Lessons Learned from EHR Business Intelligence Solutions

The latest Black Book  annual evaluation of leading healthcare and medical software and service providers across 18 operational excellence key performance indicators suggest electronic health record systems vendor are continuing to fall short of provider’s expectations leading 2013 to be the year of the great Electronic Medical Records/Electronic Health Records (EMR/EHR) vendor switch. http://www.practicefusion.com/resources/black-book-rankings-2012-top-EMR-EHR-vendors.pdf

EHRs are great at capturing episodic data, while Business Intelligence (BI) is good at looking across visits, hospitals and systems. But BI technology is useless without the data from a solid EHR adoption.  Clinical analytics and BI are growing in importance as healthcare organizations consider participation in care delivery and payment reforms, such as Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMH). Without the ability to analyze their clinical and business workflows, these organizations will not be able to identify areas for improvement efficiently and effectively. 

BI solutions additionally are leveraged to analyze data from revenue, staff performance and efficiency of operations. BI solutions, often manifested as informational dashboards, are increasingly included in hospital information systems and integrated with enterprise EHR.

Independent insight gathered indicates EHR vendors have been preoccupied with backlogged implementations and selling product (with development issues) and neglected BI as a priority. Most concerning to current EHR users are unmet pleas for sophisticated interfaces tools with other practice programs, complex connectivity and networking schemes, pacing with accountable care progresses, and the rapid EHR adoption of mobile devices.

The survey revealed that some popular “one size fits all” EHR products have failed to meet the needs of several medical specialties and cannot continue to satisfy their client base with a lack of Enterprise BI and BI tools. As far as EHR systems meeting the expectations of various medical specialties, nephrologists reported the highest rate of discontent, with 88 percent saying their EHR systems fail to meet their needs. Providers in urology, ophthalmology and gastroenterology also reported high rates of discontent. Contrastingly, a much lower number of small practice physicians (54 percent) reported that their system failed to meet their needs. Many reported an original business case and desire to use the demonstrated BI solution to promote EHR adoption.

Why have they failed 

  • Lack of commitment from top management to “make it happen in EHR’s BI commitment”
  • Lack of clear definition and agreement on business and reporting requirements to be implemented in the EHR BI solution (was ERP considered?)
  • Lack of clear BI definition and agreement on organizational structures to be implemented in the EHR
  • Lack of willingness to adjust expectations to what is practical within an EHR solution and where does and ERP pick up
  • Lack of willingness to give up traditional ways of doing things and be trained in new processes and techniques
  • Lack of willingness to accept standard ways of doing business across the enterprise
  • Lack of an effective decision-making process at the start of the EHR project and all the way through the final accepted configuration
  • Lack of willingness to change organizational structure through re-engineering
  • Lack of willingness to adapt to the new environment at:
    • The executive level
    • The operational level
    • The field level

Lessons Learn: A Recipe for Success 

Getting Started

  • Your project is as successful as the healthcare “business” says it is
  • Form a partnership with the business stakeholder: both clinical and operational
  • Agree on the desired end state (focus on the Enterprise)
  • Plan a weekly sync to read out on progress and address issues with the business

Negotiating Priority

  • Negotiate the BI priority of your project vs. others that are planned and ongoing
    • Build agreement on the criticality of your project to ensure adequate resourcing
  • Be up-front about what will be needed to build the right delivery team
    • If resourcing is an issue, work with the business to keep the scope contained to only the most critical elements
    • Communicate any scheduling impacts

Measuring Success

  • “Enabling better decisions” is a lofty but vague goal
  • Define key use cases with your clinical business stakeholders with Yes or No outcomes
    • User Adoption Goals
  • Did we achieve x% penetration of this BI tool throughout our user base?
    • Enabling new capability or function
  • Did the new feature or campaign launch on schedule?
    • Instrumenting key healthcare business objectives
  • Can we measure the segment migration of our customers?

Gap Analysis

  • Does the current data infrastructure support the project?
    • Can any existing BI reporting systems be leveraged to support the requirements?
    • Bolt on the new system to existing system if possible
    • Set reasonable expectations with regard to implementing new infrastructure?

Plan & Build

  • Dedicate your best resources
    • “Beg, Borrow, and Deal”
  • Determine your team’s bandwidth
    • Developers can go “supernova” for about two months
    • Then ease up a bit
  • Reward your team
    • They will appreciate it and be ready for the next round

Lightweight & Agile

  • Two-week sprints with clear deliverables
  • Quick daily stand-ups to discuss any blocking issues
  • Large-scale user stories can be broken up into sub-tasks
  • Put your best people on the most critical tasks
  • Bi-weekly sprint demos to business stakeholders

Live Together

  • Collocate the delivery team in a “war room” or other designated space
    • Improved collaboration and issue resolution
    • Break up business as usual and relaxed routines
    • Bring in lunches to save lots of travel and waiting time for key team members

Ramping Vendors

  • Hiring contractors to augment staff can help, but…
    • Vendors still require ramp-up time
  • Access to systems, badges, learning data models, terminology, etc.
  • Leading IT consultancies do have rock star talent
  • They are used to demonstrating value quickly
    • Integrate them with your own FTE staff to build a team of superstars
  • Avoid outsourcing key projects in their entirety

Pitfalls & How to Avoid Them

  • The success of the project will depend on a few variables including:
    • Project resourcing relative to scope of deliverables
    • Clearly understood and (lightly) documented requirements
    • Dependencies on other teams that may not have as much at stake
    • Motivation, level, and skill set of development team
    • Trust within the team and trust in the PM leading the project
    • Ongoing communication with the business stakeholders

Although different hospitals will find different land mines in the budgeting & planning process, those who have implemented healthcare BI solutions agree that certain costs are more commonly overlooked or underestimated than others. Armed with insights from across the business, BI pros vote the following areas as most likely to result in budget overrun.

  • Training
  • Integration and Testing
  • Data Conversion
  • Data Analysis
  • Consulting Costs
  • Replacing your Best and Brightest
  • Implementation Teams Can Never Stop
  • Waiting for ROI (not understanding the full solution)
  • Post-EHR BI Depression
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