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To have your cake and eat it:Planning for a future EHR and meeting todays needs
Jonah Aburrow-Jones, Senior Vice PresidentThe HCI Group
Starting in land far, far away
• Since 2009, the HITECH Act and Meaningful Use (Stage 1 and Stage 2) accelerated the implementation and adoption of EHRs in the USA.
• Phased journey to get healthcare more automated.
• Focus on using EHRs in a meaningful way, then with interoperability and data analytics truly use them to change the protocols of care.
• Rush to get automated has led to “What do I do with it now?”
– Significant costs in optimisation
– Longer time to realise benefits
– Now trying to move from Meaningful Use to Meaningful Care
– Delivering care isn’t just about an EHR
2
EHRs: Market Drivers
• Data, data everywhere – every increasing amounts, detail and need for analysis
• Increasing population, particularly elderly
• Increase in chronic disease (COPD, Type II Diabetes, Cancer)
• Increased pressure on costs (↑Drugs, ↓ Tariffs, ↓ Budgets, ↑ CIPs)
• Clinical Staffing (↓ people entering healthcare, ↑ people leaving, ↑ mobility across geographies)
• Public Healthcare systems becoming unsustainable without significant change
• ↑ expectations for access to healthcare provision, ↑ access to healthcare information and growth in personal health devices.
• Competitive differentiator between Trusts
EHRs: The Benefits
• Focus should be on the patient
• Most EHR business cases use non-patient care justifications
– Efficiency, productivity, communication, transparency and accountability
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The Future of EHRs in the NHS
• Integrated EHRs are here and more coming
• In England, it is estimated that >40 Acute Trusts will start to procure and implement new EHRs in next 24 months– The Paperless agenda
– Integrated Care
– Have to address a culture of workarounds and working in spite or despite IT systems
– Current systems are unsustainable
• Limited NHS generated evidence to support success of EHRs
• It takes at least two years to procure and implement an integrated EHR
• What happens to continuing to improve patient care during that period?
Technology Enabled Transformation
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Process
Technology
People
EN
AB
LE
Why a Transformation Project?
• By its nature, an EHR project isn’t an IT project. It is an organisational, change project on a large scale.
• Realising benefits has to start in pre-implementation of an EHR and doesn’t stop – in continues and system evolves.
• The ROI on a large integrated EHR can be >8 years.
• Benefits realisation, and therefore ROI, isn’t the job of IT departments – it is the clinical and business users
• Clinical ownership and accountability is critical
• Workflow redesign should be planned at the start point, not when the system goes live
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Advantage of EHR & Transformation
• Without alignment, one can become a limitation to the other
• Reduces start-stop
• Potential for sharing of budgets and resources
• Creates a mindset that change isn’t a bad thing
• Fosters “the art of the possible”
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Transformation Program
IT Project
Level of Benefit
Technology Enabled Transformation Program
Process Improvement & Technology
BENEFITS
+
++
£0
-
--
Project Starts
DANGER ZONE
Technology Only
Benefits
Baseline
Strategic goals, results- focused
process redesign, and effective
change management to drive value to
realisation and sustainability
Transformation
(Technology + Process
Improvement)
Process Improvement
Only
COSTS
The 3rd Element: People
• There will be very significant change management related to this transformation.
• Change impacts employees jobs and how they do their jobs
• Three people related factors that can define or constrain an EHR project:– Speed of adoption (how quickly employees make the change),
– Ultimate utilisation (how many of them in total make the change) and
– Proficiency (how effective they are when they have made the change).
• If managed ineffectively, employees are slower to make the change, fewer of them make the change and they are less effective once they have made the change.
• The vast majority of staff will be affected by integrated EHR.
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So what’s the problem?
• Trusts have to continue to improve care and cut costs in the 2 year gap between starting an EHR procurement and go live
• Every Trust has a list of tactical IT projects as well as keeping the lights on
• Every Trust has objectives setting out targets for care improvement (beyond statutory ones)
• Limited experience with large scale transformation and change projects
• Resources – financially and staff are limited
• Care for patients moves between providers
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Closing the Gap
• Develop clinical ownership and engagement at the earliest opportunity. Failure to do this will raise risk of failure.
• Evaluate and improve process but keep aligned with the long term goals.
• Baseline current state and identify the aspired future state
• Identify pain points
• Plan for short, medium and long term benefits realisation
• Invest in being ready
– Governance
– Research
– Engage with vendors early
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Closing the Gap
• Analyse best use of current systems in terms of interim and likely EHR functionality.
• Consider interim solutions.
• Be ruthless in killing projects which do not align with the longer term goals.
• Do not overstretch with too many tactical projects eating into resources needed for a strategic level one such as an EHR.
• Have structured and ongoing communication with all stakeholders – internal and external.
• Don’t believe that you can do it all yourselves.
Summary
• Having a EHR as part of a transformation project has significant benefits.
• EHR pre-implementation planning can identify and prioritisesolutions of pain points in the gap period.
• Utilise the mix of people, process and technology to help drive improvements.
• Don’t become distracted, stay aligned with goals and objectives.
• It is possible, with the right preparation and approach, to have your cake and eat it.
