In the current world of population health management and value-based reimbursement models, many health systems are embarking on the conversion of their EHR as a major goal in reaching full integration and the ability to analyze clinical and financial performance. An EHR conversion has 2 simultaneous tracks each requiring significant resources:
- Legacy system support
- Converting and implementing the new EHR
In spite of the best project planning, the preparatory work needed for the overall success of each track is often overlooked, especially in high cost/high revenue departments such as Surgical Services. These highly visible and costly projects must be managed in a way that reflects the focused scrutiny that perioperative and other critical patient care areas should receive. In a recent survey reported in Healthcare IT News, “87% of financially struggling hospitals now regret changing their EHR systems.” While there were several reasons cited for this regret, the ease of achieving “buy-in” of physicians and other clinicians and the impact on clinician ability to deliver hands-on care with the same effectiveness is worth noting because of the potential impact on operational efficiency once the conversion is completed.
There are still good reasons for hospitals to proceed with an EHR conversion, or, given the expense, to optimize an existing system. However, keeping the potential regret in mind, it has been our experience, that recognizing the following failure and corresponding solution will serve you well as you undertake your conversion effort.
The “BIG MISTAKE”: Failure to Optimize the “Gap” Period Between the Decision to Convert and Software Vendor Kick-off
Project Managers often assume that the optimization work specific to perioperative services, as well as critical standards and integration decisions, can be done as part of the design and build portion of the conversion work plan often without appropriate multi-disciplinary collaboration (i.e. Anesthesia, IT, Finance, Materials Management, Pharmacy, Radiology, Physician offices, etc.). This can lead to a new EHR that is not optimized and incorporates incomplete or inaccurate data, directly impacting your ability to improve upon your prior system experience and to derive/extract the level of analytic data required. Even worse is the convergence of limited resources and aggressive vendor timelines that often result in the decision to simply move legacy data with the intention of “fixing” it later.
The SOLUTION: Pre-Project Optimization Work & Decisions
By knowing what to expect in advance and allowing the time for key decisions, your pre-project optimization work will allow you to walk into the EHR kick-off meeting prepared to support your existing legacy system while focusing on the new system’s design and build. The pre-project optimization phase is as critical to your success as the new system implementation phase and helps you stay on time and within budget.
A well facilitated pre-project optimization phase offers the opportunity to:
- Ask the right questions to avoid common failure points in system conversions; define leading practices and understand the differences between your legacy system and the new EHR; find out what you don’t know.
- Articulate the strategic, clinical, and financial goals of the EHR conversion.
- Ensure that interdependencies among other departments, important to the strategic success of the OR, are included in decisions that are made in the early part of the overall conversion project.
- Take a fresh look at industry standards for core data and practices needed to evaluate and achieve the right level of data granularity. As the significance of analytics continues to increase, standardized data is integral to making the best design decisions about how you will capture and analyze data as well as time to evaluate the impact on various types of staff.
- Update or rework core data tables consistent with the structure of your new vendor system (is moving legacy data really the best decision?).
- Understand the entire perioperative workflow from a patient-centric viewpoint and find opportunities to eliminate inefficiencies, redundancies, reduce cost, and improve patient care and the electronic documentation of that care.
- Prepare for the variety of staff resources needed for the design, training, testing and roll-out of the new system while maintaining the same level of quality patient care; plan for “peak” periods of build activity (i.e. conversion of surgeon preference cards). Set your project team up for success by not underestimating the commitments needed for a project of this size and significance.
- Prepare for the possible re-assignment of internal resources from maintaining your legacy system to new system activities (how and by whom will the legacy system be managed?); ensure a smooth cut-over from old to new systems.
Pre-Project Optimization and focused decisions on 6 core areas of master data will directly impact the perioperative continuum from accurate scheduling of cases to appropriate patient & room readiness to the effectiveness of supply chain to cost analysis to patient/clinician satisfaction. The level of advance effort and/or the decisions related to each core area may vary but they are equally important. They include:
- Master Surgical Procedure file: this core file must be clinically discrete and impacts every other area of the department (accurate case scheduling estimates, pre-certification, clinical supply, equipment & instrumentation requirements, case documentation, case charges, payment delay/denial and reporting).
- Supply Item Master file: this core file of supply item descriptions & associated critical reporting data must be up-to-date, with a standardized format that links the supply to your purchasing system (actual cost) and charge master (revenue). Every supply used in the perioperative department must be available for documentation in the patient’s record for real-time inventory control; maintenance is determined by system integration and/or interfaces.
- Surgeon Preference Cards: these files (typically in the thousands) must be thoroughly updated for the top performers to reduce inventory, increase surgeon & staff satisfaction and improve patient care during the procedure (have the right items available at the right time with minimal returns because content is specific to a clinically accurate procedure); support ability to move from clinical preference to clinical acceptability through “apples-to-apples” comparison & contribution margin analysis.
- Clinical Documentation: the need for “good data” is greatest in the capture of clinical patient care information as evidence of value based care. Review of current clinical documentation (surgeon, nursing, resident, and anesthesia) must occur in order to transition to effective design and consistent data collection. This must be achieved to ensure portability and accessibility of one of your organization’s most valuable assets.
- Perioperative Throughput Efficiency: review of all real-time throughput metrics & introduction of industry standard time capture definitions will ensure that your system captures the right level of detail needed to make the best decisions for process improvements.
- Critical Operational Reporting: “catalog” needed reports that must be converted on Day 1 of the new EHR to maintain operational management of the department; ensure future ability to produce actionable perioperative statistical, quality, financial and regulatory reports to include surgeon-procedure case costing, resource utilization, data integrity audits, and quality of care.
Changes in reimbursement and associated patient revenue combined with the significant cost outlay related to EHR conversion is dramatically impacting the financial bottom line of hospitals as recently noted in Becker’s Hospital Review. One hospital commented that they knew their “post implementation strategy will focus on clinical productivity and operational efficiencies to return to normalized operations by year end.” Shifting some of this effort upfront during a pre-optimization phase within perioperative services can help to mitigate the burden required to normalize operations after an implementation.
Keeping your staff successful in meeting all of the expectations of a new EHR should be everyone’s common goal! Understanding the perioperative portion of patient care and the link to other departments and/or applications is a key determinant in achieving the return on investment expected for the new EHR vendor system. Ongoing financial sustainability requires having the data you need to improve the quality of care, patient/clinician satisfaction, and meet the needs of regulatory, cost, and quality reporting.