Another day, another study, but this one – about the EHR user’s satisfaction levels with their systems – seems to have some teeth. According to the survey, “EHR Satisfaction Diminishing,” which was administered by the adept AmericanEHR group, users of EHRs are becoming ever more disenfranchised with their EHRS.
According to the AmericanEHR, data was collected over a two-year period of time, from 2010 through 2012. After two years of use, and in some cases longer, practice leaders and caregivers who have time to figure out their electronic collection systems and who are past the test-drive phase say they are not happy with the technology.
I’ve made this case before, but this is one of the primary reasons I strongly recommend physicians not getting locked into extremely long-term contracts. For example, some vendors require seven years. That’s way too long. Stay away.
Nevertheless, this could just be a standard response to the technology as a whole, but let’s get to the results of the survey. For brevity’s sake, I’ve cut what I don’t find to be significant. Some of the results noted here are amazing and eye opening; you decide.
71 percent of respondents were in practices of 10 physicians or less;
The average length of time that survey respondents had been using their EHRs was more than three years at the time of the EHR satisfaction survey;
Satisfaction and usability ratings are dropping. This holds true regardless of practice size, specialty type and across multiple vendors;
Overall, EHR user satisfaction reveals a 12 percent drop in satisfied users from 2010 to 2012 and a corresponding increase in very dissatisfied users of 10 percent for the same period;
In 2012, 39 percent of clinicians would not recommend their EHR to a colleague (I’m not surprised by this, especially given my experience with vendors);
Average satisfaction level with the ability to improve patient care decreased from 2010 through 2012 for all specialty groups;
Satisfaction with ease of use dropped 13 percent between 2010 and 2012 and 37 percent reported increased dissatisfaction in 2012;
34 percent of users in 2012 were very dissatisfied with the ability to decrease workload compared to 19 percent in 2010.
Why is this happening (according to AmericanEHR)? The following hypotheses may explain some of these findings:
With Meaningful Use, users may have lost some of their workarounds or have new ones that they have to do e.g. clinical visit summary that now takes 10 clicks and as a result workflow may feel more cumbersome;
The difference between cognitive versus procedural specialists. If one asked the majority of physicians how they would rate the quality of care they provide, most would likely say very good to excellent. Unless these physicians regularly use dashboards and reports they do not know whether they are doing better using an EHR. This is more challenging with procedural specialists such as a thoracic surgeon or orthopedic surgeon. It is not clear how the EHR helps with improving quality of care for proceduralists;
As we have further analyzed the data in related to satisfaction with the ability to improve patient care by duration of EHR use prior to completing the EHR satisfaction survey, there appears to be a strong correlation between length of use an EHR and ability to improve patient care especially in those who have been using an EHR for 5+ years. This could suggest that there is a minimum period of time that someone has to use an EHR before beginning to demonstrate improvements in patient care;
Dissatisfaction may also be a result of being asked to do something with an EHR that previously was not required (prior to Meaningful Use);
There continues to be an inability to complete certain tasks electronically despite having an EHR. For example, ACOs that require a paper form to be completed for registration of each patient in a pay-for-performance program, resulting in increased workload and decreased productivity/satisfaction.
Additional observations (which are amazingly insightful):
The speed of change in relation to the Meaningful Use program may be too much too fast for many practices who are unable to cope the demands and workload;
Different populations have different expectations. The pioneers and early adopters have a greater tolerance for the problems and challenges of implementing an EHR vs. those in the mid or late majority;
EHR systems clearly have usability issues which need to be addressed even with respect to basic functionality.
Recommendations (here’s the real gold):
Training is a significant deficiency. Training is required at all stages of adoption, both at time of implementation and as more advanced functionalities are required or integrated with EHRs. Almost 50 percent of respondents in a 2011 AmericanEHR report on the correlation of training duration with EHR usability and satisfaction reported receiving less than three days of training to use their EHRs or no training at all;
Dissatisfaction levels with basic EHR functionalities highlight the need to improve existing technologies rather than just focus on adding new features and capabilities;
Clinician workload within the practice must be re-balanced. Providers are working harder and face numerous additional challenges including the impact of payment reform and the need to comply with multiple incentive/penalty programs.
In closing, according to AmericanEHR: “If these issues are not recognized and addressed, the alternative is that clinicians will do the bare minimum in order to meet meaningful use requirements.”
Along with HIMSS’ largest money maker of the year — its annual conference — it’s also time for the results of its annual leadership survey.
While the results, which are reflected in the infographic below, are certainly interesting there is one point that seems to raise a flag immediately.
Prior to that, however, let’s take a quick look at the results. Accordingly, about 66 percent of the all health IT leaders say their organization qualified for meaningful use Stage 1 and 75 percent of the same folks expect to qualify for Stage 2. Additionally, nearly 90 percent of those who took the survey say they be ready for the ICD-10 switch later this year.
As such, there’s quite a need to hire new IT folks to carry the torch.
Next, it appears that nearly 20 percent of respondents said their health systems’ security was breech (at least those who admitted as much) and that 22 percent of said security was a priority for the coming year, which should be the case if 20 percent of them faced a security issue.
I understand the scope of the survey and who its respondents are, but doesn’t it strike anyone else as slightly odd that all of the changes to come are related to the IT? All, or much, of the reform is designed to engage patients and bring them closer to their care providers? Shouldn’t it be implemented to help improve outcomes and to drive better results and make the system more fluid? I guess IT is going to be what get’s us there. But along the way, couldn’t more be done at the care level as well as the IT level? Could some of the hiring take place to serve patients rather than the practice?
I digress. Apparently, for now, we’ll have to be thankful that all of this change is leading to improved job growth and fixes to the breeches that await us.
A straightforward piece of news from TEKsystems Healthcare Services, a provider of workforce planning, human capital management and IT services to the healthcare industry, showing the following results a joint survey with HIMSS Analytics regarding health organizations’ readiness pertaining to the implementation of electronic health record (EHR) systems.
According to TEKsystems, the survey shows insights into the status of EHR implementations, the challenges healthcare organizations face and areas of improvement; TEKsystems and HIMSS Analytics surveyed 300 single and multi-hospital organizations and health professionals throughout the United States. Key findings include:
Current State of EHR Implementations
Nearly 39 percent of hospitals have surpassed Stage 4 of the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM).
Currently less than half (43 percent) of integrated delivery systems or single hospital systems have completed their EHR implementation.
Achieving end user adoption
Nearly two-thirds of healthcare professionals (64 percent) believe achieving adoption is a roadblock to a successful EHR implementation.
“Achieving meaningful use and truly improving the quality of patient care can only happen if end users fully adopt a new EHR system in an acceptable timeframe. Organizations expect their people to adapt quickly, yet many do not plan for end user training until late in the effort,” says , TEKsystems vice president of healthcare services. “Upfront training strategy development would allow for the identification of key competencies and performance indicators. As organizations transition from implementation to day-to-day operations, any deficiencies in the ability to meet the targets can be pinpointed to either a specific user group, department or globally as indicated by analytics and aligning remediation accordingly. Developing an effective adoption strategy is a critical step that needs to be detailed earlier in the process and carried throughout the life of the initiative. That includes finding the appropriate resources necessary for building, integrating and conducting the training.”
Bringing in the right people and skills
Sixty-six percent of respondents cite the challenge of finding the right workers with the right skills for the implementation. More than half struggle with finding the right people to build a training program (57 percent) or lead the classroom discussions (53 percent).
“The supply of HIT talent is not keeping pace with the demand – from clinical trainers, builders and consultants to project and program managers. Finding the necessary resources can be a daunting task for many organizations, but one that is essential to achieving a successful EHR implementation,” continues Kriete. “That includes finding the right principal trainers and scaling to meet the overall training and adoption needs.
Conducting an impactful training experience for the end users
According to more than three-quarters of healthcare professionals, results of poor EHR training implementation include: rework (85 percent), lack of applicability to real-world scenarios (84 percent), low levels of user adoption (84 percent), long learning curves (82%) and inability to leverage the system for meaningful use (77 percent).
“The importance of effective training cannot be overlooked. To avoid these outcomes, organizations must proactively build a customized training program that is led by educators with clinical and technical EHR experience. The training cannot simply be ‘off-the-shelf.’ It should align with the overall organizational goals, workflows, technical requirements and end-user job roles” states Kriete. “One method for ensuring a training program is effective and builds confidence within an organization is to engage end users, those using the system on a day-to-day basis, in the development of the curriculum.”
“In addition to leveraging end users in this process, efforts should be taken to combine synchronous and asynchronous learning methods to foster a learning environment that meets the needs of the adult learner and their hectic schedules and a learning environment that is not bound by space or time” says Von Baker, TEKsystems healthcare practice director.
Including end users in the process
Overall, less than half of clinical end-user stakeholders are deemed completely engaged in the program; even the trainers for the new system are not fully engaged, with only 59 percent reporting their trainers are completely engaged in the process.
“This study shows the majority of executives and decision makers are engaged in the implementation process, but unfortunately, this is not the case with end users. Giving end users the opportunity to provide feedback during the development of and during the training boosts their sense of ownership and increases their confidence in the system post-implementation,” comments Baker.
Continuing to support end users after go-live
More than 50 percent of healthcare organizations anticipate end users will need more than six months to adapt to the new system.
“The work does not stop once the implementation is complete. Providing post go-live support is critical to ensure the end users fully adopt the system. Best practice is to create performance support tools for end users to have ready access to how-to reference guides when the needs arise – self service. The right blend of performance support tools depends on the organizations culture, internal drivers (i.e. varied workflows, varied specialties, and geographically dispersed facilities), and available technology. Underestimating the amount and degree of post go-live support can cause a decrease in productivity and performance and increase end-user frustration,” concludes Baker.
About TEKsystems Healthcare Services
TEKsystems Healthcare Services is dedicated to providing workforce planning, human capital management and IT services to the healthcare industry. Utilizing its suite of services, including EHR Implementation Support, ICD-10 Support and Data Services for BI, Reporting and Data Warehousing, they help healthcare organizations accomplish critical initiatives related to meaningful use, compliance, analytics, network transformation and revenue cycle management.
Thanks to Ken Perez, senior vice president of marketing and director of healthcare policy at MedeAnalytics, for forwarding me the following very concise, yet detailed information about the sequester and its impact on healthcare from a white paper he drafted on the subject.
For those of you wanting to know more about how the sequestration came to be and the purpose for the reduction in spending over the next 10 years, Perez and MedeAnalytics do a great job describing the reasoning for it and its potential impact to the healthcare community in “The Sequester: Analysis of Its Impact on Healthcare.”
Thanks, Ken, for offering us a nonpartisan view of the sequester. We appreciate the objectivity to what’s become a very subjective debate. If after reviewing the following information and you have any questions or comments, leave them in the comment section. If they are for Perez, I’ll make sure he gets them and can respond.
Background of the Sequester
The Budget Control Act of 2011 (BCA) was the compromise legislative solution that enabled the United States to get through the debt crisis of the summer of 2011. The act was passed by the House of Representatives on Aug. 1, 2011, by a vote of 269-161, and by the Senate on the following day by a vote of 74-26. The BCA was signed into law by President Barack Obama on Aug. 2, 2011 as Public Law 112-25.
The intent of the BCA was to rein in long-term federal spending and raise the debt ceiling. To those ends, it put in motion $917 billion in cuts to discretionary spending (excluding Medicare) over 10 years and raised the debt ceiling by $900 billion.
In addition, the BCA created a 12-member Joint Committee of Congress (also known as the “Super Committee”) to produce proposed legislation that would reduce the deficit by at least $1.5 trillion over 10 years.
The act mandated a sequestration process (or sequester) that would be triggered if the Joint Committee was unable to agree upon a proposal with at least $1.2 trillion in spending cuts. Ultimately, to no one’s surprise, the Joint Committee failed to reach an agreement, and the sequestration process was triggered. Per the sequester: 1) The President could request a debt limit increase of up to $1.2 trillion; and 2) across-the-board cuts equal to the debt limit increase would apply to both mandatory and discretionary programs, with total reductions split equally between defense and non-defense functions.
The across-the-board spending cuts would be implemented from FY 2013 through FY 2021, a period of nine years, and apply to both mandatory and discretionary programs. The cut to Medicare would be capped at two percent and limited to cuts to provider payments.
Exempt from the cuts were Medicaid, welfare programs (e.g., food stamps), and other low-income subsidies, as well as Social Security, veterans’ benefits, civilian and military retirement, and net interest payments.
What would be the annual reduction by function of the sequester? Per Table 1, starting with the total reduction of $1.2 trillion to be applied over the nine-year period, a specified 18 percent for debt service savings is deducted, and then the result is divided by nine to arrive at the annual reduction of $109.3 billion for each year for FY 2013 through FY 2021. In every year, the annual reduction is split evenly between defense and non-defense functions, resulting in a $54.7 billion reduction for each function.
The Impact on Medicare of the Original Sequester
According to a September 2012 report from the Office of Management and Budget (OMB), the sequester would pare Medicare in FY 2013 by $11.8 billion, with the following distribution of the cuts:
Medicare Part A: $5.8 billion
Medicare Part B: $5.2 billion
Medicare Part D: $0.6 billion
Sundry (including affordable insurance exchange grants, program management, state grants and demonstrations, and fraud and abuse control): $0.2 billion
The American Taxpayer Relief Act of 2012
In early January 2013, Congress averted the so-called “fiscal cliff” by passing the American Taxpayer Relief Act of 2012, Public Law 112-240, which, among many things, pushed out the implementation of the sequester until March 1, 2013, reducing the total cut for FY 2013 by $24 billion or 22 percent to $85.3 billion.
The Enactment of the Revised Sequester and Its Impact on Healthcare
Through March 1, 2013, President Obama and congressional leaders were unable to reach an agreement to avert the automatic spending cuts of the revised sequester.
According to the Congressional Budget Office and per Table 2, for FY 2013, the total cut of $85.3 billion includes $42.7 billion in cuts to defense, $9.9 billion in cuts to Medicare, and $32.8 billion in cuts to other non-defense programs.
Medicare accounts for 12 percent of the total cut and 23 percent of the nondefense portion. How might the $9.9 billion in cuts to Medicare be allocated? In the absence of further guidance from the OMB, a reasonable approach would be to apply the same proportions as the aforementioned September 2012 OMB report. This would yield the allocation reflected in Table 3, with Medicare Parts A and B sustaining the lion’s share of the cuts.
Medicare Part A could be cut by $4.9 billion, which could include an estimated $3.1 billion cut to the Hospital Inpatient Prospective Payment System (IPPS). This cut to the IPPS would translate into an estimated $0.9 million reduction in Medicare reimbursement for the average hospital.
Medicare Part B could be cut by $4.4 billion, which could include an estimated $1.7 billion cut to physician payments and a $0.7 billion cut to the Hospital Outpatient Prospective Payment System (OPPS).
According to the rule for sequestration, reductions in Medicare will begin in the month after the sequestration order is issued, i.e., April 2013, thereby delaying some of the effect on outlays until the ensuing fiscal year. Thus, for the federal government’s FY 2013, which ends September 30, 2013, the following could be the actual cuts:
IPPS: $1.55 billion
Physician payments: $0.85 billion
OPPS: $0.35 billion
The sequester clearly affects healthcare providers in FY 2013 in a material way. Unless it is repealed by Congress, the BCA — with its annual $109.3 billion sequester cuts for each of the next eight years — will raise the specter of two-percent funding reductions for hospitals and physicians on a yearly basis.
Because of the significance of healthcare to the federal budget and the nation’s economy, the broader philosophical and fiscal debate between the two political parties on what is the best way to reduce the deficit and engender economic growth will continue to impact the reimbursement rate-setting process.
As a service to readers of Electronic Health Reporter I decided to ask its readers which sessions they most wanted to see at HIMSS13. For the record, I have attended HIMSS more than once so I understand how overwhelming it can be. However, I also understand that there are plenty of great resources available to those in attendance regarding which events to attend. Certainly, what I offer here is by no means authoritative nor is it objective.
Thus, I leave it up to you to decide what you are going to do while in New Orleans. All I can say is thanks for reading. I hope this helps.
One of the must-attend sessions at HIMSS13 will be the Interoperability Showcase, held at ongoing times between March 4 through6. During this showcase, attendees will have the opportunity to see how their personal health data moves securely from system to system. For Nextrials, it’s an opportunity to demonstrate how its clinical trial data and management platform, Prism, intersects with platforms used in hospitals and clinics. This integration can not only improve patient care — it can give patients better access to participation in clinical trials, and help clinics and hospitals contribute to the advancement of medicine.
Roundtable 305 – Proprietary vs. Third-party vs. Standards-based Device Integration: An Update, Tuesday, March 5 at 2:15 p.m., Room 293. Joe Kiani, the chairman of the Masimo Foundation for Ethics, Innovation, and Competition in Healthcare and CEO of Masimo, and I’m alarmed that more than 200,000 patients die each year of preventable deaths in U.S. hospitals. At the recent Patient Safety, Science & Technology Summit, Kiani and friend Bill Clinton issued a goal for zero preventable deaths by 2020. Eight other medical device companies – including GE Healthcare, Drager, Sonosite and Zoll – also pledge to make their data available through open architecture systems. Many other hospitals since have followed with similar commitments. The roundtable’s objectives: “Discuss the advancements and achievements in medical device integration over the last year.” While many are talking about device interoperability and patient safety, the Masimo Foundation for Ethics, Innovation, and Competition in Healthcare are actually doing something about it.
Cheryl Bailey, CNO/VP of Patient Care Services at Cullman Regional, will share her firsthand accounts of using mobile health to improve patient care and show conference-goers how the hospital reduced re-admissions by 15 percent and increased HCAHPS scores by more than 60 percent within six months using Good to Go, a recently launched mobile health platform by ExperiaHealth. Bailey will be presenting at the Nursing Informatics Symposium where she is presenting: “Improving Patient Satisfaction & Reducing Re-admissions with Better Discharge Communication.”
Accenture’s Manuel Lowenhaupt, managing director of U.S. clinical services, Monday, March 4 at 9:45a.m. “Trending Health: Using Information Technology to Deliver Clinical Outcomes.” By implementing a new clinical operating model and engaging clinicians in transformational change, Trinity Health standardized care and improved quality and safety outcomes by using information technology.
Executive Breakfast Panel: Go Big (Data) or Go Home, Tuesday, March 5 at 7 a.m., Hilton Riverside. Three CEOs discuss how the marriage of medical and pharmacy data paired with intelligent analytics will reveal remarkable insights available to all from the cloud. Speak is Atigeo CEO Michael Sandoval.
Emdeon Speaking Session: The Future of Coding is NOW: Maximizing Coding Efficiency and Accuracy Using Big Data and Analytics, Tuesday, March 5 at 11 a.m. Atigeo Director of product management, Manjula Iyer.
“Beyond the Device: A Comprehensive Mobility Strategy” on March 5, as a kick start to addressing mobility needs as they relate to business strategy, security, and infrastructure, beyond the device.
“Leveraging Smartphones to Simplify Communication Across Multiple Systems” will be helpful for organizations planning to implement or already using smartphones to communicate.
Policy and monitoring play critical roles in your information management; you need to develop a governance strategy to drive consistency and adherence to your adopted standards. Governance is essential to ensure that the right decisions and actions in the management of healthcare data are continuously taken. “Healthcare Information Governance: Establishing the Framework for Enterprise Management of Information” on March 6.
Former President Bill Clinton’s keynote on Wednesday, March 6.
“ICD-10 and Administrative Simplification” session (Education Sessions 131) will address the role of ICD-10 in administrative simplification, and the overall objective to lower costs, create uniform electronic standards, and streamline exchanges between health care providers and payers.
Other sessions of note:
#4: The Ins and Outs of Meaningful Use: Understanding Stage 1 Changes & Stage 2 Requirements, featuring Robert Anthony, Policy Analyst, CMS, March 4, 2013, 9:45 – 10:45 a.m., New Orleans Theater C
#23: Stage 1: EHR Incentive Programs, March 4, 2013, 11 a.m. – noon, New Orleans Theater C
#62: Stage 2: EHR Incentive Programs, March 5, 2013, 9:45 – 10:45 a.m., New Orleans Theater C
#81: CMS Town Hall: CMS eHealth: Building the Future, March 5, 2013, 1 – 2 p.m., New Orleans Theater C
#131: ICD-10 and Administrative Simplification, March 6, 2013, 8:30 – 9:30 a.m., Room 294
#138: Views from the Administrator, featuring Marilyn Tavenner, Acting Administrator, Chief Operating Officer, CMS, March 6, 2013, 9:45 – 10:45 a.m., New Orleans Theater C
#178: CMS Quality Measurement, March 7, 2013, 11:15 a.m. – 12:15 p.m., New Orleans Theater C
There continues to be a great deal of talk about the need to marketing a medical practice to patients as a way to engage patients and build a loyal patient following.
However, the strategies that practice leaders can take to engage those they serve seems somewhat elusive.
With Meaningful use reform continuing to bear down and patient engagement ever more important because if it, I decided to ask a few readers of Electronic Health Reporter what tactics they would take to encourage practices to market their practices and, ultimately, engage their patients.
Here are a couple of the responses I received:
Susan M. Tellem, RN, BSN
Physicians need to market their practices using free and easily accessible practices. For example:
Blogging – Content is king. “Tell patients about your new ‘whatever’ and add tags to the post that expands its potential reach. Ask for comments. Re-purpose the content on Facebook, Twitter, you practice website and you have reached your universe.”
Use Facebook – 51 percent of the world is on Facebook. “You can share photos, videos, patient before and afters, conduct surveys, ask questions, hold contests (through a third-party platform) and ‘promote’ the posts. That means for a very small amount of money, you can reach beyond the people who ‘like’ your page to their friends who are like minded and gain new followers and more patients.”
Use Twitter – It’s fast and easy, and you can say what you want in 140 characters and even post photos!
Create email newsletter – “You have an entire email database in your office that is going to waste. Send out a newsletter about what you have to offer. Use it to conduct surveys, promote discounts, special events and new procedures.”
Vicki Radner, MD
Likewise, Radner says. “Get social! Social media can and should be part of each physicians’ marketing plan. Create a blog post, Facebook entry and a tweet that describes your practice and its technology in a client-centered way. For example, ‘Want more control over your medical story? Sign up for the patient portal.’”
Clearly, social is king. I’m not surprised. Each of the responses I received were similar in nature. I would recommend the same approaches to anyone who asked because they are effective and because they are free.
In the current market, we go where those we want to serve are and we capture their attention by informing them, educating them and engaging them. Social media does just that and with a little premeditated thought, a marketing campaign can be quickly and easily implemented.
Like all things done for the first time, there may be some excitement and some fear. This is perfectly normal. Practice and repetition will help, ad in the beginning, while you are building your campaign you’ll be able to practice.
Something else to consider when creating a marketing campaign for a practice is to find people who are conducting successful campaigns and start to follow their example. There are real leaders already doing great things as far as educating and engaging patients. Do a little research and find people you can relate to then use their strategies to build your own program.
I’d love to hear more strategies for marketing a practice to patients. If you feel like sharing yours, feel free to leave a comment below.
In the past decade, academics and industry experts have published conflicting reports on whether electronic health records (EHRs) actually save money. Recent studies based on large, historical data from diverse providers suggest that EHRs haven[i]’t decreased costs[ii][iii] – contrast this with cost benefit analyses published back in 2003 that predicted EHRs would save around $15,000 to $20,000 per primary care physician per year[iv][v]. In addition, multiple vendors, academics and industry experts have published positive case studies on how EHR provides a positive return on investment or saves money in areas such as billing and staffing costs.
So why the divergence? Are providers simply not achieving what we expected in 2003? Are the positive case studies overly selective? Is it a case of what’s true for some is not true for all?
EHRs actually enable more productivity and satisfy more demand, and this is what drives cost. For providers, this also means driving up revenues.
Supply and Demand
One reason healthcare costs have not uniformly decreased is that more (efficient) supply from EHRs leads to more demand.
Firstly, consider the Jevons Paradox: energy efficiency leads to greater consumption (e.g. as air conditioning becomes more efficient and affordable, more air conditioners are purchased.) Taking a healthcare analogy, data center capacity has grown exponentially and EHR functionality has improved in recent years. In response, providers are storing larger amounts of detailed patient data and accessing greater capabilities. For example, providers are integrating IT and medical devices for real time patient data monitoring, storage and beyond. Additionally, a 2012 study supports this theory in that physicians ordered 40 percent to 70 percent more radiology exams with EHRs than with paper records. The efficiency and capability of EHRs (supply) have driven up the demand.
Secondly, I’ll paraphrase Parkinson’s Law: work expands to fill the time available. Demand for services in (public) healthcare will always outstrip the supply. This is because there is a backlog of patients waiting for currently available services and once this backlog is cleared, expectations of what should be provided will increase. It is therefore important to recognize that current health care reforms may not automatically decrease costs with EMRs in place, as demand will then increase too.
Increased demand means increased cost.
So if cost doesn’t uniformly decrease with EHRs, does anything improve? Productivity does. A 2009 Wisconsin Medical Journal Study[vi] found that physician productivity increased about 20 percent and remained at that sustained level of productivity following EHR implementation. This means that more patients were seen on a given day. Not bad, considering the average wait time to see a physician in the U.S. is 20 days.
Increased productivity, however, leads to increased costs.
Payers vs. Providers
Another way to explain the divergence may lie in who we’re actually talking about. Do we mean payers like Medicaid/Medicare or providers like primary care physicians or hospitals? Studies often reference cost but fail to discuss revenue increases that an EHR system delivers to providers. Seeing more patients means more revenue to providers. In addition, providers with integrated EHR and billing benefit by eliminating billing errors and enabling better revenue protection. Payers, however, don’t share these financial benefits as more procedures means their costs are rising. Indeed, payers may not realize the full cost savings of EHR until providers move away from pay-per-procedure to quality based payments. Quality based payments of course, are next to impossible without the enabling reporting capabilities of EHR systems.
So when we talk about the cost of EHR systems, it’s important to distinguish who we’re talking about. In addition, when comparing pre- and post-EHR situations, instead of simply asking: “What’s the cost?” we should also be asking “What do we get for this cost?”
David Farrell is an IT strategy specialist at PA Consulting Group, focusing on project management and strategy for healthcare providers. He has worked with accountable care organizations and county-run hospitals on both U.S. coasts, assisting clients in building business cases, managing project benefits and forecasting the long term infrastructure impact of EHR.
Guest post by Steven Jackson, chief operating officer, ExperiaHealth.
Every patient story is unique with engaging plots, complicated characters, emotional twists and turns, but more often than not there is a recurring theme. Somewhere in the healthcare narrative there are gaps in communication. In fact, according to the Joint Commission, an estimated 80 percent of medical errors are caused by breakdowns in communication.
Whether the disconnect is between internal and external care teams, a patient and a nurse, or in my case, a family member and a physician, any missed or misunderstood care directives can leave the patient and the health system vulnerable.
I was certainly feeling vulnerable when I arrived home after taking my son to the doctor and met my wife immediately at the door asking, “What did the doctor say?” As I recollected the physician visit and details of my dialogue with the doctor, I quickly realized I wouldn’t have all the answers she wanted to hear. I remembered most of the instructions, which I paraphrased quite succinctly. However, my wife, who is a very caring mother with a fondness for details, wanted to know exactly what the doctor said.
A similar story was told by a colleague. He described how his father was discharged from a local hospital after suffering a heart attack. At discharge, while tired and stressed from being in the hospital, his father and mother were given 30 minutes of clinical, complex information detailing his post-hospital care and medication needs. Later, when the couple tried recalling the discharge instructions to relay to my colleague, they each remembered the directives very differently – a misunderstanding that put his father at risk for an adverse event.
The CDC reports that nine out 10 adults who receive medical advice find it incomprehensible and do not know what to do to take care of themselves – creating a revolving door for institutions.
Stats and stories like these, as well as looming penalties for performance, are driving the development of innovative healthcare applications and patient portals that improve patient and family engagement, understanding and compliance of discharge instructions and other care directives. These same technologies are also improving patient safety and satisfaction, ultimately driving HCAHPS scores up and avoidable re-admissions down.
Cullman Regional Medical Center in Alabama recently reported a 63 percent increase in HCAPHS scores for questions related to discharge communication and a 15 percent reduction in re-admissions after re-engineering its discharge process using the Good to Go solution by ExperiaHealth. Good to Go blends multimedia technology with healthcare best practices to engage caregivers, patients and families in the care plan during and after a hospital stay.
During hospital discharge, Cullman Regional caregivers use smart devices and the HIPAA/HITECH compliant Good to Go application running on the deviceto capture “live” care instructions at the patient’s bedside. After the discharge session, the nurse asks the patient to listen to the captured communication, and a dialog between the caregiver and patient occurs to clarify any confusion. This conversation is also captured by the application, adapting discharge instructions in the patient’s own words and breaking down health literacy barriers. The recorded audio instructions are then made available 24/7 for the patient, family or a subsequent caregiver to listen to and review from any landline phone, mobile device or computer using unique login credentials.
In addition to audio instructions, caregivers use the solution to attach instructional videos, images and documents and post those educational resources on the patient’s personal Good to Go website to improve compliance and reduce risks. For example, if a patient has congestive heart failure, a caregiver can use the solutionto capture images of baseline swelling in the patient’s leg to help him or her monitor and manage their condition. Follow-up appointments and medication lists can also be managed in one location via the patient’s personalized Good to Go website.
With access to live care instructions and multimedia education, a couple can leave the hospital feeling secure about the discharge plan, and a father can be confident replying to an inquiry by his wife after their son’s physician visit. Hospital caregivers can also feel better because they can use the solution’s monitoring tool tracks if and when patients access their instructions, allowing Cullman Regional to gauge compliance and identify potential risks for bounce backs. This valuable information also plays a vital role in performance analytics and patient follow-up call management available via the Good to Go solution, which helps unify quality, safety and satisfaction initiatives.
By taking advantage of technology already in use and at the fingertips of caregivers, patients and families, hospitals like Cullman Regional are creating impressive last impressions and extending care beyond the hospital walls. And while technology cannot replace human interaction, it can certainly help enhance the exchange and create market differentiation as well as lasting loyalty – especially for those patients whose journeys were safer because there were no communication gaps along the way.
Healthcare stories with seamless transitions are the ones with the best endings.
Guest post by Jordan Battani, managing director of CSC’s Global Institute for Emerging Healthcare Practices.
There’s a sea change underway in healthcare in the United States, an effort that’s focused on addressing the challenge to improve healthcare quality and outcomes for patients and the population at large, while at the same time controlling and reducing healthcare cost inflation. It’s no small task, and there is no shortage of opinions about how best to make the changes that will be required.
At the core of the discussions, however, is a general understanding that a fundamental change in the traditional orientation to healthcare, and healthcare financing is required. Episode focused, fee-for-service medicine has led to a systematic bias against coordination and collaboration.
The need for change is particularly acute in a world that is increasingly defined not by acute episodes of illness and injury, but by the constant demands placed by the burden of managing the impact of chronic disease. Transformation requires an expansion from the traditional focus on patients and episodes to include populations and the entire care journey experience from wellness, through illness and back again.
In short, an expansion:
From the needs of the patient to include the needs of the population
From the support of the individual provider at the point of care to include all providers across the spectrum of care
From the activities in a particular care setting to include the activities in the entire continuum of care
From the discrete episode of illness and care to include the activities that promote wellness and prevent illness and recurrence
From the treatment of chronic disease to include its management
From islands of automation to integrated information access across the entire continuum of care
The core competency in this new orientation is the ability to practice coordinated care and to manage the financial arrangements that support it. Medicare, and many commercial health plans, refer to this competency as “accountable care.”
Practicing in this new environment requires the ability to expand care beyond the traditional boundaries of a linear provider to patient interaction during a discrete episode of acute illness or injury. In a healthcare landscape characterized by long-term chronic disease, healthcare must include the patient’s lifestyle, environment and long-term personal health risk factors in care planning, delivery and management.
Delivering that care plan cost effectively using complex clinical technologies and innovations requires coordinating and integrating the activities and information from multiple care settings and many different providers. Financing a coordinated care delivery system requires expanding payment for activities beyond fees for the services rendered for a discrete episode to include compensation for the effort and the value delivered from collaboration, coordination and integration across the continuum of settings and providers.
Not surprisingly, the tools and capabilities required for practicing in the era of coordinated care are more complex and far reaching than those required in the traditional episode-based fee-for-service model.
Successful coordinated care requires:
Clinical information and point-of-care automation to ensure that information about the patient’s entire experience of health and healthcare is available at every patient encounter – and that decision support is available to the provider who is engaged in care plan activities and adjusting the care plan based on outcomes.
Data management and integration to ensure that the healthcare data assets that are required for practicing coordinated care are rationalized, useful and consumable at all the points in the care continuum.
Health information exchange that delivers useful and consumable information across the continuum of care and enables the participation of care providers in multiple disparate care settings, systems and locations.
Patient engagement strategies and technologies bringing the patient into the care planning, delivery and management process, enabling them to act on their own behalf and to use their energies and insights to promote improved outcomes, adherence and quality care.
Care management and coordination process automation informed by information assets generated across the care continuum, supports the work of care providers in disparate locations, settings and organizations on behalf of the patient.
Performance management systems and strategies for clinical, financial and administrative processes that ensure that goals of quality, outcomes, patient safety and financial sustainability are achieved and exceeded.
In an environment characterized by multiple, conflicting and interlocking mandates and transformation requirements it’s a difficult task to take on a new set of organizational and technology strategies, and tempting to focus instead on meeting the deadlines and details of the individual programs and requirements.
There is no single road map to success and the timeline, priorities and projects for each organization will vary based on their circumstances. The only certainty is that under the current set of clinical quality, patient safety and financial pressures and requirements, organizations that fail to develop and demonstrate coordinated care capability risk long-term clinical and financial failure.
Jordan Battani is the managing director for CSC’s Global Institute for Emerging Healthcare Practices, the applied research arm of CSC’s Healthcare Group. Battani has a strong professional track record in leveraging technology solutions to deliver business value.