Modern EHRs are significant investments that constantly change and require ongoing maintenance and improvement to realize value and benefits for patient care, satisfaction and hospital operations. How can your optimization efforts be strategic ones? Let's examine key ingredients for successful EHR optimization so your healthcare organization can be prepared for the transition and understand the components of this ongoing lifecycle.
When to start optimization
Optimizations are typically most successful when they are started one to two months post go-live. Even if you are amid an EHR implementation, it’s not too early to start making plans for optimization. Organizations often simply can’t fit everything into an implementation, really making optimization efforts something to consider from the start.
"It really takes a village. Any EMR, whether it is [MEDITECH] Expanse or a different product, there is just so much work behind the scenes that goes into it. You just cannot do it in a vacuum. You need resources. You need people. You need help to get it done." – Anne Hargrave-Thomas, CEO and VP of Operations, Oakleaf Surgical Hospital/Surgery Partners
Regardless of the type of optimization you are planning for, it is important to give your users sufficient time to become familiar with the product as well as wind down from the grueling process of going LIVE with a new EHR environment.
Your new EHR offers capabilities that may spark ideas and clinicians may have a new lens to explore what’s possible and how that can improve workflows and patient care. This adjustment period is important in helping users realize what is needed instead of reacting to what was just different from their previous system.
The population of data into the live system is another big factor into that adjustment period. Simply put, some things you can’t optimize until the data and/or workflows exist. After the first month or so of use, users will also be able to identify which workflows actually need to be evaluated for improvement versus functionality that may benefit from more education. Homing in on workflows that need to be improved will go far in yielding value in your optimization efforts.
Where to begin with optimization
Conduct a formal assessment of your current EHR environment as a first step in launching an optimization project. Review the system and workflows and gather feedback from everyday users within a formal process.
Why is a holistic EHR assessment so important?
A holistic EHR assessment can identify areas of improvement that weren’t apparent during earlier phases in the lifecycle. It is important to understand that although the goal of both your organization and your EHR software provider is a solid implementation, the viewpoints and responsibilities are different. An experienced EHR partner can help you assess and bridge the gaps, whether that is a specific skillset, or translating software speak into clinical operations reality. The scope of an EHR assessment can vary depending on the perspective of the stakeholder involved.
Here are some starting points for the assessment process that informs your optimization priorities:
- Start by rounding and talking to users about features they may not understand fully. Quick wins are often gained by showing users how to do something on the spot.
- Interview users from various departments and roles and ask them about pain points – what's not working well?
- Review system configuration details.
- Observe users to identify opportunities for streamlining workflows.
- Document all pain points and optimization opportunities and set a time to prioritize them.
- Determine EHR functionality you have contracted for from your EHR vendor. When reviewing your list of functionality, it is crucial to determine what is being underutilized or possibly not utilized at all.
- Collect your findings into a concise document grouped by impact area such as patient safety, revenue, regulatory, user satisfaction, patient satisfaction, and so on. Organizing this information will also help you prioritize findings and determine next steps.
Determine priority and define a strategic roadmap
A thorough assessment of your EHR could produce optimization documents with a significant number of findings. Frankly, the results may be overwhelming to leaders and project team members. Don’t get discouraged—it’s natural for EHR implementations to need optimization.
Prioritizing the assessment findings will require strategic decisions, but in the end, your organization should walk away with a roadmap that will guide optimization projects and future investments.
For example, you may need to weigh the benefit of certain optimization items based on whether it could improve physician productivity or just make life easier for clinical staff. Or, it could make sense to prioritize an optimization that would generate revenue because a manual process wasn’t leading to consistent revenue capture. Patient safety or potential regulatory compliance items are usually high impact items to consider, too.
During the assessment prioritization review, the leadership team could decide to attack all high priority findings or those identified as “low-hanging fruit” as a way to make quick progress. It is often beneficial to break down the level of effort by service line or department to prevent putting too much strain on your healthcare system.
IT teams should be prepared to have conversations with your leadership team and key stakeholders about the additional investment (time and money) and skillsets that will be needed to move forward with optimization efforts.
Stephanie Murray, Senior Director of Epic Services at CereCore, explains,
“Epic offers a slew of tools and recommendations for optimization. But often, you need to request budget for those types of things or additional resources. And how do you do that?
One thing that's helpful, especially when communicating to business or operational leaders, is to remember the organization’s goals and how this technology leads to those goals or contributes to the completion of those goals. It may be very clear to IT that if we execute this initiative, we're going to get to the XYZ goal. But that might not be clear to operations. So, it's important to draw those lines of connection.”
The strategic roadmap that results from the EHR assessment and optimization prioritization session will identify value that can be realized by the organization but the true benefits are achieved through skillful execution.
“The CereCore team jumped right in by... adapting their delivery and standard practices to meet our teams' unique challenges. One of their consultants leading the General Ledger Optimization is a former Accountant and is helping us revamp our entire chart of accounts which will result in greater accounting standardization and financial reporting throughout North Country HealthCare."
-Darrell Bodnar, CIO North Country Healthcare
Kickoff optimization projects
Once you have tackled your optimization roadmap, it’s time to kick off the optimization phase of your EHR journey. At this point, change management principles are critical for implementation and ongoing success.
“Regardless of what system you're on, change management is a huge piece. You can optimize all day long, but if you don't tell users what you're doing or how they have to use the system in a new way, or even train them, if it's a significant change, they're still going to keep doing the same thing they've always been doing the same way they've always been doing it,” Stephanie Murray, Senior Director Epic Services at CereCore.
Here are a few things to help you make your optimizations a reality:
- Assign specific staff to the optimization project. The optimization phase should be treated like any project would be so you should assign a project manager to oversee the process.
- Develop a clear project timeline. The project manager should set important milestones and outline Go-Live dates for new functionality in departments.
- Communicate with staff about the optimization project and hold a kick-off.
- Establish communication and project meeting cadences that make sense for those involved. Maintain a project plan to keep everyone on track.
- Determine if any of the optimizations or new functionality being implemented will require end-user education and develop a training plan.
The EHR is the lifeblood of any healthcare organization and optimization that goes beyond maintenance tasks and addresses continuous improvement in processes can offer significant tangible and intangible benefits across the organization.
More resources on optimization
- Podcast: Why EHR Optimization Is Worth the Effort and Budget
- Podcast: EHR Optimization: How to Keep Improving After Go Live
- Revenue Cycle Optimization Assessment – Maximize Financial Performance Despite Increased Denials
About CereCore
CereCore® provides IT services that make it easier for hospitals and healthcare systems to focus on supporting hospital operations and transforming healthcare through technology. We partner with clients to extend their team through comprehensive IT staffing and application support, technical professional and managed services, IT advisory services, and EHR consulting, because we know firsthand the power that integrated technology has on patient care and communities.