovering a new world. Reports and analysis that were not even possible in the paper world now become so basic and obvious. The challenge often isn’t the reporting, but the realization that these new opportunities exist. In many cases, we haven’t thought this way and a change in thinking is always a challenge.

When thinking about extracting value from the EHR data, I like to think about it from two perspectives. First, can you provide information at the point of care that will make the patient care experience better for the provider and the patient? Second, can you use the EHR data to better understand an address the issues of a patient population? I’m sure there are other frames of reference as well, but these are two great places to start.

EHR Optimization and creating value from EHR data is going to be a great thing for everyone involved in healthcare and we’re just at the beginning of this process. I think it’s a huge part of what’s next for EHR. What’s your take? What are your plans for your EHR?

HIM Professional Sing-Along – Let’s Help Doctors Be Doctors Again

Posted on October 28, 2015 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

Last week, someone shared with me this amazing video and I have been singing along all weekend. There is quite a bit of skepticism in the lyrics to “EHR State of Mind” but it’s a clever expression of a physician’s view of the shortcomings of using EMRs. I enjoyed the creativity of this song and the video and I hope that these EMR issues are addressed soon as the frustrations he shared are definitely unintentional.

I have highlighted some of my favorite lines from the song below and wanted to share my interpretation from an HIM viewpoint.

“Notes used to be our story…narrative…but replaced with copy-paste…now a bloated ransom note”

This statement really resonated with me and my experiences over the past several years. I have definitely seen the decline in the quality of documentation since the install of the EMR. It doesn’t matter what vendor product is used, the reality is that the documentation has severely suffered because we’ve shifted the physicians’ attention to other workflow processes and EMR checkboxes. Copy and paste has reared its ugly head in far too many charts and we must stop the madness! HIM professionals have stepped in to assist with this by providing real-time auditing and feedback. Plus, HIM has provided assistance by enhancing documentation tools.

“Just a glorified billing platform with some patient stuff tacked on.”

I have heard similar statements on many different occasions. Some EMRs were structured around automating billing processes but that doesn’t mean they have to lack in clinical functionality. From the HIM perspective, we are accustomed to reimbursement and clinical documentation going hand in hand. Coding and billing processes were in need of an overhaul to make for more timely reimbursement and EMRs promised to do just that. Having the clinical documentation and data built into the same system was revolutionary and very exciting for us but it’s still a work in progress to optimize the clinical documentation.

“Uncle Sam promoted it but gone is the interop.” 

Wow- this is sad but true. I remember when I first heard about EMRs, HITECH, and Meaningful Use. I had dreams of sharing data with anyone involved in a patient’s care regardless of geographic location through an EMR health information exchange. Unfortunately, this hasn’t even been possible within the same zip code and sometimes not even among providers in the same organization. True interoperability is definitely missing from our EMR systems.

And lastly, “Crappy software some vendor made us.”

Out-of-the-box EMRs are not a one size fits all by any means. EMRs must be customized, trained on, and implemented in a fashion that works for each provider and healthcare system. The implementation process is not complete at “go-live”. The optimization (and most likely, re-build) period must continue indefinitely until the EMR workflows and data capture are ideal for all patient care, quality reporting, and billing purposes.

Do we really need a “new chart” or is enough optimization possible to get us where we need to be? We are constantly having discussions, starting committees, releasing updates, running reports, and everything in between with hopes that our enhancements will make the EMR more functional and meaningful. I value the feedback from physicians and other clinicians who are using the system daily because their intentions are to deliver the best patient care. EMR obstacles are unacceptable and must be fixed with the help of skilled EMR specialists, HIM and IT professionals, and workflow experts.

Enjoy the video by Dr. Z.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Thoughts on Leveraging EMRs Effectively

Posted on September 28, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Whenever I scan Twitter for #HIT ideas, I find something neat. For example, consider this intriguing tweet:

I say intriguing not because the formula outlined will surprise anyone, but rather, because it captures some very difficult problems in a concise and impactful manner.

Here’s some thoughts on the issues Portnoy raises:

* Optimization:  Of course, every healthcare IT organization works to optimize every technology it deploys. But doing so with EMRs is one of the most difficult problems it is likely to encounter. Not only do IT leaders need to optimize the EMR platform technically, they may also face external demands placed by ACOs, HIE partners and affiliated providers. And it’s also important to optimize for Meaningful Use functions.

* Workflows:  Building workflows that address the needs of various stakeholders is critical, as pre-designed vendor workflow options may be far from adequate. While implementing an EMR may be an opportunity for a hospital to redesign workflows, or to enshrine existing workflows in the EMR interface and logic, hospital leaders need to take charge of the workflow implementation process. Inefficiencies at this level can be costly and will erode the confidence of clinical teams.

* Revenue capture:  When properly implemented, EMRs can help providers generate more complete documentation for claims reimbursement, which leads to higher collections volume. As time has shown, difficult-to-use EMRs can lead to physician frustration, and in turn, cut-and-paste re-use of existing documentation — which is why carefully-designed workflow is so important. But if they are used appropriately, EMRs can boost revenue painlessly.

* Patient and provider engagement: True, IT needs to take the lead on getting the EMR in place, and must make some important deployment decisions on its own. Still, hospitals will have trouble meeting their goals if patients and providers aren’t invested in its success, and without patient interest in their data I’d argue that meeting long-term population health goals is unlikely. On the flip side, if clinicians and patients are engaged, the feedback they offer can help hospitals shape not only the future of their EMR, but also the rest of their clinical data infrastructure.

If there’s any common theme to all of this, I’d submit, it’s participation. Unlike most efforts corporate IT departments undertake, EMR rollouts are unlikely to work until everyone they touch gets on board. Hospitals can invest in any EMR technology they like, but if providers can’t use the system comfortably to document care, patients don’t log on to access their data, or revenue cycle managers don’t see how it can improve revenue capture, the project is unlikely to offer much ROI.

More CDI and EHR Optimization Discussion

Posted on December 5, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In response to the question I posted in yesterday’s blog post, “What’s the Difference Between CDI Programs and EHR Optimization?“, Richard Tomlinson, Founder and CEO of Nuclei Health Consultancy offered this response that I thought would help continue the discussion and be interesting for readers:

In answer to your excellent question, no. CDI and EHR optimization are not the same; in fact the two models are significantly different, as are their goals.

Without deep dives here, the root decision tree to choose CDI over optimization should be based upon analysis results to the issues and goals identified. What are the identified issues? And what are the identified and measurable goals.

I will share that workflow analysis is one significant differentiator between CDI and Optimization. If one of the goals mentioned above for example is to reduce time documenting , or, a shift of role assignment in portions of workflows to reduce cost or improve provider thruput, then optimization here may include the addition of technology. Sounds counterintuitive, nevertheless the business model of optimization is indeed different.

Reducing clicks in clin doc has been cited as optimization, but I am here to tell you that alone is not the case. I would tend to take that stand alone as CDI, although one can argue reducing clicks does not “improve” clinical documentation.

As an overall, I would tend to say optimization is holistic in its foundation to include analysis of workflows, content build specifications, ROI of additional technology/tools, education, with the cumulative impact compared to a set of defined clinical and business goals. CDI by contrast may support only a goal as simplistic as rearrangement or placement of data to achieve a specific benefit.

I look forward to hearing other people’s thoughts on this subject.

What’s the Difference Between CDI Programs and EHR Optimization?

Posted on December 4, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently heard someone describe their EHR optimization as a Clinical Documentation Improvement (CDI) project. It made me start to wonder if CDI and EHR optimization were quickly becoming the same thing.

While some CDI programs require EHR optimization, not all CDI programs require it. Some EHR optimization can improve clinical documentation, but not all of them. However, there is a decent overlap between the two efforts.

There are a lot of ways a CDI program can improve your clinical documentation. As we start to see full adoption of EHR software, most of the CDI programs are going to focus on the way the visit is documented in the EHR. While the EHR use might be to blame in many cases, the most important part of any CDI effort is the people that use that program. In fact, it’s often not even about how they use the program, but just the choices they make.

What has become very valuable is that EHR’s have made CDI programs much more efficient. They can run the program remotely. They can run reports that focus on common clinical documentation errors and focus their program on those specific errors. Technology can really help a CDI program to focus on the pieces of the chart that matter most.

EHR optimization on the other hand could have nothing to do with improving the clinical documentation. It very well may be that the clinical documentation is perfect. In an EHR optimization, you may only be looking at how to improve the physician workflow while maintaining the high level of clinical documentation.

EHR optimization is a powerful thing and not enough organizations are doing it. I get that they’re too distracted by meaningful use, but if we’re going to really benefit from EHR software we need more organizations focused on optimizing their EHR use.

It will be interesting to see how hospital leadership handles the governance of CDI and EHR optimization programs. They are both going to be very important going forward.

The Changing Health IT Consulting Job Market

Posted on October 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Cassie Sturdevant has a great post up on Healthcare IT Today titled “The New Health IT Consulting Skill Set.” In the post, she talks about the changing Health IT market for consultants. She’s absolutely right that between 2010-2012 it was a white hot market and that the market has since cooled down. As she mentions, that means that clients can be much more selective in who their hire. Then, she outlines a few ways to differentiate yourself as a consultant:

  1. Operations or Clinical Background
  2. Communication Skills
  3. Multi-Faceted Knowledge

Those are some good suggestions and if you read the full article, you can find more details from Cassie on each suggestion. If I were to summarize Cassie’s suggestions, it would be that healthcare organizations will need someone with a much deeper knowledge of EHR and Healthcare IT than they had to have previously.

As I look at the healthcare consulting market going forward, I see two major areas of opportunities: EHR switching and EHR optimization.

EHR Switching – Since the majority of hospitals have now implemented some form of EHR, the new EHR implementation market is drying up. However, that’s not to say that we won’t see a lot of new EHR purchases. These new EHR Purchases will instead be hospitals that are buying a new EHR. This EHR switching takes a lot of effort and skills to do it properly. Plus, it takes an organization that has a deep understanding of both the legacy and new EHR software. Watch for the EHR switching to really spike post-meaningful use.

EHR Optimization – This is a really broad area of work. However, so many of the EHR implementations were done on shortened timelines that almost no EHR optimization occurred during the implementation. This presents a major opportunity. Every organization is going to be looking for ways that they can extract more value out of their EHR investment. Consultants that have deep knowledge about how to get this value will be in high demand.

It’s still an exciting time to be in healthcare IT with lots of opportunities. It’s not the gold rush that it was, but there is still plenty of opportunity to do amazing things with an organization’s healthcare IT.

If you’re looking for a healthcare IT job, be sure to check out these Health IT company job postings:

If your organization is looking for some healthcare IT talent, check out our Healthcare IT central career website.

Is EHR Optimization Possible?

Posted on September 23, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

At the Healthcare Forum Heather Haugen, PhD posited that the Promise of an Electronic Health Record (EHR) is that it “has the potential to transform healthcare by providing clinicians access to comprehensive medical information that is secure, standardized and shared.”  She then proceeded to remind us how far we have come on the journey of adoption, but that we still haven’t gotten where we need to be.  EHR is indeed a lofty goal, but we haven’t gotten there yet.

Plus, Dr. Haugen suggested that far too many people are focused on the EHR implementation and yet that’s only one milestone along the EHR journey.  In fact, she compared looking at EHR implementation numbers to talking about the number of weddings as opposed to the success of those weddings.  EHR implementations are just an event, but we continue to talk about the wedding instead of the marriage.

When you start to look at EHR as a journey, the first steps of Selecting, Building, and Installing are relatively short parts of the journey.  However, the EHR journey also includes: leadership engagement, speed to proficiency, performance metrics, and adoption sustainment.  Each of these are crucial to EHR adoption, but are much longer journeys than the initial implementation steps.

The journey of adoption is challenging, messy and dynamic and we may never actually arrive at “EHR Adoption.”   EHR adoption has a lifecycle that’s influenced by many factors including staff turnover and software upgrades.  So every organization must be prepared for ongoing education, training and engagement with their end-users to keep the EHR journey moving forward.

When considering this challenge, Dr. Haugen asked the question: Can data help us? And then she offered the following suggestions on how data can help an organization.

  • Data saves time and resources by focusing on the right patients
  • Data incents actions
  • Data removes subjectivity

As Dr. Haugen said, “Measurement has impact.”  She then offered five key measurement areas where healthcare leaders can evaluate their EHR project.  Have users:

  • Understood how the application impacts their job?
  • Understood why the application was implemented?
  • Felt that the leadership team is committed to the success of the project?
  • Felt that the organization’s leadership helped them understand what they need to do to adopt the new system?
  • Felt that communication from the leadership team helped make them feel more comfortable about the change?

Each of the above measurements is really focused on making sure an organization has user buy in for the EHR journey.  After you get past the EHR implementation stage, Dr. Haugen offered a series of other important questions you should understand and measure in order to optimize your EHR:

  • How is the application being used?
  • How are upgrades being adopted?
  • How do we overcome workarounds?
  • Who is struggling to use the new system?
  • What areas of the application are confusing and could lead to clinical errors?
  • How can we gain increased productivity?
  • Inefficient workflows – what are they and how do we change them?

Each of these questions and measurements can help an organization realize where end users could use more or better EHR education.  Dr. Haugen suggested that the best way to close any learning gaps is to offer scenario-based learning that helps end users become more knowledgeable and confident in their work.

Dr. Haugen also offered a number of other early findings from their research on the EHR journey.  First, only a small percentage of users need one on one help.  Second, software upgrades erode adoption over time and so with every upgrade you need a commensurate effort to retrain adoption.  Third, optimization is the responsibility of clinical leaders.  Fourth, users want education delivered at the time of need.  Fifth, data still lives on paper.  Sixth, there is a lot of opportunity to improve productivity through more efficient workflows.

Dr. Haugen concluded that “Feet on the street are probably not going to be how we solve the optimization challenges.  The right data could help us solve the optimization challenges.”  The right data with fast, effective and sustainable training will take us a long way on the EHR journey to a secure, standardized, and shared medical record.

You can see Heather Haugen, PhD’s full presentation at the Healthcare Forum (embedded below):

The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience.  You can view all of the Healthcare Forum videos on The Healthcare Forum website.