Health IT Summit: Focus on end game to get most out of EHRs

CAMBRIDGE, MASS.--Focus on the end game to get quality, safety and efficiency improvements from your EHR, said Larry Garber, MD, medical director for informatics, Reliant Medical Group, based in Worcester, Mass. Garber spoke during the Institute for Health Technology Transformation’s Health IT Summit on May 7.

“Successful health IT implementations need to provide value, fit into real-world workflows, and earn the trust of the stakeholders,” he said.

To determine the potential value of an EHR system, Reliant held 17 site meetings to find out how practices could be improved. They came up with 127 issues with paper-based records, 100 benefits of an EHR and 140 functional requirements for an EHR. The management team enumerated financial benefits. It’s very important to align incentives, Garber said. “Everybody has to be winning” for this to work. For example, they offered food and beverages at all training sessions as well as continuing education credits. They also offered physicians financial compensation for the anticipated drop in productivity during the go live.

Garber also strongly recommended frequently communicating the benefits of EHRs to all users and stakeholders. “When the road gets bumpy—and it will get bumpy—remind them why we’re doing this.”

Speaking of communication, “listen to stakeholders and users because they are the experts,” he said. “Make it easy for users to provide feedback. Actively solicit feedback. Remember that user complaints are typically opportunities to improve the EHR. Set reasonable expectations and exceed when you deliver because that sets trust.  Deliver promptly on your promises.”

Reliant has clinicians embedded in its IT department who became certified analysts for their EHR system to help the organization “envision and build clinically useful and usable tools into the EHR.” With their clinical insight and workflow, Reliant moved forward efficiently, Garber said.

Reliant hired abstractors dedicated to bringing information into the new systems from the old paper records. More than 100 million records were moved and preloaded into the EHR, including 22 years of prescriptions and 16 years of labs. “When we went live, we turned on a system that looked like we’d been live for 15 years. It was amazing.”

Reliant used a phased-in approach which Garber said was important because it gave users time to become proficient. There were six-month gaps between each of the four phases. And speaking of proficiency, Garber said “training is really important.” Reliant hired college graduates interested in healthcare to train the system to users. The grads were cheap—“we got more than we normally would have been able to afford.” Many of them stayed on after the go-live to help continue to optimize the system.

Building the right foundation and paying attention to change management allows for minimal impact on productivity, Garber said. During the first week of the go live, productivity dropped about 15 percent, he said, but by the third week, “we were more productive than the two weeks prior to go live and there has been sustained productivity since then.”

Reliant’s coding compliance rate for chronic kidney disease was 20 percent but has increased to 84 percent which equals more than $2 million a year. Screening rates with clinical decision support have skyrocketed, Garber said. Reliant also is doing more testing for diabetes, from eyes to feet.

“We are cheaper than 96 percent of the country’s other group practices even though we’re doing more care. You can get true value out of EHRs if you do it right.”