In the widely cited paper “Can electronic medical record systems transform health care? Potential health benefits, savings, and costs.” published in 2005 by a group of RAND Corporation researchers, the projection was made that the adoption of Health IT could potentially save the US more than $81 billion annually.¹ However “potentially” was based on the systems being adopted widely and used effectively, and this continues to be an issue given the number of organizations still in various stages of implementation, and not always having the luxury of ensuring they support operations and workflow.  How can organizations be more proactive in ensuring they receive the benefits of their investment in Electronic Health Records (EHR)?

In the current environment of EHR purchase and implementation, Home Health Agencies (HHA) like many other health care organizations are cost sensitive and struggle with the issue of return on their investment. A few considerations are:

• Adoption
• Usability
• Training/Process Reengineering

Adoption:  Adoption of an EHR is critical to not only meet regulatory, coding & billing mandates, but as made clear with the Meaningful Use requirements, also for improved clinical outcomes.  Procrastination will be costly, and being a late adopter or laggard (last to adopt a technology) will not necessarily be beneficial, due to the clear need for home health agencies to position themselves for data exchange with other healthcare agencies.   There are a number of EHR vendors in the home health environment and seeking the best value is not very difficult with a number of websites providing evaluations and the ability to schedule demos. The time spent in researching and selecting the EHR balancing price with features, proven track record of excellent and customer support, will all yield future dividends.

Usability:  It is extremely important to ensure the EHR being selected is intuitive, easy to navigate, and designed to fit established workflows or best practice.  In other words ensure usability has been critically considered in the user interface, and the user experience is positive. This will save time (and cost) by not only reducing the adoption time at implementation, but in the future when bringing on new employees. How many steps does it take to complete an action, and is it easily remembered after a few iterations.  A classic way of determining this to request a demo of your agency’s key workflows utilizing scenarios, and requiring the vendor to demonstrate without necessarily informing them ahead of time. It is important to examine the length of time required to learn the key functionality as outlined in the next section.

Training/Process Reengineering:  The usability factor leads to the next consideration, training and ensuring staff are familiar with the EHR.  Ensuring they can quickly adopt the base functionality is the initial goal with minimal training for the majority of the staff; but also ensuring they can quickly become familiar with the productivity tools, and capitalize on the benefits of information technology.  This will ensure the predictable dip in productivity from the disruption in their workflow from technology adoption is minimized.  There are processes that will need to be reengineered to ensure they become more efficient and not simply creating workarounds and extra processes to maintain the status quo.  The implementation of a new Electronic Health Record affords the agency the opportunity to reexamine how to improve all processes from client acquisition to measuring clinical and financial outcomes.  The selection of an EHR that clearly reflects the incorporation of best practices, or is flexible enough to allow for adjustments to be made to the software without extensive resources or cost is an important consideration.

In summary, the question of whether EHRs can transform health care by reducing costs and improving quality will be determined one agency at a time and how successful they are with planning up front for future success.

References

Hillestad R, Bigelow J, Bower A, Girosi F, Meili R, Scoville R, & Taylor, R. et al. Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Affairs. 2005; 24(5):1103–17. doi: 10.1377/hlthaff.24.5.1103

Arthur L. Kellermann and Spencer S. Jones. What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology. Health Affairs, 32, no.1 (2013):63-68