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Implementing Electronic Health Records: Six Best Practices

By Jeff Goldman on 2011-03-07


Accenture recently published a report entitled Secrets of Success on the EMR Journey to Meaningful Use, which is based on interviews conducted with CIOs of health systems with advanced use of electronic medical records (EMRs). According to the report, less than 1 percent of health systems achieved mature use of EMRs in 2009, and approximately 50 percent of US hospitals are at risk of incurring penalties by 2015 for failing to meet federal requirements. Accenture estimates that an average 500-bed hospital would face annual reductions in Medicare reimbursement rates equivalent to $3 million to $6 million annually for failing to meet meaningful use requirements by 2015. What’s more, the survey finds that most major health systems underestimate the time and cost required to implement advanced EMR functions. “Meaningful use of EMRs is often wrongly characterized as a check-the-box qualification for stimulus monies,” says Mark Knickrehm, global managing director, Accenture Health Practice. “But, this survey shows that exemplary hospital CIOs and health systems are changing the way technology is used to deliver healthcare. From strategic planning, staffing and adoption, health systems are integrating technology at a previously unprecedented level, but many health systems are lagging and at risk of facing penalties.” The survey results are based on in-depth, in-person interviews conducted with 15 CIOs from select US health systems with advanced EMR use and annual revenues between $1 billion and $15 billion from April to August of 2010.

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IT Operating ExpensesBenchmarking shows that hospitals experience an 80 percent increase in IT operating expenses while transitioning to EMRs.

Hardware, Software, TrainingAccording to Accenture, the lion’s share of EMR investment over time is dedicated to hardware, software and training, which together constitute approximately 60 percent of total EMR implementation costs.

Compliance GapMore than 85 percent of hospitals are outside of the compliance range for meaningful use today, and roughly half of US hospitals are at risk of incurring penalties starting in 2015, according to Accenture.

6 Best PracticesAccenture’s benchmarking analysis suggests six best practices to help healthcare executives manage an EMR implementation:

6 Best Practices1. Strategic InitiativeEMR planning and implementation must be a strategic initiative, not an IT initiative. Having the passion, influence, engagement and attention of a hospital system’s leadership from the outsets was consistently cited by study participants as a success driver.

6 Best Practices2. Time and MoneyExpect your EMR implementation and adoption to take longer and cost more than you anticipate. Most of the health systems in Accenture’s study underestimated (by nearly 100 percent) the time and costs associated with implementing advanced EMR functions.

6 Best Practices3. Manage CostsYour IT operating costs will spike, and managing them requires leadership alignment and patience.

6 Best Practices4. Attract TalentWork to win the war for healthcare IT talent. There’s already a significant gap in qualified personnel for EMR implementation, and with 90 percent of hospitals expected to invest in installing/upgrading EMRs over the next year, there will be even greater competition for top IT talent.

6 Best Practices5. Focus on SupportHospital CIOs noted the need to think differently about the capabilities required to support EMR – the average hospital had to increase the number of FTEs focused on healthcare IT support (training, service and troubleshooting) by 45 percent as it reached mature levels of functionality and adoption.

6 Best Practices6. Culture of AdoptionBuild a culture of adoption for EMR across your organization. Every CIO that Accenture interviewed spoke about the need for a sharp focus on change management and workforce engagement to ensure that key stakeholders, particularly physicians, get behind the effort and understand its benefits.

4 Ways to Manage Time and CostsThe CIOs surveyed by Accenture reported using or considering the following ways to overcome cost and time management challenges while implementing EMR:

4 Ways to Manage Time and Costs1. TCO TargetsEstablish goals and plans for total cost of ownership targets throughout the EMR journey.

4 Ways to Manage Time and Costs2. Track PerformanceTrack performance against the stated business case, and ensure and clarify who is accountable for realizing each of the benefits to that case.

4 Ways to Manage Time and Costs3. Plan AheadDesign tailored processes and clinical workflows to incorporate EMR solutions at the start of the journey, instead of waiting until after solutions are already in place.

4 Ways to Manage Time and Costs4. Real-Time FeedbackUse real-time feedback loops from pilot studies to guide management throughout the implementation.

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