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Secrets To Success On The Journey To Meaningful Use
 

Secrets To Success On The Journey To Meaningful Use

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Accenture Health CIO Survey on EMR and Meaningful Use

Accenture Health CIO Survey on EMR and Meaningful Use

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    Secrets To Success On The Journey To Meaningful Use Secrets To Success On The Journey To Meaningful Use Document Transcript

    • Secrets of Success on the EMRJourney to Meaningful Use:Leading Hospital CIOs Reveal Key Lessons Learned
    • Passage of the HITECH Act (part of the American Mounting PressuresReinvestment and Recovery Act, or ARRA) has prompted on Health SystemsUS hospitals to strive to implement and demonstrate US hospitals are facing meaningful“meaningful use”1 of electronic medical records (EMR). By use requirements in a time of unprecedented financial pressures.Accenture’s estimates, nearly 90 percent of hospitals over According to a recent studythe next three years will invest to install or upgrade their published by the American HospitalEMRs in an attempt to meet the government’s meaningful Association (AHA), approximatelyuse requirements. The stakes are high for hospital leaders one-third of all hospitals operatedand healthcare IT teams as they wade into this complex with a loss in 2008.i Even high- performing hospitals had difficultynew environment. For those that navigate successfully, navigating the challenging operatingevidence suggests opportunities for great improvements in environment, given reimbursementpatient care delivery, outcomes and operating efficiencies. rate cuts and a sustained period ofRecognizing hospitals’ need for insights and tools, high unemployment. As the economy eases toward recovery, hospitalAccenture surveyed 15 CIOs from US health systems that executives will continue to confrontare currently EMR exemplars to glean their best practices a series of new obstacles overfor driving a more successful utilization of EMR solutions. the next five to ten years. Exhibit 1 highlights the forces bearing down on healthcare providers.Exhibit Pressures on the Operating Margins of Margins ofExhibit 1: 1: Pressures on the Operating U.S. Hospitals US HospitalsImpact of Market Forces on Provider Operating Margins Additional costs Medicare Rate Cuts Downward and risks of reform Top Line Impacts up to 15% from rate pressures requirements Healthcare Reform from all payers (e.g., ARRA) Ongoing increases in medical Severe clinical & IT costs increase supplies and IT labor shortages due to EMR and pharmaceutical drive long-term ICD-10 Bottom Line Impacts costs (~6–8%) cost increases implementation annually (3–4% increase) costs Current Reimbursement Increasing Clinical and Rising IT Payer Regulatory Operating Cuts Cost IT Labor Investment Pressures Compliance Margin Structure Shortage Costs CostsSource: Accenture analysis1 Centers for Medicare & Medicaid Services (CMS) defines meaningful use using three main components: “1. The use of a certified EHR in a meaningful manner; 2. The use of certified EHR technology for electronic exchange of health information to improve quality of health care (including e-prescribing in outpatient settings); and 3. The use of certified EHR technology to submit clinical quality and other measures.” For a full definition, please see: https://www.cms.gov/EHRIncentivePrograms/ 1
    • HIMSS Stages of EMR Maturity vs. All US Levels of Achievement Exhibit 2: HIMSS Stages of EMR Maturity vs. All U.S. Hospital Levels of Achievement Percent of Hospitals at Each Stage Stage Cumulative Capabilities 2008 2009 Mature Complete EMR; CCD transactions to share data; Meaningful Use Threshold EMR Stage 7 0.3% 0.7% data warehousing; data continuity with ED, ambulatory, OP Physician documentation (structured templates), full CDSS Stage 6 0.5% 1.6% (variance & compliance), full R-PACS Stage 5 Closed-loop medication administration 2.5% 3.8% Stage 4 CPOE, clinical decision support (clinical protocols) 2.5% 7.4% Nursing/clinical documentation (flow sheets), CDSS (error Stage 3 checking); PACS available outside Radiology 35.7% 50.9% CDR, controlled medical vocabulary, CDS, may have document Stage 2 31.4% 16.9% imaging; HIE capable Stage 1 Ancillaries- lab, rad, pharmacy-all installed 11.5% 7.2% No EMR Stage 0 All three ancillaries not installed 15.6% 11.5% Source: HIMSS In the short term, mandates Meanwhile, hospitals have come Even as all these pressures intensify, Requirements to upgrade Accenture’s EMR Study 10 percent of the total installed stemming from healthcare reform under increasing cost pressures hospitals are being asked to make technological infrastructure and hospitals in the health systems we To help prepare our clients better for will present varying complications due to the shortage of qualified significant investments in their to comply with new mandates studied. Meditech and Quadramed the EMR journey ahead, Accenture for hospitals. Some hospitals may nurses, primary care physicians healthcare IT infrastructures. pose further top-line risks for healthcare solutions were also conducted interviews with the CIOs benefit from these mandates, and clinically trained support staff. Regulations set forth by the hospitals. To be sure, the HITECH installed in a small segment of our of 15 leading US health systems, since reform will provide improved Labor costs typically account for 40 World Health Organization (WHO) Act provides incentive payments to total hospital population. [Note: We which range in revenue from $1 healthcare coverage to approximately to 50 percent of hospital operating are prompting a shift to ICD-10 encourage hospitals to adopt new are not recommending or supporting billion to $15 billion. Each system 25 million Americans by 2015, expenses.iv These costs will continue coding,2 which is expected to cost technology. However, it also contains the implementation or use of one was advanced in its EMR maturity, and 32 million by 2019.ii Other to increase as the industry struggles the industry $700 million to $2.7 penalties that will be imposed on specific EMR technology or vendor.] having achieved at least Healthcare hospitals may suffer from reduced to hire, train and retain skilled billionvii through 2013 in one-time hospitals that fail to meet strict Information and Management public spending or shifting patient resources. The total healthcare labor implementations and upgrades. implementation timelines. The Systems Society (HIMSS) Stage 4, mixes that adversely impact their gap may reach up to one million Additionally, ARRA stipulations, severity of these penalties varies and nearly all expected to achieve reimbursement rates. Over the longer nurses, physicians and healthcare including financial incentives and based on a hospital’s size and patient meaningful use before penalties term, however, reform (as currently IT resources by 2020,v representing penalties, accelerate the pace at mix. Still, Accenture estimates that begin in 2015. Study participants proposed) will almost assuredly hurt a shortage of almost 175 full-time which hospitals shift away from an average 500-bed facility would represented diverse geographies in margins at all hospitals, owing to equivalents (FTEs) per hospital.vi paper-based medical records. The face annual reductions in Medicare terms of their hospital footprints Medicare and Medicaid rate cuts resulting massive transition to reimbursement rates equivalent to a – Northeast (3), Midwest (5), West of up to 11 percent per patient.iii EMRs may translate into annual $3 million to $6 million fee annually (2) and South (5). One-third of our industry-wide expenditures of up to for failing to meet meaningful use participants represented academic $13 billion per yearviii in software, requirements by 2015. These fees medical centers. As Exhibit 3 hardware, labor and support services. weigh on the minds of hospital highlights, the EMR vendors used by executives. As Exhibit 2 highlights, this group are also diverse; however, more than 85 percent of hospitals over half of the hospitals included are outside of the compliance in the participating systems were range for meaningful use today. using Epic or Cerner. Eclipsys, GE and By Accenture’s estimates, roughly 2 ICD-10 is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, McKesson each accounted for about as classified by WHO. The code set allows more than 14,400 different codes and permits the tracking of many new diagnoses. half of US hospitals are at risk of incurring penalties starting in 2015.2 3
    • Through our 1. EMR planning and implementation must be a translated to IT operating expenses accounting for a larger percentage, These insights point to the need for interviews as well strategic initiative, not an IT nearly 200 basis points more, of the hospital’s overall operating adroit management of not only financial initiative – Having the passion, as quantitative influence, engagement and budget. Evidence also suggests resources but also programs, talent and that these expense inflections are benchmarking, attention of a hospital system’s leadership from the outset was sustained over the long term. stakeholders during each stage of the EMR we identified six consistently cited by our study participants as a success driver. 4. The war for health IT talent is on transition—whether it’s formulating an key insights that 2. It takes longer and costs – There is a significant shortage of qualified health IT professionals to implementation strategy, establishing a can help health more than most anticipate meet the demand associated with EMR implementation and support. blueprint for change, enabling employees – Most of the health systems systems successfully in our benchmarking study Nearly every CIO we interviewed and teams to adopt new ways of doing noted unfilled positions and navigate the EMR underestimated (by nearly 100 percent) the time and costs expressed concern about how their things or embedding EMR use throughout journey: associated with implementing advanced EMR functions, including health system would source enough talent from the marketplace, the entire organization (Exhibit 4). clinical order entry, nursing and physician documentation, including from EMR vendors to meet longer-term demands. Let’s now take a closer look at each clinical decision support and 5. Supporting EMR means thinking of the six insights for successful bar-coding medication. differently about capability and operating model needs – Hospital EMR adoption and use. 3. IT operating costs will spike, and managing them requires CIOs noted the need to think leadership alignment and differently about capabilities patience – Benchmarking shows required to support frontline that hospitals experience an EMR users as well as to drive 80 percent increase in their optimization of EMR-derived data through health analytics. IT operating expenses while Exhibit 4: Capabilities needed at at Each Stagethe the EMR Journey Exhibit 4: Capabilities Needed each stage of of EMR journey transitioning to EMR. This In terms of support (training, service and troubleshooting), the average hospital had to increase Financial Management the number of FTEs focused on healthcare IT support by 45 percent Exhibit 3: EMR Vendors as it reached mature levels of Represented by Study Participants Exhibit 3: EMR Vendors Represented by Study Participants functionality and adoption. Blueprint 6. Creating a culture for adoption is 5% essential – To achieve meaningful 5% use, 75 percent of the clinicians Epic in a hospital must, among other 10% Cemer things, demonstrate consistent use Enablement Strategy 30% of advanced EMR components, Stakeholder Program Eclipsys which include computerized Management Management GE physician order entry (CPOE), 10% physician documentation and McKesson closed-loop administration. Meditech Every CIO we spoke with talked about the need for a sharp focus 10% 30% Siemens Optimization on change management and Quadramed workforce engagement to ensure that key stakeholders, particularly physicians, get behind the effort and understand the benefits of using these components. Source: Accenture Talent Management4 5
    • Make EMR planning and implementation Exhibit 5: The Healthcare Ecosystem Exhibit 5: The Healthcare EcosystemHEALTHCARE ECOSYSTEM strategic initiatives, not IT initiatives Patient Consumer Patient Health Record Telehealth Patient Applications (PHR) & Other Virtually all of the CIOs we Our interviewees recommended The desire of chief executives to interviewed noted that the key developing an EMR business improve outcomes through health to scoring early wins with EMR case early for each major system analytics set these organizations implementation was securing the stakeholder, clarifying the clinical on an accelerated path to EMR Providers Payer passion and commitment of the and financial benefits for all. One planning and implementation. One CEO and the support of the hospital CIO noted, “We were late in engaging of our interviewees, in a system Hospitals Claims leadership team before embarking on all of the physician stakeholders recognized nationally for its success EMR Care Management the journey. Senior leaders must view in the ‘collective’ opportunity; it in driving health analytics, said that Rev Cycle PM Health and frame EMR as a driver of quality was not wise to do it piecemeal.” the organization’s EMR journey Exchange care delivery or, as one CIO put it, a (which began almost 30 years ago) Ambulatory Connectivity Ancillary Our study participants also suggested chance to deliver high-quality care was about capturing data in a way EMR that hospitals create a dedicated as a “system” to the communities that enabled thoughtful analysis Lab position—the Chief Medical Revenue Cycle/Practice that their organization serves. One and decisions. Another noted Pharmacy Informatics Officer (CMIO)—to serve Management leading hospital noted the passion that the CEO publicly put forth a Radiology as a bridge between the healthcare behind leveraging its EMR to test vision for transforming the health Post-Acute Care IT organization and the hospital’s if consistent use of new clinical outcomes of the metropolitan area clinical and business operations. practices and standards improved that the organization served—and The structure of this role can vary. outcomes and reduced medical then identified EMR as the tool for However, in our observations, CMIOs errors with a population of lung realizing that vision. This health Quality Outcomes/ Longitudinal Public Health report directly to the CIO or to the Community Community cancer patients. Each participating system has stated that its central Analytics Record Access Reporting Chief Medical Officer (CMO). In either hospital in our study noted that mission is to improve the health case, it is an important partnership Source: Accenture EMR implementation was a strategic of all citizens in a substantial part for the CIO. A CMIO must possess a imperative for their health system. of a very large metropolitan city. blend of deep clinical, technology and Framing the implementation in this It is investing hundreds of millions business management skills. He or she way helped leaders appropriate of dollars to establish a connected Enterprise EMR Strategy In addition, many of our participants Finally, most of the executives should also be backed by physician sufficient resources for the program health community with neighboring were subsidizing the costs of EMR we interviewed also had health engagement teams—groups of Many CIOs we interviewed said and make critical decisions on ambulatory physician groups. It is implementation for their affiliated information exchange (HIE)3 on their clinically trained personnel who can that they missed the opportunity capital investments and trade-offs. also offering significant financial physicians. This subsidization radar screen but noted that it was still “fight fires” and educate the clinical to think, at the outset, about their incentives to encourage these ranged from 50 to 100 percent, “early days” in terms of planning and Our interviewees proposed community about EMR and its usage. enterprise’s EMR journey, which affiliated physicians to adopt EMR depending on the health system commitment to HIE. Several pointed three keys to success for the During the EMR implementation, the included inpatient, outpatient and technology solutions, which is critical and on the independent physicians’ out that HIE was getting more of EMR strategic planning process: CMIO plays a central role in building ancillary services. Today, more than to enabling this connected network. willingness to adopt a preferred EMR their attention, owing to overtures engagement strategy, vision collaboration across the organization 85 percent of the health systems solution. All of the CIOs we spoke from vendors. However, they wished and enterprise EMR strategy. and ensuring buy-in from physicians. Indeed, the most frequently cited we studied are proactively engaging with noted that, regardless of the they had spent more time earlier in strategic objective by hospital CIOs ambulatory physicians as part of Engagement Strategy Vision participating in our interviews their current EMR strategy, three degree of support, getting these the planning phases thinking about independent physicians on board goals for connectivity with others in CIOs stressed the importance A subset of the CIOs we spoke was ensuring high-quality patient with significant financial incentives. was more challenging than they their healthcare ecosystem, outside of engaging not only hospital with articulated a vision for EMR care and health outcomes. Yet But they noted that doing this after anticipated, and that they fell far the walls of their own hospital. Many administrative leaders at the outset implementation early in their these hospitals also recognized the the initial planning stage made it behind their target acceptance rates. felt that because of this lack of of the EMR journey but also physician health system’s journey. But importance of realizing the financial more difficult to engage that group. early planning, they were now in a leaders. Many acknowledged that rather than framing EMR as a incentives for adopting EMR put position of having to play catch up. rework (for example, of order technology solution, they identified forth by ARRA. Nearly all of the CIOs sets and clinical work flows) was the clinical information and the noted that their organizations had required later in their health system’s associated health analytics that the incorporated incentive payments into EMR implementation because implementation would generate their strategic and budgetary plans. of limited engagement early on. to enable better care delivery and Turnover of key stakeholders and outcomes. They thus defined EMR lack of inclusion of physician as the vehicle for achieving a stakeholders, including community goal that everyone in their health physicians, worsened the problem. system cared deeply about. 3 Health information exchange is the mobilization of healthcare information electronically across organizations within a region, community or hospital system.6 7
    • Count on needing more time and money Expect your 3), possibly in an application service provider or cloud environment. Costs than you initially expected IT operating can also spike owing to an expansion Most of our survey respondents Over time, the lion’s share of EMR The hospitals we costs to spike, in the number of staff members using the EMR software, a rise in the vastly underestimated (by nearly 100 percent) the time and costs investment is dedicated to hardware, software and training, which together surveyed reported using and manage IT number of FTEs required to support or considering the more sophisticated EMR systems associated with implementing advanced EMR functions, including constitute roughly 60 percent of total EMR implementation costs. following practices to operating expenses and the steady costs of software clinical order entry, nursing However, these costs shrink over overcome cost- and time- through leadership licenses and upgrades. Interestingly, after system implementation, and physician documentation, time, and the amount spent on clinical decision support and support and maintenance labor management challenges: alignment and additional functionality (e.g., clinical decision support analytics) bar-coding medication. increases by about four times over the average implementation • Establish goals and plans for patience is sought, so the spend continues total cost of ownership targets to increase to meet greater value Many health systems time frame. Costs go from roughly throughout the EMR journey. The increasing level of complexity demand. As EMR systems continue three percent of total spend to 12 have difficulty taking into • Track performance against of EMR solutions and the challenges to pervade hospitals and replace or percent of total spend (Exhibit 6). account the increasing the stated business case and that accompany an advanced EMR connect with additional clinical and implementation often result in a administrative functions, we estimate cost of securing and ensure and clarify who is spike in IT operating expenses as that the percentage of hospital staff employing healthcare IT accountable for realizing each a percentage of total operating using an EMR could increase from of the benefits to that case. FTEs with clinical skills expenses (Exhibit 7). Data from our 40–50 percent to as much as 80–90 and the time required • Design tailored processes and benchmarking study illustrates that percent. In one leading hospital, clinical workflows to incorporate on average, a hospital’s healthcare IT approximately 75 percent of these to implement advanced EMR solutions at the start of the operating expenses as a percentage of FTEs were internally managed in the EMR functions fully. journey, instead of waiting until total operating expenses increased by short term. In the long term, the after solutions are already in place. roughly 80 percent during an advanced figure increased to approximately For example, the average time needed EMR implementation. Moreover, our 95 percent at this hospital. to reach HIMSS Stage 6 (physician • Use real-time feedback loops from pilot studies to guide management analysis highlighted that the increase documentation) was seven years,ix in operating expenses, as the hospital Managing through this inflection roughly double early expectations. throughout the implementation. reaches EMR maturity, is sustained. in healthcare IT operating costs However, with the availability of While actual expenditures may vary requires confidence, alignment and more mature and certified EMRs on across health systems, the increase in patience. This is particularly true the market, we expect EMR adoption IT operating expenses was a common given the historical role and image at HIMSS Stage 6 will be reduced Exhibit 6: Breakdown of Total EMR Market Spending theme with our survey participants. of IT organizations in the average and perhaps achieved during the US hospital. IT spending historically initial go-live of such a system. Hardware, Software, Training Costs Maintenance and Support Costs In addition, analysis of available accounted for less than three Our research suggests that the 60% data for HIMSS Stage 6 and 7 percent of total hospital revenue, average EMR implementation for hospitals shows that over time, IT and the allotted IT budget typically a 500-bed hospital might take budgets as a percentage of revenue represented less than four percent of 50% rose approximately 200 basis the overall hospital budget (Exhibit roughly five to seven years, may cost approximately $50 million points as hospitals reached more 8). These percentages are much and could result in $5 million 40% sophisticated stages of EMR use. smaller than in other US industries. % of Total EMR Costs to $6 million in government incentive payments if successful.x 30% This increase is driven by a number of forces, including the need to create interfaces with other hospital systems, 20% to design and manage middleware, to support incremental servers and to 10% shift the level of data-center support from higher tiers (many of our study 0% participants noted the need for Tier Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Source: Accenture Analysis8 9
    • Exhibit 7: Hospital IT operating expenses asas Percent of Total Operating Expenses Exhibit 7: IT Operating Expenses Percent of total Operating Expenses Exhibit 8: US provider IT Investment Relative to to Other US Industries Exhibit 8: US Provider IT Investment Relative Other U.S. Industries Sample US Provider Cost Waterfall Analysis Hospital Benchmarking Data Hospital Expectations (n = 163 hospitals) Relative to other major industries, providers have 4.5% been slow to adapt IT as a means of strategic differentiation, as highlighted by the relatively small IT spend as a percentage of revenue: 43% 4.0% - Financial Services: 5.7% - Information Technology: 5.5% 3.5% - Professional Services: 4.7% - Media: 4.6% - Telecommunications: 4.3% 3.0% 17% - Education: 4.3% - Insurance: 3.3% - Pharmaceuticals: 3.2% 8% 2.5% - Hospitality: 3.2% 3% - Travel: 3.1% - Healthcare Providers: 2.7% 18% 2.0% - Electronics: 2.7% 11% - Consumer Products: 2.5% - Retail: 1.8% 1.5% Revenue Labor Supplies Bad IT Other EBITDA Low EMR Maturity High EMR Maturity Costs Debt Expense OPEX Margin Source: Accenture’s 2010 EMR Survey & Benchmarking Survey Source: THC Financials, Caris & Company Analysis, Accenture Survey Information; Gartner IT Key Metrics Data 2010 To manage through the operating costs increases, many of our now placed through this simplified, standard set—a noted key to success. Win the war for additional 51,000 healthcare IT workers will be needed over the next But healthcare IT workers are not the only talent that hospitals need Most clinicians leave because of understaffing and the assignment interviewees recommended Standardizing order sets not only health IT talent five years to meet these challenges. to be concerned about. Clinicians constitute another crucial category of administrative responsibilities to them by hospitals seeking to provide standardizing order sets.4 Our strengthens a health system’s ability Hospitals, EMR vendors and systems research shows wide variation in to analyze data, it also makes it easier There is a significant shortage of integrators are all competing with of talent. And many hospitals view more service using fewer resources. the number of order sets across the for the system to use the clinical qualified health IT professionals to one another for these scarce workers. implementing an EMR system as a While there is no simple solution for study participants—from just 100 to decision support system (CDSS) and support EMR implementation demand way to retain and attract their clinical solving clinician staffing shortages in the next three to five years. Nearly “The skills shortage is real,” said the upwards of 2,500. Many participants to predict maintenance costs. workforce. Employee dissatisfaction in the short term, EMR may improve every CIO we interviewed noted CIO of a $3 billion health system conducted analyses revealing that and turnover are widespread problems engagement among these and other unfilled positions and expressed that participated in our study. “At numerous order sets were simply for hospitals and can significantly employees by increasing work flow concerns about how to source any given time, I have 50 unfilled not being used in their health increase annual operating expenses. efficiency. Take a large Midwestern enough talent from the marketplace IT roles. Like my peers, I need to system. They were able to rationalize For example, the average turnover health system as an example. The (and even from their EMR vendors) be focused on finding the right at least 50 percent of them; for rate for nurses across the US is 13.9 organization incorporated clinical and how to prevent attrition. skills (first) and at the right price example, by omitting those that percent per year. It is not uncommon treatment protocols into its EMR Accenture’s research shows that (second).” Another interviewee noted, were not being consistently utilized for hospitals to pay signing and system, expediting the ordering of reaching EMR maturity requires 0.2 “We could have 25 percent more across the system. This dramatically retention bonuses as large as $25,000 radiological tests, chemotherapy and healthcare IT FTEs per hospital bed. people in our IT department, but reduced the complexity of managing, to secure qualified nurses. Add to that medications.xi These changes reduced That translates into a requisite supply that would still not be enough to supporting and utilizing their EMR the costs of internal recruiting and strain on clinical staff—which in turn of approximately 155,000 FTEs in the properly support our EMR system.” solution. One leading hospital noted training for new hires, and turnover improved provider satisfaction (as going from several thousand to a US. Gartner estimates that there are Another challenge facing hospitals becomes alarmingly expensive. measured through formal surveys). few hundred order sets and cites about 110,000 skilled IT FTEs in today’s is how to keep their current IT that 60–65 percent of its orders are workforce, creating a deficit of nearly staff up to date on training. As 50,000. The Office of the National eHealth solutions become more 4 Coordinator for Health Information sophisticated, hospitals must identify An order set is a standardized list of orders for a specific diagnosis. These orders have been developed by a team of physicians who consult medical literature for evidence-based standards. Technology also estimates that an ways to ensure that their current IT employees have the skills needed to manage and use these solutions.10 11
    • To address the intensifying war for healthcare talent, our Think differently Hospital CIOs in our study noted the need to think differently about In addition, our interviewees noted that they expected to encounter survey participants recommended the following practices: • Consider creating a separate about your the capabilities required to support challenges in supporting huge • Focus on being an “employer frontline EMR users and to optimize volumes of electronic data (whether of choice” for the brightest IT organization to house specialized capability needs EMR-derived data through analytics. for electronic medical records or healthcare IT talent. Within professionals who are evaluating potential health systems as well this organization, offer a more for tomorrow’s In terms of support (training, service and troubleshooting), the number electronic health records, EHRs), securing data integrity and as jobs in other industries. attractive benefits package and a different career model; information- of FTEs hired by the average hospital increased by 45 percent as it reached supporting health analytics needs. One CIO noted concerns he and • Create talent development programs specifically for for instance, opportunities to powered mature levels of EMR functionality his peers had with analyzing and progress rapidly in the job and to and adoption. In addition, our data managing huge amounts of data. healthcare IT specialists. earn more competitive salaries environment showed that mature EMR users Most CIOs noted the importance • Take advantage of third-party than what would typically be rely on more clinically trained of the CMIO in surmounting these sourcing pools for IT workers, provided through health systems’ resources, such as registered nurses challenges. But they also lamented either onshore or offshore. traditional modest pay increases. and pharmacists, for EMR support that deep data warehousing, You may be able to source those and optimization. On average, statistical and informatics skills • Establish in-house education skills to different hospitals in approximately 30 percent of the do not reside in the average US departments to provide the your health system during your mature EMR IT organizations in our hospital. Indeed, HIMSS estimates latest training for IT staff. organization’s EMR journey. study consisted of clinically trained that only 25 percent of US hospitals • Forge partnerships with local resources—dramatic increases from have any data warehouse or mining • Establish a vendor-sponsored colleges; for example, by setting their early stages (Exhibit 9). capabilities. One leading practice “boot camp”—a local training up internship programs for IT work. that Accenture has helped implement camp to retool IT professionals for clients is the VIP Helpdesk for in the area. You can draw on the resulting talent pool to support physicians. (See sidebar “Spotlight your health system’s needs. on Accenture’s Service Desk”). “Training is key, retention is key,” said one Spotlight on Accenture is working with Accenture’s Service Desk is a large academic health a single point of contact CIO of a large academic medical center. Accenture’s system on a connected for all application and “Candidates come not only from existing Service Desk health technology initiative infrastructure and support IT staff, but also from physicians, nurses to improve patient needs. The solution lets care while maximizing users call the same number and technicians always looking for operational efficiency they use today; however, aptitude. This is a good time to identify and effectiveness. Earlier the calls are rerouted to this year, the organization Tier 1 specialists based people who are looking for career change received the highest level upon routing criteria or development,” added this CIO. designation (Stage 7) and user demographic for its EMR from HIMSS information. The solution Analytics, the industry also includes other multiple organization focused on contact channels, including the use of information email, chat and voicemail, technology in healthcare. to reach the service desk, as well as providing the self-service portal.12 13
    • Create a culture for EMR adoption Our surveyed To fully achieve meaningful use, the executives suggested majority of the clinicians in a hospital additional practices must consistently use the EMR system for creating a in their day-to-day activities, including culture for EMR advanced components such as CPOE, adoption clinical decision support, physician documentation, nursing documentation and closed-loop medication administration. Every CIO we interviewed advised Most of the CIOs we interviewed One noted spending at least an • Develop a readiness and • Maintain momentum through Most of our survey participants investing as much as possible in were actively involved in EMR-related evening every week with cohorts preparation plan. If needed, hire the EMR optimization stage. were far along in their EMR change management and engagement engagement and change management of physicians, educating them an independent firm to evaluate Implementing an EMR system journey, and many had sustained to ensure that key stakeholders, activities as well as in the recruitment on the benefits of the tools. the readiness of your clinical isn’t the end of your journey. momentum by defining an particularly physicians, are aligned of affiliated physicians as part of the environment for the changes to The resulting data must also be “EMR optimization” phase behind the EMR effort and that they hospital’s EMR ambulatory strategy. processes and work flows that optimized; that is, the organization and communicating it to their see the benefits of using the advanced accompany transition to an EMR needs to realize a return on its organizations. To win buy-in for tools. Our interviewees also strongly system. This evaluation may help EMR investment and show that optimization, stress the importance recommended engaging physicians Exhibit 9: Percentage of Clinicians you prepare your organization employees and other stakeholders of meeting key goals such as in EMR/IT governance decisions early in IT Organizations of Leading Hospitals for the change as well as build are using EMR technology driving physician adoption to the on. One executive used an outside goodwill during the EMR design, in a way that improves their target 90 percent mark, achieving firm to conduct a full EMR readiness 40% build and optimization stages. productivity and strengthens the meaningful use and realizing the assessment. As part of the assessment, bottom line. However, in many tangible and intangible benefits 35% • Provide physician-centric the firm gauged how a transition health systems, stakeholders view of EMR. Remind stakeholders that support. CIOs we interviewed to an EMR solution would impact 30% implementation as the destination. optimizing their EMR will help noted the importance of the health system’s work flows and them make better use of health 25% identifying and using multiple They celebrate completion of processes and identified where the analytics and position them to channels of engagement with this phase and then turn their organization might encounter some 20% realize their vision for connected the physician community. As attention to other challenges. As resistance to changes in ways of and quality service throughout 15% noted earlier, dedicated physician a result, optimization suffers. You doing work. The assessment helped their health ecosystem. engagement teams supporting need to take action to maintain executives determine how best to 10% your CMIO can help you articulate enthusiasm and momentum manage those impacts effectively and address physicians’ needs as through the implementation and within the clinical community. 5% they move up the adoption curve. into the optimization stage. 0% Low EMR Maturity High EMR Maturity Source: Accenture 2010 Benchmarking Survey14 15
    • Next steps i vi Between regulatory staff, healthcare IT To surmount the challenges American Hospital Association; Chartbook 2009 (http://www.aha.org/aha/research- Based on total number of hospitals in the US (5,815) divided by labor shortage changes and mounting professionals—with the that come with the and-trends/chartbook/ch4.html). of 1 million FTEs. Source: AHA Fast Facts (http://www.aha.org/aha/resource-center/ pressures on health systems tools and processes EMR journey, healthcare ii Based on projections through 2019. Statistics-and-Studies/fast-facts.html). Source: Leerink Swann estimates and to lower costs, improve needed to provide the executives can learn a Congressional Budget Office, “Industry vii “Examining the Cost of Implementing ICD-10,” Update – Hospitals: Estimating the Impact Hay Group, October 12, 2006. efficiency and enhance highest- quality patient lot from peers who have of Healthcare Reform,” March 23, 2010. viii quality of patient care, care and safety. begun the journey and iii Refers to the total savings in 2019 combining Accenture analysis based on total labor spend (internal and external support), software, the implementation captured lessons along DSH payment rate cuts and productivity hardware, training and associated vendor While taking the best adjustments to the market basket for services (such as assistance with change and adoption of EMRs the way. This report has Medicare. Source: Leerink Swann estimates management and process optimization). is a transformational possible care of patients presented key insights and and Congressional Budget Office, “Industry ix Update – Hospitals: Estimating the Impact Accenture analysis (http:// is a mission that all milestone for US hospitals recommendations from of Healthcare Reform,” March 23, 2010. www.himssanalytics.org/docs/ healthcare stakeholders stage6whitepaper.pdf). and the health industry CIOs of leading health iv Based on analysis of publicly traded hold dear, adopting and companies as well as select data provided x Accenture analysis. overall. Hospitals that can systems that have made to Accenture by private hospitals. using an EMR system xi Nicholas E. Davies Symposium Proceedings, demonstrate that they are major strides in EMR. By v “What works: Healing the healthcare staffing Ohio State (2001), as cited in “EHR requires that people shortage,” PWC (http://www.pwc.com/us/en/ and the Return on Investment through making meaningful use of considering these insights healthcare/publications/what-works-healing- HIMSS Analytics” (http://www.himss. change numerous aspects EMRs in the coming years and recommendations, the-healthcare-staffing-shortage.jhtml). org/content/files/ehr-roi.pdf). will position themselves to of how they carry out health systems seeking to their work. And that capture valuable incentives navigate the complex EMR can spark confusion and as well as avoid worrisome journey can vastly sweeten resistance. Moreover, penalties. Even more the odds of succeeding. setting up an EMR system importantly, they will equip and optimizing the data key stakeholder groups— it generates is time- clinicians, administrative consuming and expensive.16 17
    • Copyright © 2011 Accenture About Accenture About the AuthorsAll rights reserved. Accenture is a global management Mark Knickrehm is the GlobalAccenture, its logo, and consulting, technology services Managing Director of AccenturesHigh Performance Delivered and outsourcing company, with Health practice.are trademarks of Accenture. approximately 211,000 people serving Kristin Ficery is a Senior Executive clients in more than 120 countries. in Accentures Health Management Combining unparalleled experience, Consulting practice. comprehensive capabilities across all industries and business functions, and extensive research on the world’s most successful companies, Accenture collaborates with clients to help them become high-performance businesses and governments. The company generated net revenues of US$21.6 billion for the fiscal year ended Aug. 31, 2010. Its home page is www.accenture.com.