Special Contribution By John Haffty, Navin, Haffty & Associates
Are you in the process of implementing a new electronic health record system or making a significant upgrade of your existing system? If so, you are probably focusing on how to gain value from the expenditure and some return on the investment. You want to ensure the investment makes business sense for your organization and will have a long-term, positive impact.
When talking with hospitals about their upcoming MEDITECH implementations and upgrades, we’re now reframing our discussions to focus on how we will know we’ve been successful. Instead of concentrating on bringing up the system on time and on budget, we’re figuring out how we can drive value from the software.
The (HCIS) software enables change, but by itself and without changing processes and workflows, it does not deliver significant value.
The types of benefits that the high-performing organizations are achieving are really a combination of workflow and process improvements targeting qualitative as well as financial areas. To make these benefits sustainable really requires an organizational (not an IT) approach, and input from the decision-makers — the board of directors and/or the CEO.
Defining Your Top Goals – Qualitative as Well as Quantitative
When we are kicking off a project with an organization, a question we ask them as part of defining the project charter is: What are the three to five problems you would like to solve, or the three to five areas you would like to see improvement? Typically, those areas are financial-related, such as improving cash collections by 5% or reducing days in accounts receivable by five days. The hoped-for value is that the improved cash will enhance the financial performance of the hospital, reduce financial stress and all those other measurable financial benefits.
But, the benefits could also be qualitative ones. For example, there are all the Medicare and CMS quality measures based on readmission rates and the number of hospital-acquired infections — measures that affect whether a hospital receives extra funding or faces reduced funding. We will take a look at those measures and discuss how we can have a positive impact on them using the new software, which has capabilities not provided by the current software, whether it’s an existing MEDITECH system or another vendor system. With the new MEDITECH Expanse (formerly known as 6.1), there is the opportunity to focus on achieving measurable, definable goals.
We did an implementation project recently that involved a large hospital that’s a very high performer, yet their instances of sepsis were above the industry average. We knew this because we pulled industry data on definitive healthcare that CMS gathers from every U.S. hospital and identifies where each stands on both financial and qualitative measures. Using the quality surveillance feature offered in MEDITECH Expanse, and working with the hospital’s nursing and quality assurance staff, we were able to identify early warning signs of sepsis, then intervene when, for example, certain lab results suggest early onset of sepsis. As a result, the hospital dramatically reduced the number of sepsis cases, going from above industry average to below industry average. They met their quality goals and improved their financial performance as a result of the sepsis case reduction’s boost to Medicare funding and ultimately the bottom line.
That’s why we want our discussions with new hospital clients to focus on the qualitative as well as the quantitative goals. We can’t have 20 goals, however, because we simply can’t focus management attention on every area. It would just become diffused. They would get maybe 50-60% accomplished, so then nothing gets done. We’ve learned that it’s best to pick three to five goals to start, work on achieving them and then go after more goals once we have all the capabilities in place.For us, knowing what’s happening at a hospital and what’s important to the organization is key to ensuring we help them focus on the right opportunities.
Applying Software Capabilities and Best Practices to Workflows
MEDITECH Expanse is highly leverage-able for optimizing workflows. When we’re working with an organization, we bring diagrams we have developed of what the ideal workflow or process should be. Our discussions on being transformative are geared toward getting the organization to see why a certain workflow will work for them and how it is based on best practices and fully leveraging the capabilities of the software.
Our intention is to motivate the organization to take advantage of the best workflow design, but inevitably there will be someone or a group of people in the organization who will not consider or accept the workflow or process change. They will question the logic of the change because it’s uncomfortable and they believe their current processes are working for them. Resistance to change is the number one reason people won’t try to take full advantage of the software.That’s why we put a practice in place where resistance or disagreements are brought to the executive team to determine if there’s a legitimate business reason for not following the recommended best practice.
IT is really intended to be an enabler to the organization’s performance and not a goal in itself. The organizations that don’t try to achieve value from the new software are those that have turned it over to the IT staff, putting them in the awkward position of trying to drive workflow change among co-workers without top-down authority. Because resistance to change is common at all levels in an organization, it is necessary to socialize the process among the participants and work to get their collective buy-in. The people pushing back aren’t taking into account how processes flow outside of their departments. That’s why we lean on executive leadership, not individual departments, to look at the whole picture and make process decisions. Ideally, we want an executive team that’s chaired by the CEO, because then everybody realizes the software is important to the whole organization and potentially applies to every aspect of it.
To illustrate why process discussions need to be navigated by the executive team, we had a situation with a hospital where we were replacing a third-party lab product with MEDITECH’s lab product although the current software had some capabilities providing slightly more efficiency with one function. The lab director was resistant because the MEDITECH product was going to add 20 minutes each day to the workload of one of his technicians, however it was also going to save half an FTE in the pharmacy.
New processes may require behavior change, but they bring compliance to some quality measures that can lead to better decisions and better outcomes. When we look at driving value, it is roughly 80% process or workflow change and 20% software capabilities, and this is true whether we’re talking about MEDITECH Expanse or any of the other prominent vendors out there.
Taking a Holistic Approach
The implementation process is also very different now from what organizations may have experienced when they first installed their EHR system. Those who installed MEDITECH Magic 30 years ago didn’t install everything at once. Nursing software wasn’t installed the same time as admitting, billing and lab — each capability was installed incrementally. Now we take the “big bang” approach and install the whole system at once, as all the software is integrated. That’s the way to do it. Any approach short of a full implementation is only going to lead to sub-optimal outcomes.
I think the industry has accepted that we need to do that, and is starting to realize that we’re now no longer taking a departmental perspective with each implementation — we‘re looking at how the project will affect the whole organization. We’re also getting organizations to use the opportunity to take a step back and examine how their entire organization operates — even areas that wouldn’t be impacted by the new software — so they can see where there are overlooked areas needing improvement.
More importantly, by encouraging organizations to reflect on how the capabilities of the new software can drive processes as well as value that earlier software versions could not, we’re creating a new mindset that revolves around improving quality measures and workflows that will ultimately elevate the level of patient care.
About John Haffty:
John Haffty brings over thirty years of Healthcare Information Systems experience and is a recognized expert in the MEDITECH HCIS. Since its founding in 2001, Navin, Haffty & Associates has grown into the largest consulting company that is focused exclusively in the MEDITECH market. John has worked with some of MEDITECH’s largest and most complex organizations. Further, John meets regularly with the leadership of MEDITECH to maintain close contact on their developments and plans and to share real-world experience with them.