Strategies to Advance EHR Optimization
Actionable advice about how to develop a comprehensive approach to iteratively improve your Electronic Health Record System.
As a result of external considerations, healthcare organizations are under increased pressure because of demographic changes. Patients are requiring more access to care and are demanding more convenient care. But EHR solutions are expensive.
Let us show you how value-based care, coupled with EHR optimization, can lead to transformational change in healthcare delivery, moving healthcare from a transactional to preventative model.
Our Advice
Critical Insight
- Value-based care, coupled with EHR optimization, can lead to transformational change in healthcare delivery, moving healthcare from a transactional to preventative model.
- Using a structured approach to EHR optimization initiative will drive alignment, identify IT automation priorities, and dig deep into continuous process-improvement.
Impact and Result
- Discover and address process gaps in your current EHR solution.
- Ensure alignment with EHR process and business capabilities within your organization.
- Identify and action specific optimization tactics and approaches.
Strategies to Advance EHR Optimization Research & Tools
1. Strategies to Advance EHR Optimization – A guide to help optimize your current electronic health record (EHR) system to improve patient care.
Health IT is responsible for enabling skilled healthcare professionals working in a high-stress environment. It requires excellent IT management practices and continuous optimization efforts.
Taking a comprehensive view of EHR technologies in the environments in which they operate allows for the inclusion of people and process improvements; this is key to pursuing value-based care and supporting positive patient outcomes.
Using a structured approach to EHR optimization initiative will drive alignment, identify IT automation priorities, and dig deep into continuous process-improvement.
Strategies to Advance Electronic Health Record (EHR) Optimization
Actionable advice on how to develop a comprehensive approach to iteratively improve your EHR system.
EHR Optimization Overview
This research is designed for:
- Hospital and healthcare CIOs and business leaders seeking to re-evaluate their current EHR solution.
- Hospital and healthcare CIOs and business leaders looking for advice about developing an EHR optimization roadmap.
- Health departments and Health Information Exchanges (HIE) routing data between clinical providers and payers.
This research will help you:
- Understand the evolution of the EHR market to uncover strategic areas to improve your EHR.
- Identify and align stakeholders with a common vision for optimization.
- Develop a plan for feature releases and tactics that can help you optimize your existing EHR.
- Ask the right questions prior to and during an optimization phase.
This research will also assist you with:
- Discovering and addressing process gaps in your current EHR solution.
- Ensuring alignment with EHR process and business capabilities within your organization.
- Identifying and actioning specific optimization tactics and approaches (through other Info-Tech Research provided).
Benefits of EHR Optimization
Outcomes of a successful system EHR improvement strategy.
- Decreased length of patient stay in an acute care setting by improving charting tools, bed management, access to imaging files, diagnostic tests, and discharge planning.
- Improved patient safety by mitigating adverse drug events and readmissions through providing accurate, real-time information about patients at the point of care.
- Streamlined patient access through standardized quality assurance processes that reduce claim denials and improve revenue cycle management.
- Secure sharing of patient information within and outside of current point-of-care settings that will enable convenient and reliable care.
- Evolved clinical decision support tools to drive rules focused on automation and best practices in clinical documentation.
- Reduced variability of care by developing workflows that improve EHR operational governance and clinical pathways.
- Development of real-time performance tracking by using established business analytic tools and integrated dashboards.
Digital health record implementation costs vary from $5 million to over $20 million. It is important to identify and mitigate hidden costs during a deployment cycle including decreased revenue, loss of productivity, and decreased patient visits.
–Jeff Green, EHR in Practice, 2022.
What is the difference between an electronic health record and an electronic medical record?
| An electronic health record is a longitudinal record of patient treatment history, compiled from multiple clinical sources. It can be shared, with patient consent. | An electronic medical record is a single record of patient treatment history stored within a health care provider, compiled from one clinical source. |
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Source: “What Information?” Health IT.
Simplified health IT clinical record landscape
Source: “A Simplified Diagram”, Research Gate.
EHR Adoption and Optimization Trends
Electronic health record adoption is widespread among hospitals and private practices.
The Office of the National Coordinator reported that 95% of US hospitals have implemented an electronic health record system.
Source: “Electronic Health Record Adoption”, Health IT.
HIMSS Analytics recently published a report which indicated that two-thirds of health IT leaders are currently using cloud-based technologies.
Source: EHR Intelligence, 2020
One of the biggest drivers for EHR adoption is to improve decision making and knowledge. As a result of external considerations, healthcare organizations are under increased pressure because of demographic changes. Patients are requiring more access to care and are demanding more convenient care.
Info-Tech Insight
Value-based care coupled with EHR optimization can lead to transformational change in healthcare delivery moving healthcare from a transactional to preventative model.
Global EHR market analysis
Over 500 vendors are competing in the healthcare marketplace with some type of EHR solution.
- Market size has been estimated at USD 27.2 billion in 2021 with a combined annual growth rate (CAGR) of 4.0% over the next eight years (Grandview Research, 2021).
- Acute care comprises over 40% of the EHR implementations, with Ambulatory and Post-Acute making up the remainder of implementations.
- My Health Record is an Australian EHR initiative that is designed to enable broad health record interoperability across the nation.
- In 2021, 50% of new EHR implementations were cloud-based and are popular with physicians and healthcare providers.
- Cerner is a market leader in the global EHR market with a presence in Africa, Europe, Latin-America, and the Middle-East.
- InterSystems, Epic, eClinicalWorks, Dedalus, MEDITECH, Allscripts, AfgaHealthCare, NextGen, Phillips, GE, and ChipSoft are also represented globally. (Klas Research, 2019)
Electronic health record (EHR) implementations by system type
(Source: Grandview Research, 2022).
Four vendors comprise 77% of the ambulatory EHR market
Serving acute care and specialty hospitals.
Purchasing activity and contract observations in 2020.
- Contracting varied through 2020, with 77 hospitals reporting an impact on their existing contract during Q1 of the year.
- Epic remains a leader in the U.S. EHR marketplace, capturing just over 1/3 of the acute care market.
- Vendors adding hospital beds: Allscripts +13 and Epic +19,247.
- Cerner secured 19 contracts with standalone hospitals, followed by Meditech and Epic.
Source: (Beckers Hospital Review, 2021).
Top EHR vendors by U.S. market share
Klas Research, 2021
EHR post-implementation pain points
Pervasive stakeholder frustrations after electronic health record system implementations
| Administration | Data | Clinical | Technology |
|---|---|---|---|
| Changing priorities | Data hygiene | Clinical adoption | Cumbersome user interfaces |
| Unclear objectives | Data access | Team training | Poor vendor support |
| Reoccurring vendor maintenance costs | Analytical reports | Change management | Intra-system interoperability |
| Billing errors | Lack of complete patient information | Medication errors | Rapid vendor updates causing break-fix scenarios |
EHR operationalization lifecycle:
System stabilization
- Providers can return to regular levels of productivity.
- High and medium-priority issues from go-live are resolved.
Provider proficiency
- All practice areas have adopted new workflows.
- Check-point to identify and move to the enhancement cycle.
System enhancements
- Low priority issues identified during launch must be addressed.
- Ongoing training is in place and provider relationship management is well established.
- Performance metrics are in place and stable.
Source: ECG Management Consultants
Eight practical tactics to enable a team-based EHR optimization strategy
| 1. | Align leadership goals with EHR optimization goals | Ensure that the entire optimization team is working toward the same goal. |
| 2. | Evaluate and analyze unnecessary clinical tasks preformed in EHR | Identify and address unnecessary work. For example, are clinicians getting too many alerts? Do you have single-sign-on enabled? Reduce clicks within the EHR, enable auto populate discreate data fields that already captured within the EHR. |
| 3. | Assess hardware and physical-environment for quick-win solutions | Evaluate existing workstations and exam rooms. A mitigation tactic is to ensure that label printers are available in every exam room. |
| 4. | Reduce provider burden of order entry and documentation | Clinical paperwork leads to burnout and professional dissatisfaction. Develop checklists for communicating physician-ordered tests that can be entered into the system by clerical teams. Develop team documentation and virtual dictation through natural language process. |
| 5. | Leverage software and clinical teams in developing optimization tactics | Send out an after-visit summary and encourage patients to sign up for patient portals. |
| 6. | Use clinician feedback to drive adoption | Enable hands-on and at-the-elbow support for users when a major change is released. Encourage peer-to-peer learning. |
| 7. | Improve information flow throughout the healthcare system | Re-evaluate and re-think information flows within the entire health system. Information overload contributes to burn-out and additional work. |
| 8. | Measure EHR-use data | Leverage EHR-use data and track metrics related to click counts, work-after-work. Mitigate, as much as possible, after-hours work for physicians. |
Source: American Medical Association
EHR optimization value-effort matrix
| Outcome | Potential value realized | Process area | Level of effort | Projected investment |
| Increase throughput and connect patients and caregivers to community resources |
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High effort | $$$$$ |
| Strengthen patient safety and support |
|
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Medium effort | $$$ |
| Streamline revenue cycle management |
|
|
Medium effort | $$$ |
| Improve clinical decision support |
|
|
Medium effort | $$$ |
| Develop population health and community surveillance |
|
|
High effort | $$$$ |
| Increased patient satisfaction |
|
|
Low effort | $$ |
Source: Healthcare IT Today, 2017
EHR Optimization Project Stakeholders
- Understand the roles necessary to improve your EHR.
- Recognize the role of each player can play and align the team to roles within your organizational structure.
| Title | Role within the project structure |
| Organizational Sponsor |
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| Project Manager |
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| Business Unit Leaders |
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| Project Team |
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| Steering Committee |
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Define the EHR Optimization Team
Consider the core team functions when putting together the project team. Form a cross-functional team (i.e. across IT, Informatics, Operations) to create a well-aligned EHR optimization strategy.
Don’t let your project team become too large when trying to include all relevant stakeholders. Carefully limiting the size of the project team will enable effective decision making while still including functional business units such as clinical leads, administrative leads, and IT.
| Required skills/knowledge | Suggested project team members | |
|---|---|---|
| IT | ||
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| Organization | ||
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| Other | ||
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Understand the EHR drivers and organizational objectives
| Clinical needs | Organizational drivers | Technology drivers | Environmental factors | |
|---|---|---|---|---|
| Definition | A clinical need is a requirement associated with a particular business process. | Organizational drivers can be thought of as organizational goals. These are tangible benefits the business can measure such as customer retention, operation excellence, and financial performance. | Technology drivers are technological changes that support the IT strategy. Many organizations turn to technology systems to help them obtain a competitive edge. For example, enabling patient portals, improved reporting and analytical capabilities. | These are external considerations and factors that take place outside of the organization. They have a direct affect on the way business is conducted inside the organization. These are often outside the control of the organization. |
| Examples |
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Align your EHR optimization strategy with the organizational strategy
| Organizational strategy | Unified strategy | EHR ptimization strategy |
|---|---|---|
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Your organizational strategy:
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EHR optimization can be and should be linked, with metrics, to the organizational strategy and ultimate business objectives. |
Your EHR strategy:
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EHR projects are more successful when the management team understands the strategic importance and the criticality of alignment. Time needs to be spent upfront aligning business strategies with EHR capabilities. Effective alignment between IT and the business should happen daily. Alignment doesn’t just need to occur just at the executive level, but at each level of the organization.
Assess and document the EHR landscape
Example analysis
| External environmental considerations | Organizational needs | Technology drivers | Pain points | Opportunities | Organizational goals |
|---|---|---|---|---|---|
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Level 1 capability map
In developing a reference architecture, you are aiming to create a primary view of an organization is known as a capability map.
A capability defines what an organization does to enable value creation, rather than how.
Value streams:
- Connect business goals to the organization’s value realization activities; they enable the organization in the marketplace by engaging with interconnected activities.
Organizational capabilities:
- Represent stable business functions.
- Are unique and independent of each other.
- Will typically have a defined business outcome.
Develop a capability map to document where your healthcare organization needs to prioritize specific areas for further assessment and potential optimization.
Note: Illustrative Example.
Example: strategic goals to capabilities map
Note: Illustrative Example.
Assess the effectiveness of your EHR
Pre-optimization questions
- Is the vendor responsive to your organization’s specific needs?
- Can an improved internal training approach resolve the issue?
- Do I have the right skills on my team to optimize the current EHR? If not, you may need to outsource.
- Is this the right time to adapt existing clinical/nonclinical workflows?
- How will the optimization strategy affect your current patient/provider relationships?
- Is there existing functionality that is not currently being used and why?
- Are there APIs that we could leverage that offer more flexibility?
- What key performance indicators (KPIs) are we capturing and are they still relevant?
- What process areas do you want to focus on and what differentiates your healthcare organization?
- Is there effective internal client relationship management? Are we connecting with providers to understand how they are using the system and is IT responsive to their recommendations?
- Does our organization foster a culture of training and continuous learning?
Our recommendation is to leverage APIs to solve integration issues
- The 21st Century Cures Act Final Rule, which went into effect on December 31, 2022, will improve patient access to personal health information. It established standards and technical requirements for third-party apps to connect to certified EHRs (Health IT, 2021).
- Application Program Interfaces (APIs) facilitate easier use for patients to connect their smartphones, tablets, and other apps to access their patient health information.
- In 2019, 7 in 10 non-federal acute care hospitals used APIs to help patients gain access to their information (EHR Intelligence, 2021).
- Increased access to their health information will result in more patient portal and health app usage.
Adapted from MuleSoft Accelerator for Healthcare, 2022
Download Build a Data Integration Strategy
Next Steps
Address processes gaps by reviewing your application portfolio:
- EHR and related technologies are invaluable to the goal of organizational enablement, but they must have supported processes driven by business goals.
- Identify areas where capabilities need to be improved and work toward optimization.
Support user satisfaction by managing technical debt:
- The best technology in the world won’t deliver business results if it’s not working for the users who need it.
- Understand concerns, communicate improvements, and support users in all roles.
Improve data quality:
- Data quality is unique to each business unit and requires tolerance, not perfection.
- Implement data quality initiatives that are aligned with overall business objectives and aimed at addressing data practices and the data itself.
Proactively manage vendors:
- Vendor management is a critical component of technology enablement and IT satisfaction.
- Assess your current satisfaction against that of your peers and work toward building a process that is best fit for your organization.
Info-Tech Insight
Enabling skilled healthcare professionals working in a high-stress environment requires excellent IT management practices and continuous optimization efforts.
Your technology portfolio and architecture are important, but health IT professionals must go deeper. Taking a comprehensive view of EHR technologies in the environments in which they operate allows for the inclusion of people and process improvements. This is key to pursuing value-based care and support positive patient outcomes.
Using a structured approach to EHR optimization initiative will drive alignment, identify IT automation priorities, and dig deep into continuous process-improvement.
Research Contributors
Robert Fayle
Research Practice Lead Enterprise Applications
Info-Tech Research Group
Robert has more than 20 years of experience developing ERP applications in the wholesale/retail space as well as for the printing industry. Robert has also worked in the Education and Healthcare markets.
Neal Rosenblatt
Executive Counselor
Info-Tech Research Group
Neal has over 20 years of progressive public health research science and informatics leadership experience in the public sector across local and state government.
Bibliography
Basch, Peter, Christine Sinsky, Marie Brown, et al. “Electronic Health Record Optimization”. American Medical Association, 30 August 2018.
Campbell, Justin. ”EMR Clinical Optimization Infographic – EMR Clinical Optimization Series”, Healthcare IT Today. 12 July 2017.
Drees, Jackie. “EHR Market Share 2021: 10 Things to Know about Major Players Epic, Cerner, Meditech & Allscripts”. Accessed 15 March 2022.
“Electronic Health Records Market Size Report”, Grandview Research. Accessed 15 Mar. 2022.
“EHR Optimization: Stabilization”, ECGMC. 26 July 2017. https://www.ecgmc.com/thought-leadership/blog/the-three-phases-of-ehr-optimization-part-one. Accessed 15 Mar. 2022.
Fargnoli, Ralph. “ Beyond implementation: Optimizing EHRs to realize results.” KPMG, 2017.
“Figure 1: A Simplified Diagram Demonstrating Electronic Health Record System Taken from Orion” ResearchGate. Accessed 5 Mar 2022.
Green, Jeff. “How Much EHR Costs and How to Set Your Budget”, EHR in Practice. Accessed 15 March 2022.
Hall, Susan D. “Hospitals Don’t Factor in Full Cost of EHR Implementation.” Fierce Healthcare, 13 Feb. 2014.
Jason, Christopher. “3 Reasons to Favor Cloud-Based EHRs Over In-House EHRs.” EHR Intelligence. 27 Jan 2020.
Johnson, Christian and Vaishali Patel. “Harnessing Electronic Health Data in the Palm of Your Hand: New Survey Data Shows Increasing Availability of Patient-Facing APIs and Early Uptake by Patients.” Health IT Buzz, 17 Nov. 2021.
Nelson, Hannah. “APIs That Connect to Certified EHR Technology on the Rise.” EHR Intelligence. 18 Nov 2021.
“Office-Based Physician Electronic Health Record Adoption”, HealthIT.Gov. Accessed 10 Mar. 2022.
MuleSoft. “MuleSoft Accelerator for Healthcare.” Anypoint Exchange, 13 December 2022.
Santos, Everton and Jonathan Christensen. “Global (Non-US) EMR Market Share 2019”, KLAS Research. 2 May 2019.
“What Information Does an Electronic Health Record (EHR) Contain?” HealthIT.Gov. N.d. Accessed 21 Mar. 2022.
“Who Are the Key Stakeholders during Electronic Health Record (EHR) Implementation?” HealthIT.Gov. N.d. Accessed 15 Mar. 2022.
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