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Everyone knows that routine maintenance is required to keep a home, car or even a person in good shape and performing well. The same is true in regards to our Electronic Health Records. To meet the requirements and capitalize on the benefits of meaningful use, the US market has seen an unprecedented amount of EHR implementations. However, many organizations aren’t seeing the expected benefits. Factors such as rushed, system-focused implementations, lack of standardization or focus on workflows, end-user and physician dissatisfaction, high ticket and request volumes and/or sub-optimal training are major drivers for optimization needs. Routine maintenance and pro-active EHR optimization are a constant and ongoing necessity and should be treated that way from a planning, budgeting and prioritization perspective. Here are some key areas to consider in a post-EHR go live world.
Most organizations use a ticketing system to log EHR issues. Following an EHR activation, ticket volumes often increase to the point where an organization cannot manage the volume and cannot differentiate priority issues from common, organizational issues. This is exacerbated by the constant “pull” of resources that are now needed for other organizational objectives and projects.
The truth is, your EHR “project” doesn’t go away when the system goes live. Rather, a program management organization, complete with an integrated Governance structure, must manage upgrades, maintenance and optimization. A great first step is understanding issues and prioritizing ongoing efforts for your teams and your organization. A thorough review, cleanup, validation and categorization of all issues should be conducted. This requires the establishment and ongoing execution of a ticket intake and review process that identifies the priority and necessity, understands the source of the problem (e.g., user proficiency, workflow inefficiency, build defects) and reconciles that against the objectives of the organization. It is critical to include operational and clinical leaders in this process and often requires time for interviewing and even shadowing clinical and operational users to fully understand and accurately document issues.
Most issues can be categorized into four areas:
• Break/fix are issues with the software functionality that need to be fixed by either the IT analysts or vendor.
2. System Enhancement
• Enhancement issues pertain to desired functionality that is either not yet developed by the vendor or not yet implemented by the IT department.
• Workflow issues arise when a process or procedure is inefficient.
• Training issues occur when the system is functioning as designed but the end user is unaware of how to use it properly. Training may also be needed to teach advanced functionality.
"A program management organization, complete with an integrated governance structure, must manage upgrades, maintenance and optimization"
After categorization, issues should be prioritized. The prioritization process should be carried out through the Program Management and Governance structure and is typically not simply an “IT” process. Understanding the issues and requests, prioritizing them against the organizational objectives and then including them in the ongoing capital and operating plans allows adequate focus, funding and validation for the work. This may be simple and quick—break/fix items, refresher training, etc. However, the focus may be more complex and cross multiple areas of the organization—new system functionality, upgrades, workflow redesign, etc. The latter often requires the organization to move back into “project mode” with a detailed timeline, project plan and in some cases, capital funding.
Now that a structure is in place, resources are adequately funded and work is prioritized, the organization can move forward knowing that the EHR can be properly maintained, but also leveraged for its true functionality. There will be many moving parts that may involve system configuration, system upgrades, workflow redesign and end user training. Having a dedicated optimization team and project manager that interacts and coordinates with the key operational and clinical leaders is key to ensuring success, but also aides in optimizing an EHR solution that supports the organization’s objectives as well as the patient experience.
Optimum Healthcare IT provides optimization services that are customized to meet our client’s needs whether a full assessment and plan are needed or just hands on resources. An example of our streamlined methodology is shown above.