HIStalk Practice Interviews Jeff A. Drasnin, MD, ESD Pediatric Group

Jeff A. Drasnin, MD is a partner with ESD Pediatric Group of Cincinnati, OH

Tell me about yourself and the practice.

We are located in Cincinnati, Ohio. We have two office locations, one more of a city office and one more of a suburban office. There’s a total of seven practitioners, five of which are physicians and two nurse practitioners. The practice was founded all the way back in the forties, so it’s kind of grown over the years. We provide care to primarily insurance-carrying patients, although we do do a percentage of Medicaid.

We have about 10,000 patients in our practice, so I would call us kind of a medium-sized pediatric practice. We are not hospital-owned. We are affiliated with Cincinnati Children’s just in the sense that we take care of patients there, but we are not on the payroll of Cincinnati Children’s in any way. But when we started looking for IT solutions going back to the mid-2000s, we were in an all-paper situation as people were back then. We outsourced our billing in order for someone to do our collections for us. Years and years ago we did our own collections, but doctors doing collections – it’s kind of like bicycle mechanics fixing cars. It’s not really what we’re designed to do.

We used a company that we didn’t like because we never knew where our money was. But we also knew that we didn’t do it very well, so initially the electronic piece for us came in the form of collections. That’s where we got hooked up with athenahealth in 2007, because their web-based technology really improved our collections. You can’t run a practice and/or a business without the cash. That was the first piece. And then as things moved on, we wanted to go completely electronic and we picked up the second piece of their offering, athenaClinicals in May of 2009. Our first step was to get our financial house in order, which we were able to do, and then we moved on to the clinical aspects and have been running with that ever since.

Tell me about the selection process for both the financial and clinical pieces.

A lot of it was luck, and I’ll say that to this day. We had several different vendors come and make presentations to us. Initially, we had found athena through one of my staff that went to another medical office and said, “Hey, what are you guys using? What do you got?” And then I followed up on that and started calling some practice administrators in town that had already used a collections piece, asking who do you use and do you like them and what regrets do you have and what could be better, etc. And when I talked to the group that was using athena at the time, the only regret this office manager had was that they didn’t choose them sooner. That was it. And now, six years later, I would actually give the same answer if somebody asked me that question.

The thing that we were upset about with our collections company is we didn’t know where our money was going. Our staff punched all these claims into the computer and then we sent it to this other company. We never knew what was coming. We just literally sat there and watched the bank accounts on a daily basis, kind of hoping we’d get something. But we had no idea what was coming, what was being written off, what wasn’t being paid per contract and all those things. With athena what we liked the most was that it was very transparent, that no claim was going to be written off by them. If we wanted to drill down on even a single claim, we knew where it was, and they did the vast majority of the work. We didn’t get rid of any staff – we repurposed people to do better things. Our days in account receivable went from being in the forties or fifties down to somewhere like 16 or 17 now.

Our cash flow has been much smoother in the sense that I didn’t have to hope and pray that we were going to get money in the account today. I know roughly X number of dollars comes relatively smoothly into the account on a daily basis, which is kind of nice. You can budget things and go from there.

So, we were on athenaCollector for a couple of years. Then we started looking at the medical records, and it just made sense to us to use one that was integrated. I know some of the other practices in town that use athena for their collections and they use a different medical record system. And everything’s fine and they don’t have any problems with that. But the way we looked at it, if athena can do the EMR piece anywhere close to as well they do the collections piece, well, let’s just choose them. We’ve had a great experience so far, and again we’re going on over four years now. I still have no regrets.

Did you seriously look at any other EMRs?

Yeah, we did. In Cincinnati, there’s a group of pediatricians that were using NextGen, which is a little bit supported by Cincinnati Childrens in kind of a weird way, with the Stark Law exemptions. And we looked at that, we looked at Allscripts, we looked at a couple of other different ones. But we were very much attracted to the web-based concept. We loved the fact that we were not going to maintain servers at our office.

We’ve got one IT guy who comes here every once in a while just to make sure that all the computers are up and running, the network’s running okay, and when people have log-in problems or a computer gets spammed or something like that. And that’s the extent of our IT costs. And that’s amazing. We don’t even have a T1 line. We have a DSL or a cable line, depending on which office we’re at. And as long as that is active, we’re ready to roll. And if there’s ever a glitch in the system, which there’s not been in a long time, you’ve got a relatively large company that is working to get every provider back up on the network at the same time. If we use something software-based and a server goes down or something happens, then I got to call my IT guy, he’s got to run over, he’s got to figure out what’s going on in my system, and it’s on my dime to get all that going, as opposed to being part of the subscription. We really like the subscription component, because the fees that we pay are very similar to just maintenance fees on software. The subscription fee for athena depends on what you’re using and it is not all that different than what you’re going to pay to maintain your software-based system.

We also looked at start-up costs with the other systems. Our start-up costs with athena were relatively minimal. But other pediatric groups here in town have spent tons and tons of money just getting up and running. We didn’t and that was huge for a small practice like ours. Prior to athena doing our collections, we really struggled from a cash flow perspective. Cash flow is just not an issue now. We’re busier than we were 10 years ago, but that’s only part of the reason why we’re in order. I think the number one reason is that the financial ducks are in a row and now everything is tied together.

Tell me about implementation process and how you got physician buy-in and  changed workflows.

We liked our workflow and my goal when going electronic was to have an EMR that allowed us to still work in our office the same way that we always worked, because over the years we found a way that we felt works well. Two of the partners are on the younger side and like computers and we sold EMR as a positive from the beginning. We got all the physicians on the same page first, and then we took that positive message to the staff. I think if you don’t have the physicians on board – and that’s sometimes hard within larger groups – then there are those who basically sabotage the whole concept. Once people get thinking it’s going to be hard or difficult, then you’re behind the eight ball.

We were very lucky in the sense that there were two of us who researched and set things up and the other three partners said, “Whatever you guys think is best, we’re going to be with you on it.” And what we did is looked at our workflow. When we did the implementation we had two athena staff members come out to Cincinnati twice. They were also here on our go-live, they looked at our workflow to set up all the pathways so that we could run our office electronically the same way we’ve been running it before – but do it better. They came in and did a lot of groundwork and a lot of things were done remotely.

Since we had been on the Collector system for a while, athena could fill in a lot of things based on claims data, such as shot records and diagnoses, going back two years prior. We looked at our schedule going forward, picked a go-live date, and then we did what’s called a rolling abstraction. We decided as docs which types of things we wanted at our fingertips that should be scanned into the system for easy access. We didn’t scan entire charts; we scanned parts of charts.

We put in the information for all our upcoming well-checks and all of our pre-scheduled appointments and then we tried to put them in as quickly as we could when appointments were made. Within several months, we went from A to Z and back-filled everybody.

The other thing that myself and my other IT partner did was to make two sheets of paper that we presented them to the staff. We said, “Here’s how we do this task today.” With the next piece of paper we said, “Here’s how we do the same task tomorrow,” – meaning when we go live. Once our staff saw that they knew it really wasn’t that big of a change.

So with a vaccine, what do I do? Well, I used to go write the lot numbers in the log book. Now I go to my laptop and I enter my log numbers here. For a strep test I used to go write in this log book and I’d go put it on a little sticky note piece of paper and I’d stick it on front of the doctor’s chart. Now I go in the computer and enter the result, etc. We ran through that and you could see that there was a lot of nodding in the crowd and that’s where the real buy-in from the staff started.

We did that prior to the go-live so that when the go-live came, it was like, oh, okay, we know how we’re going to do it. And we actually did not change our schedule. We didn’t cut back at all. We just hopped on the bike and started riding. And it really wasn’t an issue.

Something that I hear from many of my compatriots who are also physicians is that with their go-lives they wean down the schedule and it’s chaos and craziness. We just didn’t have that. Maybe we were lucky, maybe some of it’s athena. I’m sure a lot of it’s athena. I think some of it was probably us, too. You got to have buy-in and you’ve got to have buy-in before you do it. And I think that’s where we were in one sense very lucky.

What kind of devices are the physicians using for their charting?

We started out with Lenovo X61s, which were tablets with pens. We bought 15 or 20 of them. The physicians and the medical assistants were all using the same one, but the girls on the phone just used desktop PCs. We ran those until probably about a year ago. Those were Windows XP and they were fine and still functional, but as athenaClinicals has gotten more in depth, in order to create these screens that are our chart, you’ve got to have a processor that’s going to pound through some of that. We found these basic dual core Intels were fine, but things were slowing down a little bit.

The most frustrating thing that could happen to any physician or any provider is slow. When you click on something, it better come up right away. We’ve upgraded and our physicians now carry Lenovo Yogas, the Windows 8 touchscreens. Those were a little bit on the expensive side, so for the staff we ended up getting Acer Windows 8 touchscreens and they work great. They love the touchscreen because there’s a lot of scrolling in Clinicals and using that finger on a touchscreen is great.

Do you enter any free text?

I do still enter a fair bit of free text. I’m a fairly good typist. We have templates and lots of clicks but I still find that when I write down the history for a patient, I still like to type a couple sentences. So I’d be lost without my keyboard.

Are you typing in front of the patient?

I try not to do too much typing with the patient. I carry my Yoga into the room and I use it mostly for reference. Sometimes I’ll enter in a couple orders if I can multitask that and still maintain eye contact. I try not to stare at my screen in the room, but I like it because I can see what the last antibiotic they were on. I can see where their favorite pharmacy is. I can look at a shot record. I have the information at my fingertips to answer any questions that the parents are going to throw at me.

But, I try not to type my notes in there. I don’t want to change how I see my patients -I like how I see my patients. Instead of a folder, I carry the computer. I make a couple of quick notes, I put in orders, prescriptions, and things that must be done in real time. I do those pretty quickly. But a lot of times, I’ll fill in my charts later.

In the good old days when I was on paper, I would do the same thing. I would have a big pile of charts. I’d call my wife when I was done seeing patients and she would ask, “How many charts you got?” Well, I got like 15, so she says, “Oh, it’s going to be like, what, 45 minutes or I’ll see you in an hour?”

Whereas now with it being electronic and web-based, as soon as I see my last patient, I walk straight out the door. I’ve got young kids and I’m home for dinner on time every night. I play with the kids, help with their homework, put them to bed. And then I’ll polish off my charts on the couch with my feet up and ESPN on. From a lifestyle perspective, it was a game changer. I coach tee ball, I coach soccer. I can get to my kids’ practices because as soon as I’m done, I’m out the door and I can tinker with that later. It’s huge.

Are you or have you attested for Meaningful Use?

As pediatricians, we are kind of screwed, unless we take care of a Medicaid population, which we don’t, really. We don’t meet the 20 percent criteria. We applied for it but we’re not going to get any Meaningful Use money. But we’re using those same things for things like patient-centered medical home.

Are you using the EHR for any quality reporting initiatives?

Yeah, we’re actually in the process of getting the PCMH, the patient-centered medical home. The beauty of athena is all of your data basically lives in databases and can be sliced and diced in whatever way that you want to. I’m blessed that I have a practice administrator who’s also a CPA, who runs reports on this stuff all day long. She ran reports from the collections side for years before we went to Clinicals. And now, we can slice and dice and pick out populations and produce data very, very easily, which is tremendous for us.

We need that for PCMH. You have to prove that you do it better. We have an asthma initiative and take it one step farther using athenaCommunicator. Every year when flu shots come around, we send emails, texts, phone calls to all of our asthmatics. We actually are in a friendly competition with our other compatriots in town to try to see who can get more of their asthmatics their flu shots. We keep track of that stuff.

And with a couple of payers in town, there are actually P4P payments that we get based on hitting certain percentiles and it is very easy for us to report that. If we didn’t have the electronic system, we wouldn’t have the same ease. It’s one thing to have your data in a computer. It’s another thing getting your data out of the computer and that’s where a lot of practices that I’ve spoken with have issues. Practices who are not on athena and who are even more progressive than us, who got on electronic records even earlier than we did and have systems that produce good notes, but, they can’t get their data back out. They can’t run reports.

With athena, we can create the vast majority of reports ourselves, and if there’s something a little more detailed, then you can pay athena to do it for you. But we really haven’t needed to do that much. But we use the Communicator to improve patient care. We use it to schedule density. We work kind of like a dentist in the sense that, if it’s been six months since your last cleaning, you better believe you’ll got a postcard in your mailbox. We do the same thing electronically, so every time we see a patient, we put a tickler into athena that will tell the front desk to make that next appointment, whether it’s a check-up or a follow-up appointment. If they don’t make that appointment, we use the tickler to start calling the house.

For example, for a pediatrician, it’s check-ups. We want to get all of our patients in on an annual basis because we think that’s important, obviously. Once kids get a little bigger and don’t need a form filled out and are otherwise healthy, parents sometimes don’t take them in, even when insurance plans are paying for well childcare once a year.

Now they’re aware that they’re due for their check-up and they’ll come in. In my practice, we don’t have an open check-up appointment until mid-November. Our schedule’s booked. Not only is it better care, but from a financial perspective, it’s been tremendous for us. Same thing for our asthmatics. We like to see our asthmatics every six months so they get their tickler for an annual check-up, and in between at six months, we want to do an asthma check with them. We use the system to send emails and 80 percent of our patients active on our patient portal.

That’s an impressive number.

It’s amazing. I get messages and you can easily send back messages. The patient portal is mobilized so if you have an iPhone or an android, it pops up on your phone. I’ll have parents email me questions or send it through the portal and it pops right in my system and I answer it. They get an email right away and tell me that I’ve answered their question. I may go back and forth with them two or three times in the course of a morning and there’s no nurse involved in that. That type of communication is just insane, in a good way. Tthe families that use that are just blown away by the ease at which they can do that, that you can actually email your doctor and you might have an answer in 10 minutes. I come out of a room in between patients, look at the computer, click on a message, and answer it. It’s very easy and that’s really changed how we roll.

People don’t realize how cool it is until they do it. I joke around with some of my parents, and say you guys haven’t “portalized” me in a while. And then sure enough, at the end of the day I’ll get a message after they get home or something. For very easy, simple questions it streamlines care. And doesn’t cost me any time. If you were to call the office and talk to the nurse, what does the nurse do? She puts your question in the computer, sends it to me, I type it back to her, then she calls the patient back and says Dr. Jansen said this. Whereas with the patient portal, you can get a very quick question and it’s very, very easy. That’s the whole Communicator component – the patient portal, the reminder calls, the ticklers. When they send out those calls, the parent answers the phone and then presses a button, and can actually talk to a live operator at athena who actually schedules the appointment. That’s how our schedule stays so full to very little effort of my staff’s part. It’s pretty amazing.

Anything else that you’d like to add?

I could talk about athena into the night. I think that it’s helped make a small practice like ours look like a much bigger practice because we’ve got a multi-million dollar company behind us and everything that we do is run through them. Everything about the way that my office runs is different. We have two offices. Before, we had a phone room in both offices. Now it’s all centralized. The first part of it was to get the dollars in order. The second part of it was to improve the care. Those two things go hand in hand. I think that when you use a fully-integrated system–a collections system, an EMR system and then some sort of patient portal communication system – when you put all those together on the same platform, they seamlessly integrate.

And over time, they improve. Being web-based we get an update once a month or every other month. They’re not major things, so they don’t throw off everybody’s workflow. But a new button here, a new thing, a new that. And we don’t have to put any effort into that.

News 9/17/13

The ONC releases models for Notices of Privacy Practices for healthcare providers, which reflect the Omnibus Rule regulatory changes that go into effect September 23.

Quality Insights of Delaware REC becomes the nation’s first REC to have 1,000 primary care providers demonstrate Stage 1 MU.

Here’s a figure that surprised me: 41 percent of US consumers would be willing to switch doctors to gain online access to their own EMR. As much as I love the idea of having full access to my personal health records, it would take more than the prospect of EMR access to motivate me to switch physicians. I do agree with the 84 percent of consumers who believe they should have full access to their EMR, and, mildly annoyed that only a third of physician think it’s a good idea. Currently only a third of Americans have full online access to their EMR, but  more than half track some aspect of their health history online, including physical activity, weight, and/or blood pressure.

The AMA releases the 2014 CPT code set, which includes 335 code changes

Washington Orthopaedics & Sports Medicine (DC/MD) selects SRS EHR for its 11 providers and three locations.

The eight-provider Tustin Irvine Medical Group (CA) selects iSALUS Healthcare’s OfficeEMR.

Kansas Nephrology Physicians is implementing Benchmark Systems’ billing platform for its seven-physician practice.

Hayes Management Technology adds its go-live support and legacy support services to its website.

GMed adds LDM Group’s messaging programs for patient medication compliance to its EHR platform for gastroenterology.

Mann Ear, Nose & Throat (NC) provides its 10,000 patients mobile access to their medical information using echoBase’s Resonate software platform.

Frost & Sullivan presents Vitera Healthcare Solutions its 2013 North American Customer Value Enhancement Award for outstanding performance and success, which recognizes the company’s focus on implementing strategies to create customer value.

Nuance Communications announces an Epic-optimized version of its Dragon Medical 360 | Network Edition.

The American College of Physicians is the latest industry group to suggest changes for the EHR incentive program. In a letter to CMS, the ACP says that the current Meaningful Use timeline is “aggressive” and warns that  the program’s success may be limited when combined with overly ambitious objectives. The ACP recommends that requirements become less prescriptive to allow EPs of all specialties to be creative in applying technology to the unique characteristics of their practice, specialty, and patient population.

Email Inga.

DOCtalk by Dr. Gregg 9/16/13

Cannoli and Crowdsourcing

In a recent post, I discussed the “take the cannoli” attitude that pervades certain segments of the HIT world. Several very kind comments via email about that post plus a recent “event” caused me a mental revisitation of the concept.

The event is the HealthTap “Summer 2013 Top Doctor Competition.” This has brought a slew of emails to my inbox. Several a day from the HealthTap promo peeps, in fact, which in their seemingly never-ending thrust to inspire my participation, have actually ended up causing me to react quite contrarily.

Lemme ‘splain, Lucy.

I was a very early HealthTap contributor, and because of those early efforts, I’ve continued to grow a certain “presence” in the HealthTap community via the social network, grown upon my early input. I say “early input” because it has been quite some time since I’ve engaged with the HealthTap platform to any real extent. I haven’t provided any new answers to medical questions or attempted to spread my online presence there in quite a while. I wasn’t 100 percent sure why I hadn’t continued participating with the HealthTap platform until I got hit with the cannoli, so to speak. Their recent email onslaught clarified my reticence.

The key concept behind HealthTap is crowdsourcing. They have created a platform for consumers to interact with healthcare providers that is free for all. (So far!) Consumers ask brief questions and doctors from all around provide short, non-patient-specific answers. Providers can also throw out little snippets of medical wisdom and knowledge that are available for all to search and see. There are followers and networks; there are contests and award badges – all the typical social network fun is there in a fairly nice-looking tool.

One conundrum re: HealthTap has been that of time. If I spend time providing expert knowledge or answers to questions there, it means I’m not spending time elsewhere – not with my family, not chillin’, not doing something that generates income, not in our local free clinic, not blathering on HIStalk Practice. While garnering a sense of “I done somebody good” is not an ignoble thing, in this situation it is a very impersonal sense of do-goodness. It isn’t like helping a friend, a family member, a patient, or a neighbor.

Now, I have no qualms about helping folks unknown – and I hope I have, at least a little – but what the recent overkill of HealthTap Summer 2013 Top Doctor Competition emails has done is to confirm my suspicions that my do-good sensibilities are being manipulated. (i.e., I think I see somebody taking my cannoli.)

HealthTap thrives via provider input. In fact, they’ve scored millions of dollars in investor capital based solely on the value of the provider expertise they’ve accumulated. But, unless you’ve nothing better to do, a provider gets zilch from the investment of time and intellectual property save a sense of trying to do something good. (Well, that and a digital wall full of contrived digital “awards.”)

With this new contest, I’ve recently been receiving several emails every day trying to inspire my further contributions so that I can “win” in their summer games. These emails are obviously auto-generated and daily conflict with themselves and the website’s own ranking telling me I’m in some #1 or #18 or #2 “Top” spot, all on the same day. Maybe I’m wrong, but I’ve started to feel a little put upon. I’ve started to feel more manipulated than inspired. I’ve started to wonder why I should spend my insufficient spare time helping the HealthTap hierarchy make millions when all I get is a badge. (“Badges? We don’t need no stinkin’ badges!” comes immediately to mind.)

If HealthTap is making money off my years of costly training and even more years of garnered health experience and all I get is a good feeling (OK, and a badge), isn’t that essentially a “take the cannoli” slap in the face?

There are probably lots of good folks at HealthTap, and I realize I’m not endearing myself to them here. I also know that lots of my colleagues likely disagree with my take on this. To be clear, I don’t have anything against the overall concept of making good, concise, and easily readable health answers freely available to consumers. But I’m sorry; I think too many companies are getting in on this whole “take the providers’ experience and knowledge and leave him or her naught but a thank you – or a badge” concept. (EHR vendors have been doing this for some time – taking their provider users’ experience and input to help create a more saleable product, often paying nada for the contributions.)

We’re in the healthcare realm here. It isn’t akin to asking a consumer what they like or don’t like about a refrigerator or toaster; consumers typically have no expertise nor vested interest in the value of their insights. OK, maybe they hope they get a better toaster someday, but, they generally haven’t trained for years as appliance design gurus. In the healthcare space, this is taking formally acquired know-how and profiting from it, with no remuneration to the expert.

In this particular instance, consumers get help while HealthTap gets money. The least HealthTap could do is share a little of that profit with the professionals they rely upon to generate both the resources and the profit.

If you’re going to make money off our (providers’) efforts or expertise, please have the courtesy to share. Healthcare doesn’t need any more vultures. Providers are getting squeezed enough as it is.

In other words, leave us some cannoli.

From the trenches…

“He looks like he’s just been told there’s no cannelloni in the world.” – Phil Stone

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 9/12/13

Health IT expenditures are rising as physician offices continue to adopt and optimize EHRs, according to an MGMA cost survey report. Annual IT expenditures per FTE physicians were $19,439 in 2012, a 28 percent increase since 2008. Offices also report increases in median staffing costs as additional personnel are hired to manage operations and provide clinical, and ancillary support. MGMA theorizes the increased staff costs may be the result of initiatives to improve patient satisfaction and provide more patient-centric care. The full report must be purchased so it’s unclear if MGMA proposes options for cutting costs, such as migrating to a cloud-based EHR to reduce IT expenses or merging with a larger practice/selling out to a hospital to leverage IT and staffing resources.

A couple of recent studies indicate the use of EMRs in physician offices can positively impact care. In a JAMA-published study, researchers found that switching from paper to EMRs led to “modest reductions” in the number of ED visits by diabetics (519 vs. 490 visits per 1,000 patients) and hospitalizations (251 vs. 239 per 1,000 patients). Also in JAMA:. a research letter reported that using an EMR that included automated growth monitoring helped doctors pick up on cases of possible growth disorders among kids.

And from another JAMA article: small EHR-enabled clinics that participated in an P4P incentive program showed slightly more improvements in cardiovascular care processes and outcomes.

Twin Fountains Primary Care Clinic (TX) implements simplifyMD’s EHR/PM platform.

MGMA-ACMPE names Garth Jordan (EDUCAUSE) COO.

ZirMed will offer tools to help providers transition to ICD-10.

Athenahealth releases the Demandforce automated marketing and communication service created by Intuit. Demandforce will be available on the athenahealth Marketplace for providers using athenaCommunicator and is designed to increase patient engagement, attract new patients, and measure the impact of marketing and social media efforts.

I just received my first MGMA party invite and it looks to be a fun one. Interestingly the invite highlights the host company’s RCM solutions, and makes no mention of the fact that it is a leading provider of ambulatory EHR solutions. Could this be a foreshadowing of what vendors will be highlighting this year?

eClinicalWorks and NextGen reseller PracticeMax acquires Chicago-based Medi-Data Service, a provider of billing and PM services.

Every year US consumers spend 52 hours researching  health information online, but only make three visits to the doctor. Americans are most likely to search a pharma-sponsored website after being given a diagnosis from a physician, but also jump to the web before filling a prescription and after experiencing new symptoms. WebMD is the online resource most often accessed by physicians.

Ophthalmology EMR provider Medflow will use DataMotion Direct to enable the secure exchange of PHI for its 2,800 physician customers.

The 110-provider Prima CARE (MA/RI) selects Ingenious Med’s mobile revenue capture technology.

Email Inga.

From the Consultant’s Corner 9/10/13

What’s Your EHR’s ROI?

Mention “return on investment” in the same breath as “electronic health record,” and you’re likely to get a mixed reaction because the promised benefits of reducing costs and improving quality have been offset by reduced physician productivity or dips in financial performance for many organizations. While these risks are real, the potential “soft” benefits of improved quality and enhanced patient satisfaction, as well as “hard” benefits of improved revenue, are also real.

Given the capital investment needed to purchase and implement an EHR, you’d think that every healthcare organization installing these applications would have documented baseline performance; set clearly defined goals in terms of quality, expenses, and revenues; and established processes for monitoring their progress toward meeting these goals. However, I’ve found that’s not the case for most organizations making these large-scale investments.

In my experience, those organizations that do actively monitor results and work toward specific ROI goals seem to have better success with their EHR implementation, both clinically and financially. While some may not be seeing a cash increase at the end of the day, they are closing the gap between expenses and revenue. More importantly, they are better positioned for competing in an evolving reimbursement landscape where there is a shift from volume to value.

So how do you define and measure the ROI for your EHR? Here’s where you can start.

Measure baseline performance. Before starting down the road to implementation, you have to understand key baseline performance measures, including patient satisfaction, physician productivity, revenue cycle performance, and perhaps most importantly, key quality measures. By understanding these measures, leadership can set quantifiable goals and monitor the progress toward those goals. What is not measured is not going to be managed, and what is not managed is not going to improve a practice’s quality-cost curve.

Set expected ROI goals, not just financial goals. While a practice may not see a purely financial return from its EHR investment for several years, it is important to monitor financial results in order to mitigate risks of decreased physician productivity and practice revenue. Because quality will play an increasingly important role in reimbursement, workflows and system build decisions during implementation must support the capture of clinical data in a manner that ensures reporting is transparent and efficient.

Monitor ongoing performance. Unfortunately, once the system is live, the work is not necessarily finished. Dashboards and reports must be utilized to continually monitor your organization’s performance and to compare results with expected outcomes. While the goal is to ensure continual improvement, this step also is effective in proactively identifying post-implementation problems.

By setting realistic goals for your EHR, defining performance measures, establishing baselines, and monitoring data over time, your organization can truly get a handle on whether the EHR is living up to expectations and delivering a solid return on investment.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.