Fix processes first
Add an EHR only after freeing clinicians through efficient care protocols
It’s no great insight that implementing an electronic health record involves significant expenditures of time and resources as well as temporary disruptions to the care environment. Six months after the final rule on meaningful use was published, many hospitals are in the final discussions with vendors about critical needs and outcomes. Prior to choosing an EHR, it is imperative that providers and vendors discuss the EHR’s capabilities and how the system will support the hospital’s efforts to achieve total hospital efficiency.
While this seems obvious, part of that discovery process is an examination of the care coordination protocols that affect each hospital’s efficiency. The challenge for providers is making sure they have laid the groundwork to implement the process smoothly so the EHR’s benefits accrue as quickly as possible. With the exception of a few industry leaders, most hospitals will make the mistake of integrating an EHR into a system of protocols, logistics and methodologies that have not been designed to maximize a hospital’s total efficiency.
Avoiding this scenario requires looking beyond the emergency department or intensive-care unit where a hospital has implemented advanced-care management protocols. Hospitals must consider how the EHR will affect the broader institution, including its advanced-care practices and those yet to be optimized. If they do not, the EHR will become “digital cement” that prevents the facility from realizing the full benefits of an EHR and potentially hinders future efficiency efforts. When coupled with the ongoing debate over whether EHRs will actually improve efficiency, it is clear that hospitals should first optimize the care coordination protocols that govern efficient care delivery.
Using advanced process re-engineering methodologies is an important prerequisite for EHR success. Every C-level executive should consider this when choreographing patient flow and maximizing throughput. Operational methodologies most often associated with manufacturing processes, such as Lean, Six Sigma and Toyota Production System, are rapidly gaining favor as the best means to increase efficiency. Besides lower resource utilization, increased capacity, improved profitability and greater quality, synchronized patient flow will remove many of the logistical problems that reduce the time clinicians have to spend with patients.
Too often, front-line caregivers are burdened with non-clinical activities that involve boarding, scheduling and transport instead of providing care. These activities create waste in a process for which efficiency is critically important. Adding an EHR to this dynamic will not improve care; instead it may paralyze already overburdened caregivers. By improving patient flow and logistics across the entire hospital, nurses and doctors will be freed to spend more time with patients.
Clinicians can use this additional time to achieve an optimal balance of patient care and documentation. Incorporating an EHR in a hectic environment buffeted by inconsistent patient flow and demands will not establish a solid foundation for success. The effects of having more time at the bedside for clinicians will be enhanced by the EHR’s inclusion of decision-support protocols, computerized physician order entry, test results and other functionalities that are anticipated to transform care.
Increasing efficiency through advancedcare coordination methodologies begins with developing a consensus that the hospital is committed to transforming its operations. Once that mindset is accepted, it is important to understand how processes are completed. This can be done through mapping workflow to accomplish key patient flow tasks. A review of the workflows will identify opportunities for improvement (such as waste, no value added and rework).
Once the opportunities are identified, an optimal future-state process design leads to the elimination of unnecessary steps in the workflow process. Upon implementation, processes are standardized and key metrics and milestones are established, resulting in: optimized patient flow for all patients; reduced non-value-added activities and waits; and increased hospital efficiency.
The final component to maximizing efficiency and realizing the attendant gains is using adaptive systems software and technology that automates the process, provides visibility to and management of key metrics and milestones, and ensures optimal patient flow. By using a software platform that maps to the new care model and integrates with other related hospital systems such as EHRs, realtime performance information is available for the entire hospital as well as specific patients. Not only will this ensure on-time, complete and correct actions regarding hospital operations, but it also will provide clinical leaders with valuable data about patient care, treatment and outcomes.
EHRs are an important piece in developing a high-quality, low-cost health system. If the foundation upon which they are built is disorganized, inefficient and overburdened, however, they will fail to live up to their potential. The country is spending too much money on EHR implementations to ignore the need to first commit to greater hospital efficiency. Designing processes focused on value-added patient care will radically change the care environment for clinicians and provide an ideal environment for integrating EHRs.