Add an EHR only after freeing clinicians
through efficient care protocols
By Dr. Tim Jahn for HealthLeaders
Media
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 advanced-care 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,
real-time 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.
Dr. Tim Jahn is chief quality officer of the eastern
Wisconsin division of Hospital Sisters Health
System, Springfield, Ill.