Where’s the Beef (Benefits)?

Healthcare costs in the U.S. just topped $3T per year and the U.S. has the most expensive healthcare costs per citizen of any country by far. This leaves many in the industry asking: do we receive the value for the cost of our healthcare and are we getting our money’s worth? Unfortunately, our clinical/quality outcomes don’t justify the extra expense. There are many other factors driving up our healthcare costs such as social, legal, regulatory and reimbursement incentives.

As healthcare IT professionals, how can we help as we invest millions in healthcare information technology? Where’s the benefits? What have we achieved for the billions we’ve spent on new EMRs?

Meaningful Use (MU) stimulus incentives created a large wave of EMR implementations. Many health systems implemented EMRs in a hurry to hit the MU deadlines. Now they are asking, what did we achieve? Did we improve clinical quality? Can we quantify? Did we improve our financial situation?

Many organizations have achieved significant benefits from their EMRs. Look at the Davies Award winner applications² to see how they achieved significant quantitative, qualitative and subjective benefits. The following are some recommendations around achieving these benefits:

1). Engage your operational leadership. This is probably the most critical component of achieving benefits. Many operational/clinical leaders think EMRs are 90% technical and 10% operational whereas IT thinks EMRs are 90% operational/clinical and 10% technical. One of the best ways to get the operational/clinical leadership engaged is to focus on achieving expected benefits. Technology provides the capacity to achieve the benefits, but it takes the people using the improved processes to really drive the value.

2). Identify Key Performance Indicators (KPIs) early and measure before, during and after the implementation. It’s important to start to measure beforehand to establish a baseline and eliminate the Hawthorne Effect. Also, some KPIs have seasonal variations. I recall from one Davies Award winner where they thought they were down $2M/month in respiratory charges after go-live. Once they realized they were measuring flu season versus non-flu season, they actually were up $1M/month for similar patient volumes.

3). When choosing – consider KPIs you can more easily measure. Are you capturing these measurements today? Do you have existing reports? Does this KPI require extensive manual effort such as time and motion studies or manual reviews? Again, the easier to collect KPIs, the more likely you will measure and continue to monitor.

4). Don’t select too many KPIs as you can lose your focus on the critical ones (common ones include cash collections, length of stay, readmission rates, etc.).

5). Don’t argue over who gets credit for the benefits. For example, did your Lean Sigma program achieve those benefits or did the new EMR? The main goal is to achieve and sustain the benefits.

6). Avoid punishment if you don’t achieve the improvement as expected. Did something else in the business change or do we need to adjust our workflow? If so, understand why and make the necessary adjustments if possible.

How do we know the value we are providing our patients, if we didn’t monitor and measure KPIs before during and after the implementation? Isn’t the Hippocratic Oath “First Do No Harm?” Let’s make a positive impact ensuring our health organizations achieve higher quality care more cost effectively for the patients they serve!

1: See http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/ from December 2014.

2: See http://www.himss.org/News/NewsDetail.aspx?ItemNumber=6408 for the Davies Awards information.