Becker's Hospital Review

103 Executive Briefing Sponsored by: H ealthcare organizations around the world have collectively invested billions in EHRs. Further investment is almost certain as the technology's documented ability to improve outcomes can help support more efficient, safer care models essential to the success of value-based care. The global EHR market is projected to reach nearly $24 billion by 2020, up from $15.56 billion in 2013, according to a Transparency Market Research report. Hospitals and health systems will continue to make significant investments in EHRs as the industry becomes more reliant on data and more focused on personalized care. Many organizations that have already gone live with EHRs have yet to achieve full return on investment. Numerous provider organizations around the nation anticipated the technology would ultimately save money or pay for itself through process improvements. However, challenges associated with the technology — burnout among physicians and staff from increased clerical and administrative burden as well as the significant overhead associated with supporting enterprise EHRs— have undercut these expectations. The situation has left many hospital CIOs to navigate the liminal space between EHR go-live and the truly data- driven healthcare of the future. EHR optimization cannot be achieved with quick, one-time fixes. These high-powered systems must be treated like any other piece of sophisticated equipment and maintained with regular "care and feeding," according to Bill Grana, CEO of HCTec, a national provider of healthcare IT workforce solutions based in Nashville, Tenn. "Health systems face an enormous set of challenges just getting these EHR systems implemented and activated, but really that's just the beginning," said Mr. Grana during an interview with Becker's Hospital Review. "One could argue the post go-live challenges are even more significant." With its staff of more than 500 consultants and 225-plus corporate team members, HCTec provides comprehensive healthcare workforce solutions to more than 1,000 hospitals around the nation. EHR optimization and support as well as achieving return on investment in health IT are among the company's areas of focus. At Kansas City, Mo.-based Saint Luke's Health System, collaboration with HCTec helped the system develop a strategy to meaningfully increase overall productivity and employee satisfaction after a systemwide EHR go-live contributed to higher rates of dissatisfaction and turnover in the IT department. With HCTec solutions in place, staff were able to spend more time on productive tasks and less time working to address EHR maintenance issues. The strategy has contributed to an 80 percent reduction in staff turnover and helped yield a projected cost savings of $20 million over the span of five years. Mr. Grana's background includes significant experience with high growth health IT companies. These include founder, leadership and board roles in software and technology enabled firms in the workplace population health management, occupational medicine, and laboratory markets. He recently spoke to Becker's about EHR optimization, HCTec's collaboration with health systems, and the future of health IT. Editor's note: Responses have been lightly edited for length and clarity. Question: Can you tell me about HCTec's partnership with Saint Luke's? Bill Grana: Saint Luke's Health System comprises a number of hospitals and outpatient and ambulatory clinics in the Kansas City area. We have a longstanding relationship, working with them on both IT and revenue cycle. They engaged us a couple of years ago to help with a big challenge they faced in the ongoing maintenance, or what I like to call the ongoing care and feeding, that's required to keep these monolithic EHR systems like Epic healthy. You don't just implement them and let them go. Staff also must do the work of supporting the regular updates required to meet changing regulatory requirements and help end users take advantage of the new features, functionality and productivity enhancements that come along with those upgrades. St. Luke's found they didn't have adequacy of resources for optimization work, which is really geared around how you configure and modify the system based upon the changing needs of your clinical and administrative users. So, we came in and provided a solution that deals with support and maintenance, which allowed their team to focus more on the value-driving work. It's increased satisfaction among the IT team dramatically, because that lower level work is not what analysts and higher-level IT folks get great joy out of having to perform on a daily basis. We're taking more of that rote work off their hands and giving them the opportunity to focus on things that really drive value and return on investment. We've also helped them reduce attrition among their IT team, and we've reduced expected hard and soft costs over the initial five-year term of our agreement by about $20 million. Q: What are some top pain points with the EHR among physicians, and how have you seen healthcare organizations work to resolve these issues? BG: I think what the studies show thus far is that the EHR, in terms of what it means for a physician's workday and overall satisfaction, has not been a positive contributor. The amount of administrative and clerical work that physicians are doing today versus what they were doing pre-digitization of the clinical experience is far greater. Some studies say physicians are spending twice the time they once did on documentation. That's obviously not a positive thing. On the flip side, I think the advantage that collecting data through the EHR provides to clinical users is meaningful and can help providers understand things like who in their patient population is doing better post-procedure and why. I don't think it's fair to say that there's a one-size-fits-all solution to the problem. I think it varies by specialty as well. It's difficult to create a single EHR system that works in every single unique care delivery environment. We've also seen the establishment of clinical and non-clinical work groups that deliver feedback to IT organizations to help identify opportunities for optimization. More tactically, we've seen systems hire scribes to support key users. This allows physicians to focus on the patient and practice medicine as opposed to being computer and laptop jockeys. How to achieve EHR ROI in a post-go-live world: 6 Qs with HCTec's CEO Bill Grana

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