Using Chapter 4 attached AB2
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AB102615_Ch04.pptxHealth IT and EHRs: Principles and Practice, Sixth Edition
Chapter 4: Health IT Goal Setting and Measuring the Impact on Healthcare Value
© 2017 American Health Information Management Association
© 2017 American Health Information Management Association
Value and Controversy
Many believe and an increasing number of studies demonstrate that widespread adoption of EHR and health IT:
Increases efficiency
Improves patient care
Yet there are also increasing concerns about:
Financial return on investment
Potential unintended consequences
Reduced time for patient-clinician interaction
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Critical Success Factor
Understand what benefits are feasible and establish specific goals and processes to achieve them
Organizations need to setting expectations, monitor results, and provide feedback to get the most from EHR and health IT
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Value and the Triple Aim Goals
Value is the fair return in goods, services, or money for something exchanged
In the US healthcare system, value has been defined as care that is safe, effective, patient-centered, timely, efficient, and equitable
Health reform has adopted the Triple Aim goals to:
Improve the experience of care
Improve the health of a population
Decrease per capita costs of healthcare
When science, informatics, incentives, and culture for continuous improvement and innovation exist in healthcare, the result is a learning health system
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Triple Aim and Learning Health System
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Setting Goals and Expectations for Achieving Value
Goal is a specific, intended result of a strategy
Goals must be Specific, Measurable, Achievable, Realistic, and Time-based (SMART)
Smart goals should Teach and organization to Reach higher levels of performance by Engaging everyone in Testing hypotheses through Cross-functional Cooperation in a Human fashion (STRETCH).
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Writing SMART Goals
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Setting Expectations for Goal Achievement
Copyright © 2016, Margret\A Consulting, LLC. Reprinted with permission.
© 2017 American Health Information Management Association
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.
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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.
Expectation setting must be accompanied by reassurance that there is support to achieve the goals.
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Goal Setting and Vendor Selection
Vendors should be selected based on their product’s ability to support goal achievement
Contract negotiation should reflect milestones related to the organization’s goals for the technology being acquired
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Goal Setting and System Configuration, Testing, and Training
Goals with clear metrics and explicit descriptions of how an organization’s objectives will be met with health IT focuses implementation:
Systems will be configured properly
Systems will not pass testing without evidence of being able to support goals
Training will related goals directly to what is being trained and the competencies achieved
© 2017 American Health Information Management Association
Copyright © 2016, Margret\A Consulting, LLC. Reprinted with permission.
Monitoring Goal Achievement
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Determining if Expected Benefits are Achieved
It is not easy to determine whether expected benefits have been achieved.
Benefits studies must be appropriately constructed to determine if goals are being met
Confounding variables confuse interpretation of data and make it difficult to determine results
There are several types of benefits descriptions
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Quantitative vs. Qualitative Benefits
Source: Forrestal 2016
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Quantifiable vs. Anecdotal Benefits
Meta-analysis that integrates findings from many similar organizations using similar systems may improve the value of anecdotal results.
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Benefits Measurement, Reporting, and Improvement
Measurement alone rarely results in continual improvement.
Metrics must be established to measure benefits
Findings of measurements must be reported to appropriate stakeholders so they have feedback on whether desired benefits are being realized or if improvements are needed.
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Measurement
Metric is a standardized description of what will be measured.
The term “measure” is often used when the appropriate term should be “metric”
Two types of measures:
Process
Outcomes
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Reporting Systems
Collect data consistent with the metrics/measures set forth
Offer comparisons and trending information between baseline data and current state
May provide recommendations for further improvement
Note: a culture of “shame and blame” has existed in healthcare, often leading to healthcare persons hiding rather than reporting errors. Reports must be accurate, trustworthy, timely, equitable, and transparent to be effective
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Improvement
Reports should help individuals recognize a specific opportunity for improvement
Clinical decision support provides data for a specific case at the point of care
Integrating clinical and financial data can help providers select appropriate drugs, make referrals, avoid duplicative and unnecessary diagnostic studies, and coordinate care
Reporting may encourage healthy competition that can lead to change
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Benefits of Health IT and EHR
Clinical
Financial
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Clinical Benefits
Clinical quality measures (CQM) have been established to measure outcomes for many common disease conditions
Electronic CQM (eCQM) are being developed from CQMs, that have largely been fairly comprehensive documents with little guidance on data to be collected or how reporting should be accomplished
Though CQMs are available for many of the most common healthcare conditions, an issue is that there are many near-duplicate measures
National Quality Forum is a consensus-driven organization committed to creating CQMs. Medicare uses NQF measures.
But many commercial health plans generate their own versions of measures – to the point that there are many versions of the same measures, resulting in extra work for providers and inability to make valid comparisons
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Example of NQF CQM Excerpt from Page 1 of 3 for Measure 0059
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Excerpt from Page 2 of 3
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Measuring Clinical Impact of EHR and Health IT
Access to clinical information
Patient follow-up/recalls
Reduced errors/patient safety
More tailored patient education
Enhanced documentation
Physician-patient communications/more time to spend with patients
Clinical decision making with guidelines and protocols
New models of care
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Quantifying Clinical Benefits: Example 1
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Quantifying Clinical Benefits: Example 2
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Support for New Models of Care
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New Payment Models
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New Organizational and Care Delivery Models
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Financial Benefits
Cost savings
Example: reduction in forms production in paperless environment
Cost avoidance
Example: avoiding staff recruitment costs because staff retained longer
Revenue increases
Example: Accurate E&M coding
Contribution to profit
Example: Reduce complications from adverse drug events that cut out profits in a discounted fee for service or managed care environment
Productivity improvements
Example: See two more patients in a day due to less time on documentation
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Financial Impact Analysis
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Total Cost of Ownership: Costs
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Total Cost of Ownership: Benefits
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Data Collection for Financial Analysis
Cost data
Hardware
Software
Implementation
Benefits Data
Cost savings
Cost avoidance
Revenue increases
Contribution to profit
Productivity improvements
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Cost-Benefit Analysis
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Cumulative Impact Showing Payback Period
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