1. EHR Goal Setting and Impact on Quality of Care
Chapter 5
EHR Goal Setting and Impact on Quality of Care

2. 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

3. 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!

4. Quantitative Vs. Qualitative Benefits

5. “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

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

7. 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

8. Goal Setting for EHR Benefits
Goals help achieve the intended result of a strategy
Goals must be
Specific
Measurable
Attainable
Realistic
Timely
Example
Within six months of acquiring an EHR, we will achieve 90% compliance with cervical cancer screening guidelines through a patient-specific reminder

9. What does Goal Setting do?

10. 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

11. 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

12. 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

13. 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

14. Economic Benefits Cost savings Cost avoidance Revenue increases
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

15. 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

16. Quantifying Clinical Benefits

17. 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

18. 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

19. 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

20. 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

21. 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