Congress’ passage of the stimulus package and the inclusion of the HITECH Act provided healthcare providers of all sizes with a $19.2 billion incentive to implement electronic health records (EHRs). While many providers have spent millions of dollars upgrading their IT software, the challenge remains to create a functional system that works in conjunction with the provision of patient care and can ultimately demonstrate both access to information and improved outcomes, hence “meaningful use.” And that typically has a lot more to do with physician and clinician adoption, workflow efficiency, and strong project management than with technology.
The intent of moving to electronic processes is to improve quality and timeliness of care, reduce costs, and share potentially lifesaving information across a continuum of providers by switching from paper and phone-based systems to EHRs. However, when you consider that 32 percent of all IT projects fail and 44 percent are late and/or over budget, you realize there are many hurdles before reaching “meaningful use.” Still, it is a worthy challenge given that sharing data, integration and communication are key components of reaching meaningful use – and this is something we have needed to improve in healthcare for some time. The foundation has to be in place so that the pursuit of meaningful use does not end in the graveyard of failed projects. Executive buy-in from the C-suite, physician/clinician leadership and coordination across the enterprise, thoughtful consideration of physician/clinician adoption, and workflows that are coordinated with other projects and can quantify and demonstrate value are all key building blocks of success.
I have been helping clients tackle this challenge with a system I call HITECH PMO (Project Management Office). The PMO is an acknowledgement that IT projects must follow a very complex critical path in order to reach successful implementation. The HITECH PMO provides a successful framework for reaching “meaningful use” while working very collaboratively with the clinical and operational stakeholders within the system. This is critical because many clients have between $100 million and $825 million in incentive dollars at risk. Key elements of a successful HITECH PMO include:
Accountability – Making sure the people who are critical to the success of the project understand their responsibility, their deadlines, and the impact of their decisions and efforts on the overall project outcomes. If the system is managed by an outside source, creating weekly status reports designed to open the lines of communication between the IT department and leadership of the company is critical. By setting up a system of checks and balances, staff is held accountable for their projects and each issue is dealt with in a timely manner. From the front end, the PMO system is designed with the company’s strategic goals in mind.
Integration – One of the most common reasons that IT projects get off track is the failure of people involved to make sure all of the moving parts of the project are coordinated. Communication and a clear understanding of the impact of the IT project on the clinical and operational domains within the healthcare system and an action plan to execute in collaboration with the involved stakeholders are critical elements of success. This same concept is equally important in reverse – an understanding of clinical decision-making on IT projects is also crucial.
Transparency – It is essential that accurate updates of the project’s status are communicated to stakeholders so that as the project gains momentum, that momentum can be shared with as many people as possible, and the buy-in of the organization is broadened as much as possible.
Specialization – In order to calculate progress toward reaching “meaningful use,” use specialized tracking tools. At North Highland, we call ours the “Meaningful Thermometer.” Embedded within the tools are rules that govern how objectives need to be met, as well as logic that helps determine the total potential reimbursement a facility can expect. These tools allow executives to calculate progress toward “meaningful use” and make real-time decisions about investments and progress and can mitigate risk as needed.
While the initial focus of the PMO service is on meeting the various benchmarks set by the HITECH Act, the end goal is to create a process that results in a successful EHR system that delivers long-term improvements in care and cost savings for the entire healthcare system.
Fletcher Lance leads the national healthcare practice at North Highland and is based in the Nashville office. He joined the company in 2005 and has more than 15 years of experience in healthcare management and information technology consulting. Lance works with healthcare providers, payers and healthcare IT ventures. A few of the companies he has worked with include Healthways, Inc., Renal Advantage Inc., and HealthSpring, Inc.