Title of brochure. Moving toward High Performance through Electronic Medical Record Programs

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1 Title of brochure Moving toward High Performance through Electronic Medical Record Programs

2 2

3 Introduction Health care providers recognize the need to significantly improve health care outcomes while facing the challenges of rising costs, lack of interoperability and sporadic innovation. Hospitals, health systems, clinics and physician practices are implementing electronic medical record solutions in order to improve health care management for the individuals and communities they serve, and this has opened the door for health care organizations to achieve high performance. 3

4 Many health care provider organizations in the United States have embarked on electronic medical record (EMR) programs over the past decade and have realized very different results overall as well as a variety of results in their inpatient and ambulatory patient care settings. The casual observer might think that these dramatically differing results are easily explainable by: A lack of adequate funding or appropriately skilled resources. Too many competing internal initiatives. Too large an organization to accomplish all that an EMR program entails. A lack of organizational interest or active support for the EMR program. Resistance from clinicians who would rather not adopt new technologies. 4

5 Figure 1. Logical progression toward high performance Foundational capabilities HCO benefits Outcomes Data analysis, trending and reporting Non-physician order entry CPOE Non-physician clinical documentation Physician clinical documentation Clinical standardization Clinical and financial integration Ancillaries Medication management erx + Pervasive deployment and adoption by clinicians = Reduced care management errors Reduced adverse drug events and risk Reduced care duplication Patient and disease analysis Optimized clinical processes Improved resource utilization and training Improved coding and reimbursement Reduced costs Improved clinical outcomes Improved revenue capture Ensure adequate privacy and security protection for personal health information Improved quality, safety, efficiency and reduced health disparities Improved engagement with patients and families Improved care coordination Reduced costs Improved clinical outcomes Improved revenue capture Improved population and public health Continuous improvement Foundational capabilities, plus pervasive deployment and adoption by clinicians, enable a provider organization to realize enterprise benefits and outcomes. Accenture believes that several factors separate organizations that have achieved a more significant level of EMR maturity from the rest of the organizations. High performers: Focus on implementing a foundational set of capabilities. Deploy foundational capabilities as quickly as possible to all patient care settings in the enterprise. Support and enable a majority of their clinicians to adopt foundational capabilities, as they are made available. Exchange health information with community physicians and consumers. Achieve significant levels of overall automation within their enterprise. In addition to the desire to provide better outcomes to patients, there are bottom-line factors related to mature EMR performance. The American Recovery and Reinvestment Act (ARRA) legislation will provide substantial financial incentives for provider organizations that have attained a meaningful use level of EMR performance. The legislation also will bring stiff financial penalties for organizations that have not achieved this critical level of EMR performance (by 2017). To achieve the goals recently set by the United States federal government and to move closer to attaining high performance, Accenture believes that there is a logical progression of activities that need to occur at a majority of the provider organizations in the nation. (See Figure 1.) Taking measured steps toward maximizing EMR value Beginning with a set of foundational capabilities, implemented pervasively and adopted broadly by clinicians, enables the provider organization to realize a number of important benefits within the organization. It is through this pragmatic progression of activities that organizations are able to demonstrate a level of performance that contributes to improved population and public health management within their own communities of care. In contrast, organizations that implement foundational capabilities using a piecemeal approach, making multiple loops through the progression of activities, tend to experience elongated timelines, above average spending and overall suboptimized levels of EMR maturity and value. The more efficiently those provider organizations, individually, are able to progress through this sequence of required steps, the greater the speed to value for achieving national health care goals. 5

6 Figure 2. Dimensions of EMR maturity Overall automation Maturity dimensions Overall automation High performance Progressing Lagging Increasing levels of maturity Capability Pervasiveness Adoption Information exchange EMR maturity framework to measure high performance Accenture has developed an EMR maturity framework to assist organizations in achieving high performance. The multidimensional cube shown in Figure 2 represents the EMR maturity framework. Each side and the top of the cube represents one of the major dimensions of EMR maturity (capabilities, pervasiveness of deployment, adoption, information exchange and overall automation). Based on the framework, the five dimensions of EMR maturity are defined as: Capabilities The set of foundational EMR functions that, when implemented, provide the greatest value to the organization. Pervasiveness Indicates the percentage of patient care settings that have the foundational EMR capabilities available. Adoption Indicates the percentage of total employed and affiliated clinicians who are exclusively using the EMR capabilities for the management and delivery of care within the provider organization. Level of automation The measurement of an organization s progress toward an optimized set of clinical processes, clinical workflow enablement and a paperless health care environment. Information exchange Represents the level of extension of the EMR outside of the provider organization s enterprise to both community physicians and consumers of health care services. This extension begins to enable electronic health record (EHR) capabilities regionally and nationally. A greater level of EMR maturity is achieved when the five dimensions of maturity are part of an overall EMR strategy supported by the following EMR program critical success factors: A clear and compelling vision of EMR success. Executive sponsorship and commitment to EMR program results. Clinicians who are involved and have accepted ownership for achieving the vision. Measuring, tracking and reporting on progress on all key dimensions. A passionate focus on continuous improvement. 6

7 Figure 3. A model which identifies the levels of maturity supported by multiple dimensions influencing high performance Ensure adequate privacy and security protection for personal health information Improved quality, safety, efficiency and reduced health disparities Engagement with patients and their families Improved care coordination Improved population and public health Reduced costs* Improved clinical outcomes* Improved revenue capture* Continuous improvement Most EMR implementation is complete (IP and Ambulatory). May need additional sites or greater adoption. Less capability implementation, fewer sites and less adoption. High performance Progressing Lagging Enterprise implementation and standardization are mostly complete, paperless operations are in place, and information is exchanged with both community physicians and consumers. * Accenture additions to HITECH goals. Increasing levels of maturity Supporting continuous improvement in care management and delivery Accenture finds that organizations that have implemented, deployed and adopted most foundational EMR capabilities are further along on EMR maturity and are therefore better positioned for continuous improvement of health care management and delivery. Within the EMR maturity framework, we have identified the three levels of maturity supported by the five maturity dimensions. (See Figure 3.) Overall maturity is represented horizontally from the bottom to the top of the framework for the three maturity levels of lagging, progressing and high performance. Sub-dimensions are represented as vertical slices on each maturity dimension. Each individual cell of the framework includes a description of the attributes of an organization at that horizontal level of maturity for that specific vertical sub-dimension. (See Figure 4 on page 8.) For example: an organization at the high-performance level of EMR maturity within the dimension of capability and within the sub-dimension of order management is able to demonstrate all of the lower levels of sub-dimension capabilities as well as: Enterprise standardization of evidencebased Computerized Physician Order Entry (CPOE) Order Sets by specialty. Enterprise standardization of nonphysician order entry. 7

8 Figure 4. Sub-dimensions of EMR maturity CDR Order Mgt Capability Meds Mgt Clin Doc Pt Admin Report & Anal Inpatient Owned/ Affil Phys Pervasiveness Comm Phys Consumers Inpatient Adoption Owned/ Affil Phys Comm Phys Consumers Info Exchange Standards EMR Platform Cert Phys, Cons, Ext to Phys/Cons Overall Automation Clinical Process Optim EMR Sys Paper WorkflowReduction Optim Identifying high performers using the EMR maturity framework In a 2009 Accenture EMR study of provider organizations in the United States, the EMR maturity framework and the associated methodology were employed to identify their gaps and measure their composite EMR maturity. By examining a selected set of foundational capabilities, the level of pervasiveness of deployments, the depth and breadth of clinician adoption, the level of extension beyond the provider organization enterprise and the overall level of automation, each provider organization was placed on the EMR maturity framework and compared to other participants on a variety of characteristics, including maturity level and organization size. Generally, provider organizations had less overall EMR maturity when viewed from the perspective of the enterprise versus from the perspective of the inpatient environment separately from the ambulatory environment. This is important because the coordination of care can only be accomplished when inpatient and ambulatory settings have achieved an optimal level of EMR maturity. Additionally, organizations' size and scale, as depicted in Figure 5, had little to no impact on overall EMR maturity. Organizations at the lagging or progressing level of overall EMR maturity have taken a piecemeal approach to progressing through each of the required activities versus a holistic approach to achieving pervasively deployed and broadly adopted foundational capabilities as quickly as possible. The study revealed a number of observations that, when combined with the EMR maturity framework, can help to guide organizations and assist them in improving their EMR program outcomes. Several observations emerged from the study: Some provider organizations still have significant gaps in foundational capabilities. 8

9 Figure 5. Size and scale of health care organizations in relation to EMR maturity EMR Maturity High performance Progressing Lagging HCO size Smallest Middle Largest Note: Bubble sizes indicate size of health care organization. A total of 15 percent of the provider organizations participating in the 2009 EMR study have achieved a high performance level of EMR maturity. Even where foundational capabilities exist, the majority of organizations studied have not deployed the capabilities pervasively to all available patient care settings. Ambulatory setting EMR maturity generally lags that of inpatient setting EMR maturity. Non-physician clinician levels of adoption of available capabilities generally exceed physician levels of adoption. Few organizations studied are focusing, tracking and reporting on all key dimensions of EMR maturity. When they are taking these steps, they are achieving greater levels of maturity. More time spent on the EMR journey did not necessarily yield greater overall EMR maturity. Organizations that invested more in their EMR programs did not necessarily achieve greater value. Greater levels of EMR maturity are possible when an organization implements over a shorter period of time. The size or scale of the organization did not have an impact on results. The vendor platform chosen also did not have a noticeable effect on results. Achieving a high-performance level of EMR maturity is possible and positions providers to improve the health status of their communities. New strategies will be required for many provider organizations to achieve greater levels of EMR maturity and to improve care delivered to the populations they serve. 9

10 Conclusions The imperative for achieving improved clinical outcomes in health care and the ARRA legislation have created a burning platform for provider organizations to accelerate their progress in achieving EMR maturity over the next two to three years. Accenture has outlined the steps organizations may take to advance toward achieving high performance through their EMR programs. Implementing foundational EMR capabilities with a holistic approach Accenture research reveals that provider organizations that have viewed capabilities, pervasive deployments and adoption holistically, rather than as separate endeavors to be tackled one-by-one, are further along on the critical path toward high performance and contributing to national health care reform. Based on Accenture s 2009 EMR study, a number of provider organizations will need to retool their EMR programs to attain maturity levels required to achieve national goals and, ultimately, high performance. Acting on the data to improve outcomes Only those organizations that had attained a greater level of EMR maturity were able to demonstrate an ability to mine the data resident in their EMR solution and transform this data into real-time, actionable clinical information used to support the continuous improvement of care based on clinical knowledge of trends and outcomes. Becoming a high performer Accenture believes that high performers deploy foundational capabilities as quickly as possible to all patient care settings in the enterprise to improve outcomes. They distinguish themselves by supporting and ensuring clinicians adoption of new EMR capabilities, and they harness the benefits of automation across the enterprise. By striving for high performance, these organizations are positioned to seize ARRA incentives, but more importantly, they have strategies in place that will allow them to provide better, safer care at reduced costs to the populations they serve. Based on its experience and expertise in helping health care organizations, Accenture can help you achieve high performance through your EMR program. 10

11 Where is your organization on the EMR maturity framework? Do you know where your organization is on the path to high-value EMR performance? Do you know how your EMR performance compares to high performers in the nation? Do you have an objective baseline against which you will measure your progress going forward? Do you have a means of assessing your current and future investments in your EMR program and prioritizing those with the greatest value? Do you have a road map that charts your path toward high performance with milestones that allow you to measure, track and report on all key maturity dimensions of success? 11

12 About the Accenture Institute for Health & Public Service Value The Accenture Institute for Health & Public Service Value is dedicated to promoting high performance in the health care sector and in public service delivery, policy-making and governance. Through research and development initiatives, the Institute aims to help health care and public service organizations deliver better social, economic and health outcomes for the people they serve. Its home page is healthpublicservicevalue. About the Accenture Innovation Center for Health The Accenture Innovation Center for Health provides innovative resources and recommended actions for achieving high performance in the health care industry. The Center, part of the Accenture Institute for Health & Public Service Value, produces industry-leading white papers and hosts engaging client workshops and roundtable discussions. The Accenture Innovation Center for Health, combined with Accenture's deep health industry experience, offers exceptional reach, speed and flexibility to help clients achieve high performance. Its home page is innovationcenterforhealth. About Accenture Accenture is a global management consulting, technology services and outsourcing company. Combining unparalleled experience, comprehensive capabilities across all industries and business functions, and extensive research on the world's most successful companies, Accenture collaborates with clients to help them become high-performance businesses and governments. With approximately 177,000 people serving clients in more than 120 countries, the company generated net revenues of US $21.58 billion for the fiscal year ended August 31, Its home page is For more information on how Accenture can help you, please contact: Kathy Loeb Deniese Chaney Copyright 2009 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture.

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