This document discusses setting goals and measuring the impact of health IT and EHRs on healthcare value. It outlines that while EHRs can increase efficiency and improve care, concerns exist about return on investment and unintended consequences. Organizations must understand feasible benefits, set specific and measurable goals, and monitor results to maximize EHR value. Goals should align with the "Triple Aim" of improving care experiences, population health, and costs. Proper goal setting, education, change management, vendor selection, and system implementation are critical to realizing benefits. Both quantitative and qualitative metrics are needed to determine if goals are achieved.

1. © 2017 American Health Information Management Association© 2017 American Health Information Management Association
Health IT and EHRs:
Principles and Practice, Sixth Edition
Chapter 4: Health IT Goal
Setting and Measuring the
Impact on Healthcare Value

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Value and Controversy
• Many believe and an increasing number of
studies demonstrate that widespread adoption of
EHR and health IT:
o Increases efficiency
o Improves patient care
• Yet there are also increasing concerns about:
o Financial return on investment
o Potential unintended consequences
o Reduced time for patient-clinician interaction

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Critical Success Factor
• Understand what benefits are feasible and
establish specific goals and processes to
achieve them
• Organizations need to setting
expectations, monitor results, and provide
feedback to get the most from EHR and
health IT

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Value and the Triple Aim Goals
• Value is the fair return in goods, services, or money for
something exchanged
• In the US healthcare system, value has been defined as
care that is safe, effective, patient-centered, timely, efficient,
and equitable
• Health reform has adopted the Triple Aim goals to:
o Improve the experience of care
o Improve the health of a population
o Decrease per capita costs of healthcare
• When science, informatics, incentives, and culture for
continuous improvement and innovation exist in healthcare,
the result is a learning health system

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Triple Aim and Learning Health System

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Setting Goals and Expectations
for Achieving Value
• Goal is a specific, intended result of a
strategy
– Goals must be Specific, Measurable, Achievable,
Realistic, and Time-based (SMART)
– Smart goals should Teach and organization to
Reach higher levels of performance by Engaging
everyone in Testing hypotheses through Cross-
functional Cooperation in a Human fashion
(STRETCH).

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Writing SMART Goals

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Setting Expectations for Goal Achievement
Copyright © 2016, MargretA Consulting, LLC. Reprinted with permission.

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Goal Setting and Education
• Stakeholders must understand what an
EHR can do and what is feasible in order
to set appropriate goals.
o Too moderate goals will not yield sufficient
benefit to return investment.
o Too great expectations will result in
disappointment.
• Education is needed to set realistic goals.

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Goal Setting and Change
Management
• Identifying goals can lead to stakeholder buy-in.
• Goal setting is a part of change management.
o It must allow participation to achieve goal ownership.
• It allows for anticipation of change.
• Goals must be expressed as benefits that are
real.
• Expectation setting must be accompanied by
reassurance that there is support to achieve the
goals.

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Goal Setting and Vendor
Selection
• Vendors should be selected based on their
product’s ability to support goal
achievement
• Contract negotiation should reflect
milestones related to the organization’s
goals for the technology being acquired

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Goal Setting and System
Configuration, Testing, and
Training
• Goals with clear metrics and explicit
descriptions of how an organization’s
objectives will be met with health IT
focuses implementation:
o Systems will be configured properly
o Systems will not pass testing without evidence
of being able to support goals
o Training will related goals directly to what is
being trained and the competencies achieved

13. © 2017 American Health Information Management AssociationCopyright © 2016, MargretA Consulting, LLC. Reprinted with permission.
Monitoring Goal Achievement

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Determining if Expected
Benefits are Achieved
• It is not easy to determine whether expected
benefits have been achieved.
o Benefits studies must be appropriately
constructed to determine if goals are being met
o Confounding variables confuse interpretation of
data and make it difficult to determine results
• There are several types of benefits
descriptions

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Quantitative vs. Qualitative Benefits
Source: Forrestal 2016

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Quantifiable vs. Anecdotal Benefits
• Meta-analysis that integrates findings from many similar
organizations using similar systems may improve the value of
anecdotal results.

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Benefits Measurement,
Reporting, and Improvement
• Measurement alone rarely results in continual
improvement.
• Metrics must be established to measure
benefits
• Findings of measurements must be reported
to appropriate stakeholders so they have
feedback on whether desired benefits are
being realized or if improvements are
needed.

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Measurement
• Metric is a standardized description of
what will be measured.
o The term “measure” is often used when the
appropriate term should be “metric”
• Two types of measures:
o Process
o Outcomes

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Reporting Systems
• Collect data consistent with the metrics/measures
set forth
• Offer comparisons and trending information
between baseline data and current state
• May provide recommendations for further
improvement
Note: a culture of “shame and blame” has existed in
healthcare, often leading to healthcare persons hiding rather
than reporting errors. Reports must be accurate, trustworthy,
timely, equitable, and transparent to be effective

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Improvement
• Reports should help individuals recognize a
specific opportunity for improvement
o Clinical decision support provides data for a specific
case at the point of care
o Integrating clinical and financial data can help providers
select appropriate drugs, make referrals, avoid
duplicative and unnecessary diagnostic studies, and
coordinate care
• Reporting may encourage healthy competition that
can lead to change

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Benefits of Health IT and EHR
• Clinical
• Financial

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Clinical Benefits
• Clinical quality measures (CQM) have been established to
measure outcomes for many common disease conditions
o Electronic CQM (eCQM) are being developed from CQMs, that have
largely been fairly comprehensive documents with little guidance on
data to be collected or how reporting should be accomplished
• Though CQMs are available for many of the most common
healthcare conditions, an issue is that there are many near-
duplicate measures
o National Quality Forum is a consensus-driven organization
committed to creating CQMs. Medicare uses NQF measures.
o But many commercial health plans generate their own versions of
measures – to the point that there are many versions of the same
measures, resulting in extra work for providers and inability to make
valid comparisons

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Example of NQF CQM Excerpt from Page 1 of 3 for
Measure 0059

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Excerpt from Page 2 of 3

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Measuring Clinical Impact of EHR and Health
IT
• Access to clinical information
• Patient follow-up/recalls
• Reduced errors/patient safety
• More tailored patient education
• Enhanced documentation
• Physician-patient communications/more time to spend
with patients
• Clinical decision making with guidelines and protocols
• New models of care

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Quantifying Clinical Benefits: Example 1

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Quantifying Clinical Benefits: Example 2

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Support for New Models of Care

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New Payment Models

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New Organizational and Care
Delivery Models

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Financial Benefits
• Cost savings
o Example: reduction in forms production in paperless environment
• Cost avoidance
o Example: avoiding staff recruitment costs because staff retained longer
• Revenue increases
o Example: Accurate E&M coding
• Contribution to profit
o Example: Reduce complications from adverse drug events that cut out
profits in a discounted fee for service or managed care environment
• Productivity improvements
o Example: See two more patients in a day due to less time on
documentation

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Financial Impact Analysis

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Total Cost of Ownership: Costs

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Total Cost of Ownership:
Benefits

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Data Collection for Financial
Analysis
• Cost data
o Hardware
o Software
o Implementation
• Benefits Data
o Cost savings
o Cost avoidance
o Revenue increases
o Contribution to profit
o Productivity
improvements

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Cost-Benefit Analysis

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Cumulative Impact Showing
Payback Period