Week 2 Journal

Using the attached form, complete this weeks reflections related to your readings, assignments, and implications for current or future practice.

Health 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

© 2017 American Health Information Management Association
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

© 2017 American Health Information Management Association
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

© 2017 American Health Information Management Association
Triple Aim and Learning Health System

© 2017 American Health Information Management Association
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).

© 2017 American Health Information Management Association
Writing SMART Goals

© 2017 American Health Information Management Association
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.

© 2017 American Health Information Management Association
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.

© 2017 American Health Information Management Association
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

© 2017 American Health Information Management Association
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

© 2017 American Health Information Management Association
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

© 2017 American Health Information Management Association
Quantitative vs. Qualitative Benefits
Source: Forrestal 2016

© 2017 American Health Information Management Association
Quantifiable vs. Anecdotal Benefits
Meta-analysis that integrates findings from many similar organizations using similar systems may improve the value of anecdotal results.

© 2017 American Health Information Management Association
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.

© 2017 American Health Information Management Association
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

© 2017 American Health Information Management Association
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

© 2017 American Health Information Management Association
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

© 2017 American Health Information Management Association
Benefits of Health IT and EHR
Clinical
Financial

© 2017 American Health Information Management Association
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

© 2017 American Health Information Management Association
Example of NQF CQM Excerpt from Page 1 of 3 for Measure 0059

© 2017 American Health Information Management Association

Excerpt from Page 2 of 3

© 2017 American Health Information Management Association
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

© 2017 American Health Information Management Association
Quantifying Clinical Benefits: Example 1

© 2017 American Health Information Management Association
Quantifying Clinical Benefits: Example 2

© 2017 American Health Information Management Association
Support for New Models of Care

© 2017 American Health Information Management Association
New Payment Models

© 2017 American Health Information Management Association
New Organizational and Care Delivery Models

© 2017 American Health Information Management Association
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

© 2017 American Health Information Management Association
Financial Impact Analysis

© 2017 American Health Information Management Association
Total Cost of Ownership: Costs

© 2017 American Health Information Management Association
Total Cost of Ownership: Benefits

© 2017 American Health Information Management Association
Data Collection for Financial Analysis
Cost data
Hardware
Software
Implementation
Benefits Data
Cost savings
Cost avoidance
Revenue increases
Contribution to profit
Productivity improvements

© 2017 American Health Information Management Association
Cost-Benefit Analysis

© 2017 American Health Information Management Association
Cumulative Impact Showing Payback Period

© 2017 American Health Information Management Association

Reflective Journal

Name:

Date:

1. Summarize and reflect on this week’s, readings and learning activities.

2. How will these concepts impact your own professional practice now or in the future?

Reflective Journal Rubric

20 pts

Discussion Criteria

Exemplary

10 Points

Developing

7 Points

Needs Improvement

4 Points

Faculty Comments

Application of Course Knowledge 

Journal contributes reflections and unique perspectives or insights gleaned from weekly objectives or examples from the healthcare field.

Journal entry has limited application of course knowledge and demonstration of perspectives.

Journal does not reflect application of course knowledge and personal insights or examples from healthcare.

Grammar, Syntax, APA Format

APA format, grammar, spelling, and/or punctuation are accurate, or with zero to three errors.

Four to six errors in APA format, grammar, spelling, and syntax noted.

Journal entry contains greater than six errors in APA format, grammar, spelling, and/or punctuation or repeatedly makes the same errors after faculty feedback.