Best Practices in EHR Implementations

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1 WHITE PAPERS FOR REAL PEOPLE Best Practices in EHR Implementations by TIM LIDDELL VICE PRESIDENT, PROVIDER DEPLOYMENT BETSY CROSS DIRECTOR, PROVIDER DEPLOYMENT

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3 CONTENTS The SaaS Delivery Model... 1 January 2012 is Around the Corner... 2 A New Approach to EHR... 3 Enterprise-Level EHR Implementations: Some of the Pitfalls... 4 Keys to Success... 5 Go Live is Only the Beginning... 6 Electronic health record (EHR) systems are receiving a lot of attention in the industry. In addition to creating electronic patient records, they fundamentally change the way a practice works by improving operational efficiency and streamlining workflow. A decision to implement an EHR is not just about technology, but about introducing important decision-making and change in a practice to gain maximum benefits. IDC Health Insights projects that the EHR software market will increase from nearly $1.9 billion in 2009 to $3.8 billion in According to IDC, outpatient EHR software spending totaled $663.5 million in 2009 but should rise to $1.41 billion by The inpatient EHR market is expected to grow from $1.3 billion in 2009 to $2.4 billion by A recent Medical Group Management Association (MGMA) study reveals medical practices with fully functioning EHR systems reported increases of almost $50,000 in total medical revenues after operating costs per full-time physician over practices that still use paper records. Hospital-owned, or delivery-system-owned, multi-specialty practices had a median of $42,042 operating margin than their paper-based counterparts. Practices that adopt web-based solutions may garner even greater rewards because there is no hardware investment. Looking strategically ahead five years, the trend toward the expanded use of clinical data, beyond the four walls of the individual EHR, will continue. Interoperability standards and regulations will continue to develop, providing a strong foundation for unaffiliated providers and allied health organizations to collaborate, working toward the goal of improved patient care. The EHR will become the clinical nerve center of the practice -- a platform for facilitating accurate exchange of patient information on a wide variety of fronts. The SaaS Delivery Model SaaS model solutions are those where software is provided as a service. Applications are served up remotely. Such a model allows several benefits to accrue for customers. SaaS model solutions reduce hardware costs by eliminating the need for clients to purchase expensive servers. SaaS solutions are more secure, easier to support and more convenient to upgrade. 1

4 One of the most important things to remember about any software solution is that the output should be intelligence, not just data. January 2012 is Around the Corner The ever-changing healthcare regulatory environment has a significant effect on practice automation solution strategies and adoption. With the January 2012 HIPAA Version 5010 mandate only a few months away, if a provider doesn t have an automated solution or its practice management solution is not 5010-compliant, that physician practice may consider several technological options purchasing a solution for the first time, upgrading a current solution, or ripping out an existing system and replacing it with a solution that offers more capabilities and a better ROI. In many cases, implementing a practice management and EHR solution together may be the best solution, given the cost of practice management upgrades and a desire to be eligible for meaningful use incentives. To get the maximum meaningful use incentive payment, Medicare-eligible providers must begin participation by Some typical questions surrounding technology solution strategies follow: Do I need a practice management system? How would an upgrade or a new system affect my practice s workflow? Is my practice management solution even 5010-compliant? Will my legacy EHR system meet Stage 1 meaningful use requirements so I can collect federal incentive funds? Do I need to buy a new system or system upgrade so I m compliant with future meaningful use Stages 2 and 3? How will I be ready for the ICD-10 codes (mandated for October 2013) change? Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There s an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HSPA). The Medicaid EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation and demonstrate meaningful use for up to five remaining participation years. Medicare EHR Incentive Program, Adopt 2011 Adopt 2012 Adopt 2013 Adopt 2014 Adopt $18,000 $0 $0 $0 $ $12,000 $18,000 $0 $0 $ $8,000 $12,000 $15,000 $0 $ $4,000 $8,000 $12,000 $15,000 $ $2,000 $4,000 $8,000 $12,000 $ $0 $2,000 $4,000 $8,000 $0 Total $44,000 $44,000 $39,000 $35,000 $0 Sources: Centers for Medicare & Medicaid Services and NaviNet, Inc. 2

5 One of the most important things to remember about any software solution is that the output should be intelligence, not just data. The best EHR systems take physician practices to the next level in terms of business intelligence, enabling them to deliver better patient care and capture greater revenue, in addition to enabling them to meet federal mandates. The clinical support staff learns to use a state-of-the-art EHR system in a step-by-step fashion, making the training process seem intuitive. EHR Implementation Approach A New Approach to EHR There is some noise in the marketplace about EHR systems decreasing productivity instead of making physician practices more efficient. Many EHR systems focus on the provider on a functional basis. Because this same provider is responsible for generating physician practice revenue, the high-revenue member of the team is on a steep technological learning curve that takes time away from clinical responsibilities. State-of-the-art EHR solutions turn that model upside down and focus on the clinical support staff, easing the steep learning curve for clinicians by minimizing provider impact wherever possible. They empower physicians by giving them the right information at the right time point of service. The tasks the staff accomplishes with these solutions enable the physician to deliver better patient care while streamlining the administrative process. In this way, the clinical support staff learns to use a state-of-the-art EHR system in a step-by-step fashion, making the training process seem intuitive. Modular frameworks are metrics-based and are structured to build clinical automation into the normal administrative workflow. The staff sees progress to meaningful use based on key performance indicators (KPIs). The focus is on the intelligence that can be accessed from the EHR system. NaviNet EMR Implementation Approach Provider Notes Kick-Off E-prescribing Nurse Intake Provider Order Entry, Tasks, Order Fulfillment Scanning Reporting 25 % 40 % 60 % 85 % 100 % MEANINGFUL USE 2 WEEKS 4 WEEKS 8 WEEKS 16 WEEKS 20 WEEKS 3

6 Enterprise-Level EHR Implementations: Some of the Pitfalls Everyone has heard horror stories of EHR implementations gone wrong. The pitfalls are many and surround the key strategic objectives of planning, implementation and sustainability. The pitfalls can be avoided by developing a strategic measureable plan -- and executing against that plan to drive solution results. Planning The words we are going to implement a new technology system can make people s eyeballs roll back into their heads, induce yawns and instill fear in even the most intrepid office administrator. A lot of people panic when they realize that they have to endure a new technology solution implementation. Intellectually, they understand the benefits, but the process to those benefits can be painful. While many physician practices may contract with an experienced consulting firm, if the practice is unable to articulate a strong vision and strategic plan throughout the management continuum, the advisor doesn t have enough input to choose the proper system for the particular practice. The purchaser internal or external simply lacks a comprehensive stakeholder endorsement and might not choose the appropriate system. There also often are hidden or unexpected costs. Hardware is a commodity, and costs may not be well outlined, particularly in the case of SaaS products. Implementation costs, training costs, and upgrade costs are extras that are frequently underestimated cost-wise or not even considered when a project is being scoped. Absent a strong, end-result-oriented vision, the EHR product selection process can become vendor-led. A vendor s feature preferences are emphasized to the detriment of enterprise needs. Intrepid physician leadership and administrative voice are essential during the planning and product selection. The entire staff must give comprehensive representation across specialties and technical skills so that the solution purchased meets the clinical and administrative requirements of the particular office. Healthcare professionals also must design an accountable leadership structure so that measureable end results are plotted along specified timelines to validate the benefit of the actual EHR system. Implementation Most physician practices don t have large IT staffs. In fact, many providers hire contractors to fix their technology. Extrapolate that to an EHR implementation, and imagine how understaffed and poorly aligned an internal implementation team might be. Practices need to budget for the implementation. Also, when addressing a pain point, healthcare professionals might not properly align with enterprise governance. While implementation variances occur frequently between employed and affiliated providers, they can be avoided by ensuring that the program is properly aligned with the overriding enterprise governance. 4

7 Establishing a feedback loop that encompasses all stakeholders is essential to tracking progress and negotiating roadblocks. All stakeholders need to participate in plan rollout development. Different stakeholders have different goals. Communication among all stakeholders is essential in ensuring that the enterprise goals translate into properly sequenced implementation actions. Establishing a feedback loop that encompasses all stakeholders is essential to tracking progress and negotiating roadblocks. A welldeveloped change management program wrapped around the implementation will ensure that behavior and attitudes adapt in accordance with the technically changing workflow. Flexibility is a key attribute that will make sure the implementation is a two steps forward process, not a two steps backward process. Sustainability Physician practices need to plan ahead and think long term about supporting their solution. Federal mandates will be ongoing. Adoption report cards and benchmarking are key elements in creating a long-term plan. The most successful organizations publicize their successes. This not only motivates the enterprise, but spreads awareness outside the four walls of the organization. Keys to Success Resources Structured to Build Momentum Taking an enterprise-wide approach to purchasing an EHR solution is a key to success. This approach seems overwhelming at first, but organizations geared up for successful implementations break down the process into teams. Steering Committee Carries representation from all stakeholders. Product Selection Team Comprehensive stakeholder representation, emphasizing key clinical users: physicians, senior clinical support staff. Implementation Team -- Organized to support the three critical elements People, Process, Technology. Must be credible to physician and senior clinical users. Vision/Strategic Plan Documenting a strategic integration plan is essential to creating an authoritative, end-results-oriented long-term EHR solution plan. The following points should be considered as tactics when plotting the strategy: The steering committee carrying representation from all stakeholders should draft the plan. All stakeholders and executive management should endorse the integration plan and ensure that it is fully funded. Concrete, metrics-based goals should be integrated into the plan on a long-term basis. 5

8 All aspects of the integration plan need to be well communicated to and supported by physicians, clinical support staff, and mid-level management. Product Selection Again, follow the strategic plan. The product selection has to align with the needs of the enterprise; the enterprise shouldn t try to fit its requirements into a set product box. The selection team should include practicing physicians with enterprise-wide credibility. They will serve as the anchors of the decision and also be the strongest objection handlers. Making an apples-to-apples comparison is much easier than an oranges-to-apples comparison. The selection team should ask the EHR solution vendors to present their solutions in an easily comparable format. Implementation The software and workflow build out must collaboratively combine usage standards with individual department needs. This critical collaboration is new, and the effort is often underestimated. Implementation activities should grow from a formal strategic project plan that has been accountably accepted by all stakeholders and includes formal timelines and progress feedback. All functionality/infrastructure should be tested and confirmed in workflow simulation prior to Go Live. Departmental pilots should be implemented to test and confirm functionality/infrastructure under true burden. Rollout success should be confirmed in each practice location against formal goals. Go Live is Only the Beginning Confirming and publishing progress to goals and communicating these results to all participants is critical to ongoing EHR execution. The most successful enterprises create adoption report cards that benchmark user adoption relative to peers across the enterprise. Facilitated user groups within which users can distribute tips/tricks and to resolve adoption roadblocks helps spur adoption and attitude change management. A facilitated enhancement request process to surface needed product and workflow changes empowers users and addresses pain points. A quarterly review of goal accomplishment and next steps in the EHR implementation journey helps benchmark progress and surface issues before they become pain points. 6

9 About NaviNet NaviNet, America s largest real-time healthcare communications network, securely links leading health plans, industry partners and the government to hundreds of thousands of physicians, clinicians and other healthcare professionals. More than 75 percent of the nation s physicians are enrolled in the NaviNet Network, which touches 121 million covered lives. NaviNet s solutions and services for unified patient information management (UPIM) address the full lifecycle of healthcare data management by providing single-source access to patient-centric administrative, financial and clinical information to reduce costs, increase efficiencies and improve quality of care. The NaviNet solution suite includes NaviNet Insurer Connect, NaviNet PM, NaviNet EMR, NaviNet Mobile Connect, NaviNet Doc Xchange, and NaviNet Medicare Connect. For more information, or to sign up for NaviNet, please visit or call or Please contact Tim Liddell or Betsy Cross with any questions regarding the content of this White Paper. Tim Liddell Vice President, Provider Deployment NaviNet Betsy Cross Director, Provider Deployment NaviNet 7

10 Copyright 2011 NaviNet, Inc. All rights reserved. NaviNet is a registered trademark of NaviNet, Inc.

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