1. How to Achieve Your Multi-Million Dollar Value from Your EHR Investment February 17, 2014

2. ingenuity | intensity | integrityPage 2 Discuss industry challenges in realizing value from IT investments Learning Objectives Participants will: Review a practical framework for evaluating your organization’s capability to realize value. Learn key tactics for getting your organization focused on benefits and ROI.

3. ingenuity | intensity | integrityPage 3 Results of CIO Prioritization Exercise (October 2012 CHIME Fall Forum) Actual funded priorities over the next 2 years What else in an ideal world would you focus on in the next 2 years? Votes:

4. ingenuity | intensity | integrityPage 4 Realize the Full Benefit of the EHR What are stakeholders saying? “Our system just doesn’t seem to work well, and I have heard from colleagues that there is a better EHR out there – let’s buy that new system!” “Documentation is full of too much extra stuff, and I can’t find the information I need to take care of my patients – how do we fix this?” “We spent lots of time and dollars to put in this system and have been working with it for 4 years but we still haven’t seen any improvements in our coding and revenue.” There are many symptoms of EHRs that are under-performing Dissatisfied clinicians, staff and patients/customers Low adoption rates Multiple workarounds Promised benefits (clinical and revenue) unrealized

5. ingenuity | intensity | integrityPage 5 Population Health Experience of Care Per Capita Cost Physician engagement/ satisfaction Accountable care Brand/reputation Data driven culture Meaningful Use ICD-10 Shift from volume-based care to value-based care Value Realization Key Drivers

6. Page 6ingenuity | intensity | integrity Value Realization (VR) Framework

7. ingenuity | intensity | integrityPage 7 Value Realization: What is it? Optimize the user experience (physicians, staff and patients/ consumers) 1. Optimize 2. Measure 3. Realize Measure associated benefit metrics Realize increased value from your EHR investment

8. ingenuity | intensity | integrityPage 8 Value Realization: Core Competencies In order to maximize the value of an Electronic Health Record (EHR), it is critical to develop a roadmap that addresses many core competencies, all in support of an optimized user experience and continuous value realization.

9. ingenuity | intensity | integrityPage 9 Value Realization: Competency Definitions 2. Governance: focus on value, accountability, alignment and mitigation of risks. 3. Change Leadership: Create a culture and a framework to make changes faster, smarter and more effective. 1. User Experience: Optimize the process and supporting systems to enhance the overall user experience (both clinicians and patients/consumers). 4. Performance Improvement: Measure the output of a particular process or procedure, then modify it to increase the output, increase efficiency and effectiveness. 5. Training and Education: Offer learning methods that match the time constraints and learning styles of end users to introduce new functionality and improved ways of interacting with the system. 6. IT Services: Align business and IT objectives to ensure delivery of value to the organization while mitigating risks and maximizing user satisfaction.

10. ingenuity | intensity | integrityPage 10 Value Realization Maturity Model Level 1: Structures and priorities remain implementation- focused; KPIs and supporting metrics are not defined or understood Level 2: A roadmap for value realization is developed; change control and prioritization become a priority Level 3: Multi-disciplinary governance structure; priority of changes aligned to goals and benefit realization Level 4: Value is measured and realized; continuous improvement FOUNDATIONALASPIRATIONALPROFICIENTTRANSFORMED Processes are established to manage and measure metrics and KPIs Analytics capabilities enhanced Pockets of proficiency Change control board and process established Training addresses needs Centrally chartered performance improvement projects Leaders held accountable for outcomes Satisfaction and adoption is increasing Benefit metrics owned, tracked and actively managed Quality and efficiency maximized Value is expected and outcomes are achieved User groups are leveraged PEOPLE, POLICIES, TECHNOLOGY ADOPTION Limited benefit metrics Large backlog of requests Productivity and process efficiency is low Low adoption and user satisfaction

11. ingenuity | intensity | integrityPage 11 EHR Value Realization Framework Level 1: Structures and priorities remain implementation- focused; KPIs and supporting metrics are not defined or understood Level 2: A roadmap for value realization is developed; change control and prioritization become a priority Level 3: Multi-disciplinary governance structure; priority of changes aligned to goals and benefit realization Level 4: Value is measured and realized; continuous Improvement FOUNDATIONALASPIRATIONALPROFICIENTTRANSFORMED 1.User Experience 2.Governance 3.Change Leadership 4.Performance Improvement 5.Training and Education 6.IT Services Competencies Maturity Levels BENEFITS FRAMEWORK People Process Technology

12. ingenuity | intensity | integrityPage 12 Steps in the EHR VR Methodology “Call to Action” 1.Shared framework and goals 2.Project Kickoff “Assess the Current State” 1.Evaluate experiences, perceptions and beliefs 2.Analyze current system configuration / opportunities 3.Document influencing factors “Define the Vision” 1.Facilitate group visioning 2.Develop guiding principles “Plan and Execute” 1.Implement quick wins (intense short-term effort; big benefit 2.Develop roadmap

13. Page 13ingenuity | intensity | integrity Benefits Framework

14. ingenuity | intensity | integrityPage 14 How Do You Know When You Have Achieved Value from Your EMR? Benefits must be measured and managed to achieve value. Quality Patient Experience Safety Cost VALUE

15. ingenuity | intensity | integrityPage 15 Benefits Framework Process to Identify, Track and Manage Benefits Develop short-list of strategic benefit objectives with named owners Secure executive agreement Describe and communicate each benefit objective including: – Benefit statement – what will be achieved? – Selected metric(s) – how it will be tracked? – Expected outcome – what is the target? – Timeframe to realize outcome – when will the target be achieved? – Required technology change – what design/configuration will support this? – Required process change – what process/staffing will support this? Establish governance group to oversee benefit metric progress and address any barriers Develop tool to track the status of the functional build and process changes required to achieve expected benefit outcome Develop tool to track the status of benefit metrics based on expected timeline to goal

16. ingenuity | intensity | integrityPage 16 Example Metrics Goal: Improve Coding Efficiency Category Benefit ObjectiveMeasurement Tools Ease of MeasureActionable Baseline Available June 2013 Quality Ensure that documentation justifies the intensity of services actually rendered to assign proper DRG. Provide clinical, quality, coding and regulatory requirements, with standards, to streamline documentation to support clinical facts of the case/appropriate intensity of care. Measure # of CDI queries before and after documentation changes. Focus on top 5 coding related denials and reduce those denials. Measure charges coded per hour before and after documentation changes. Yes Physician Satisfaction Revenue X Cost

17. ingenuity | intensity | integrityPage 17 The potential to realize significant benefits from your EHR is high when you manage your initiatives using a Benefits Framework. Industry Examples Allina Health Clinical resource use - $12.4 mm Adverse drug events - $4.8 mm Duplicate testing - $800,000 Drug utilization/cost - $600,000 Documentation workload - $1.7 mm Order proc. workload - $1.2 mm HIM workload - $2.5 mm Accounts rec. reduction - $2.4 mm Denial reduction - $15.5 mm Data quality improvement - $7.8 mm Net revenue increases - $5.1 mm Revenue cycle FTEs - $800,000 Texas Health Resources Evidence-based care - > $50 mm Medication safety - $8-15 mm Complications reduction - NQ Order turnaround time - 1-2 hrs Increase efficiency - NQ Patient throughput - ED LOS cut Reduce paper forms - $1 mm Reduce denials - NQ Optimize medication use Charge capture - $ 2-3 mm Sentara Healthcare Nursing OT, retention - $5.2 mm IT maintenance - $4.2 mm Medical rec./transcript. - $4.1 mm Increased O/P services - $3.2 mm Reduced length of stay - $3.1 mm Reduced ADEs - $2.9 mm Reduced paper/storage - $2.4 mm Other improvements - $4.9 mm Total: $60-69 million Across 13 hospitals Total: $55.6 million Across 11 hospitals Total: $30 million Across 11 hospitals Source: HIMSS Davies Award Applications

18. ingenuity | intensity | integrityPage 18 Key Takeaways Engagement is required from all parts of the organization; this is not an IT initiative Value realization is a multi-dimensional effort; need to consider organizational structures, behaviors and processes Benefits must be measured and managed to achieve value There are no quick fixes to achieve sustained value It is critical to understand where you are starting from across all competency areas before you can develop a plan to improve and achieve your vision Strive to develop a balanced plan that facilitates quick wins and aligns to the strategies of the organization Change leadership is required to establish a culture where value is expected and achieved

19. Page 19ingenuity | intensity | integrity Q&A