At this point, most U.S. health systems have adopted the use of electronic health records (EHRs). But there are still circumstances under which a health system might see a new implementation (or de-implementation). And even for the majority of health systems that utilize an EHR, they will inevitably eventually need an upgrade, and will always need to critically think about how they can be improving their workflows and the patient experience.
On today’s podcast, Nordic’s Head of Thought Leadership Dr. Jerome Pagani sits down with two of Nordic’s Practice Leaders, Abby Polich from Implementation and Wally Ward from Performance Improvement. They discuss a holistic approach to a successful business-driven implementation, as well as why user-centered design, long-term change management, and ongoing trainings are critical for continuously optimized business-driven implementations.
Listen here:
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Show Notes:
[00:00] Intros
[01:23] EHR implementations yesterday and today
[03:13] Considerations when upgrading or replacing EHRs
[04:33] How EHR implementations can lead to clinical, operational, and financial improvements
[07:43] Factors to consider when undergoing a business-driven implementation
[08:48] Marks of a successful business-driven implementation
[10:23] The business-driven factors behind today's implementations
[12:17] Consolidation in the healthcare industry to stay competitive
Transcript:
Dr. Jerome Pagani: Abby, Wally, thanks so much for joining us today.
Abby Polich: Thanks for having us.
Wally Ward: Yeah. Thanks for being here. Good to see you again.
Dr. Jerome Pagani: Abby, at this point, healthcare is 20 to 30 years deep into EHR implementations. The whys and hows have changed considerably since those early days. But let's step back for a moment and talk about those early days of implementation. What drove them and what's different today?
Abby Polich: Absolutely. Quite a while ago it was to satisfy meaningful use. The early days were getting off of paper systems and going to electronic medical records, and that was a significant change for healthcare in general because not only were we changing the way that patient care was provided, but also there was a fairly large lack of computer skills too. So being able to change the way that they provided patient care, not only with the system, but also just how they did their jobs. I think EHRs made healthcare safer. No illegible notes due to poor handwriting. Standards across healthcare. But that was the start, if you will. Fast forward to today. Now we're looking at lots of different technology options, lots of third party add ons such as registration systems on your phone and then consent mergers and acquisitions as well. A lot of what we do is not just only bringing organizations onto new systems, but bringing them together and uniting them as one system.
Dr. Jerome Pagani: So was there just a lot of digitizing records and it basically didn't have much impact on clinical workflows?
Abby Polich: Well, I think that it certainly had an impact on clinical workflows because not only were we digitizing patient records, it was completely changing the workflows that the healthcare providers used from start to finish at the front desk all the way through physicians providing care and then post patient visit with how we build them as well.
Dr. Jerome Pagani: So today's market has shifted. How should healthcare systems approach the decision whether to implement a new EHR or do an upgrade?
Abby Polich: Yeah, so as today’s market has shifted, it's not really just about the technology anymore, though technology is certainly a factor. We're always continually adding on applications, adding on third parties to make the patient experience better and everything is never it's never really done, if you will. But really what we're trying to determine is the right things to do in general. So strengthening relationships across the continuum. So we want to make sure that we're sharing patient records with other health systems so that we can provide better patient care. We want to focus on interoperability so we can have more access to better data. And then we're always focusing on the patient experience. Healthcare is becoming more consumer driven, and so we want to make sure we can meet the patient where they are. And so that could be anywhere from being able to register on your phone all the way to paying your bill on your phone.
Wally Ward: So as we look at these new technologies that providers are implementing, we need to really be able to assess, does it improve clinical satisfaction, does it improve the patient experience, and can it help drive increased operational efficiencies across the healthcare continuum?
Dr. Jerome Pagani: That's a great point Wally. You mention how technology really should be able to enable efficiencies and we're in the midst of the Big Squeeze that a number of factors that are putting enormous pressure on health systems. As they consider multimillion dollar implementations or upgrades, health systems want to maximize the value they get from that investment. Can you talk a little bit more about how these implementations enable clinical and operational and even financial improvements?
Wally Ward: Yeah, absolutely. We've seen through the years as EHRs have been implemented, there's been a lot of scar tissue created, so to speak, from the implementations. We saw a lot of clients who spent so much time and effort implementing their EHR that they really didn't focus on operational efficiencies as they were implementing the EHR. We think it's important that while you're implementing your EHR or your new technology, you're also reassessing your workflows. You're looking at how you optimize the system. How do you get the value out of the new system, as opposed to continuing to do what you've been doing all along, but now you just have a new technology? We really think it's important that you have a combined process that's looking at how you optimize workflows and clinical care, how you optimize your revenue cycle processes, how you're being more efficient in scheduling, dealing with your patients, how you're improving the satisfaction for the physicians, etc., while you're implementing the EHR.
Dr. Jerome Pagani: Abby, are implementations done exactly the same way today as when we first started?
Abby Polich: Absolutely not. We have changed the way that we implement in the sense of, back in the day, if you will, it was focused on making the system work. You, you pushed the right buttons. You, you knew the workflows, if you will. But it was it was about here is step one, here is step two. Now, we're really focused on user centered design. Ultimately, I feel that's where some of the scar tissue that Wally was speaking about comes from, when you're not focused on the clinician, you're not focused on the end user, and you're ultimately then not focused on the patient, you're just focusing on making the system work. Instead, we now focus, of course, on the workflow, but making sure that it is focused on being the most efficient that you can not only from an IT perspective, but from operational perspective. We're focusing on long term change management and making sure that folks understand what's going to happen to them through the implementation and then continuous education and training. And to those two pieces, the change management and education are usually the two things that tend to get cut from budgets. And so we really hone in on the fact that those really help to support IT and operational alignment and can help us with staff satisfaction, retainment, and we can really help to focus on making sure that we're looking at the implementation not as an IT project, but as a health system project that, again, focuses on the IT needs, the clinician needs, and operations as well.
Dr. Jerome Pagani: This sounds like we're talking about health businesses undergoing a really business-driven implementation decision.
Abby Polich: It has to be to make the implementation successful. Again, it can't just be step one, step two, step three. It needs to be how do we help the health system do best by our patients, do best by their staff, but also truly run as an efficient business?
Dr. Jerome Pagani: And Wally, from your perspective, what should health systems be focused on when they're undergoing that change?
Wally Ward: In our view, a benefits driven implementation really starts to look at early on, what are the benefits that we hope to realize out of the implementation? Is it an opportunity to minimize our impact on accounts receivable? Do we look at eliminating redundant systems, sunsetting those systems? How do we increase cash flow? How do we improve patient satisfaction? And last but not least is, how do we improve physician satisfaction as, they have to use these tools to document and treat the patients that they see on a regular basis?
Dr. Jerome Pagani: And so we've talked a little bit the kinds of factors that can stand in the way of a successful implementation, a little bit about the success factors that you look for. Can you give us a few examples of, of how that's come together and where you've seen it work really well?
Abby Polich: I think with starting with alignment sessions, as Wally had noted, are very important, but also focusing on alignment within senior leadership to make sure that their guiding principles are the same, that their end goals are the same. Because if we don't know where we're driving with the changes that come with the implementation and the focus is on the business, then we don't know if we're successful. So we need to be able to start from the beginning and monitor right from the start from where we want to end. Begin with the end in mind, if you will.
Wally Ward: And as we look at the evolution of implementations over the last 20 to 30 years, as we talked about earlier, we've moved from implementations really being a technology project to being an overall business project. The technology is the enabler to improve the delivery of care to our patients, patient satisfaction, operational efficiency, clinical efficiency. What we're seeing is much more focus now on the overall impact to the organization as opposed to just getting this new technology installed, which was where it started with, as Abby said, meaningful use. The government prompted and really promoted a movement toward digitizing patient records. But what we wound up with in a lot of cases was digitized records, but we're still doing the same thing. We just now had a digital form instead of a paper form.
Dr. Jerome Pagani: So, what’s driving the business decisions behind implementations today?
Wally Ward: You know, in today's market with the pressures that hospital systems are under and the activity we're seeing in acquisitions of smaller organizations by larger organizations, the ability to have everybody on the same EHR drives a lot more efficiency than if we have some part of the organization is on one EHR, and others on the other EHR, getting everybody on the same EHR drives efficiency.
Abby Polich: Some of the additional implementation projects that we're seeing right now are not simply within a health system, but also extending EHRs to other health systems that may not necessarily be able to afford them on their own, smaller health systems, if you will, in a partnership or affiliated type agreement. And I think a lot of the principles that we have talked about today still stand. You need to still be aligned from a leadership perspective. Change management is so very critical to ensure that the organizations understand what they are receiving with this relationship, what's coming through from a technology perspective, as well as the business and operational support they will or will not receive. Just making sure everybody is ready for that change and continually educated with what is coming down the pike.
Dr. Jerome Pagani: And this sounds like it's also important for that aspect of decentralized care that we've talked about, where care is now being given in more and different locations from where it previously had been, having that sort of shared record or single source of truth about the patient.
Abby Polich: Absolutely. When you think about care being provided in a remote location, access to records is incredibly important to access to be able to understand who you can call, should you have an issue with the technology or with any type of additional process, is also critical too.
Dr. Jerome Pagani: Health systems are at risk at disintermediation like no other time before. And instead of competing with just other middle market health businesses, we're really looking at competitors who are from big tech and retail. And so being able to operate at scale, we see some consolidation in that sphere that can help health systems compete.
Abby Polich: Health systems now are coming together to pool resources that now in the market we see more mergers and acquisitions and then they in turn bring disparate systems that they need to focus on an implementation project that is a business project, if you will, to make sure that they can use the data appropriately.
Wally Ward: Yeah. And disparate systems make it more challenging and difficult to aggregate data across the patient population, to look for efficiency, to look for how we provide better services to our patients, how we start to stratify those patients into high risk patients, low risk patients, those patients with chronic diseases that need many more services than other patients do.
Abby Polich: And when you're focusing in on competitors such as the retail markets and whatnot, ensuring that we're really focusing on the data driven processes, the business processes, the tools to be efficient is imperative. And in the past we have always focused on patient care, that will never change. But you need to bring the business side into the healthcare side as well.
Dr. Jerome Pagani: Wally, Abby, thanks so much for coming today. This was really great.
Wally Ward: Thank you. This was a great podcast. We enjoyed it.
Abby Polich: Thank you for having us.