Summer is my favorite time of the year, mostly because I love ice cream! Of course, it also happens to be bathing suit time, and it seems like an opportunity to streamline my waist as well. It may sound oxymoronic to say I love ice cream and that I am thinking about my waistline, however with constant improvement and transformation, I can find a great balance for the optimal state, or at least keep trying. I take this exact same approach in my day-to-day work with clients. How do we streamline, increase efficiency, save money, and get the Electronic Health Record into its most optimal state?
Optimization is the key, and like ice cream, it can come in 31 flavors and all different shapes and sizes. Many healthcare IT departments have project-driven roadmaps and have recently been focused on regulatory-driven or vendor-driven projects, such as Meaningful Use, ICD-10, Quality Reporting, Interface Migrations (e.g. ConnectR to CIE/Rhapsody), Upgrades, and Hot Fixes. Often, these project-driven departments overlook or have difficulty finding time to perform the optimization work that I typically find my clients needing. “We need to do an optimization but just have to find the time.” An effective approach to this common dilemma is to consider dissecting what could be a large project into more achievable mini projects. This produces quick wins and successes with immediate results, versus tackling the grand project which will take a longer time to yield improvements. Optimization is about more than just user experience/satisfaction; it also directly impacts finances associated with opportunities such as reducing inefficient staffing costs and exploiting untapped revenue gains.
Using the Galen methodology, we break down an optimization project into something that can be easily achieved with incremental goals. Our methodology includes the following phases: Discovery, Approach, Adaptive Execution, Activation, and Operations. Let’s walk through how an organization can take any one of the many flavors of an optimization project and reap the rewards.
- Discovery: the first step is to understand the need. Is the need reducing clicks, decreasing time of task completion or note signing, or is it participating in a new regulatory reporting (PQRS, PCHM) program to gain revenue? Is it possible to develop an optimization program that covers all of this in some aspect?
- Approach: next, develop the plan. Decide on the metrics, qualify the goals, and clearly state deliverables that denote success. A simple example of a type of optimization is benchmarking current state on the time it takes providers to verify a result or sign a note. Both of these drive patient safety and quality. How long it takes to sign a note can have a revenue impact if claims are held until notes are signed to avoid audit ramifications. Due to ICD-10 compliance, future audits rates are expected to increase, and this is a great “flavor” of optimization to consider.
- Adaptive execution: documenting the plan is key. This important step of clearly stating tasks and deliverables helps to limit the risk for project failure. List out the resources utilized and actual tasks to be executed in order to meet the desired goals/metrics.
- Activation: follow the plan. This seems like it would be the easiest but, in my opinion, is often the hardest phase of any project. Periodic benchmarking of goals/metrics and mitigating risks that come up along the way can be a challenge, just like the summertime carnival game “Whack-a-Mole.”
- Operations: plan for support. Every project, regardless of the size, should have a period of support/maintenance. Some projects lack this phase, and once the metrics/baselines are achieved and the project is completed, things just go back to the way they were. Change is hard! Just as with controlling my ice cream intake and streamlining the ole waistline, continued support and maintenance is required.
Now that we have a methodology in place, what could an optimization project look like in your organization?
Below are some suggestions/examples to consider:
- Enterprise optimization: usually this refers to the configuration/build of a given area within the application. It could be that you decided on a fast implementation to gather adoption at the onset, but you now want to go back and fine-tune. Perhaps resources have changed since the initial rollout, and the current team wants to look under the hood at a deeper level. The following areas are typically reviewed in an optimization for recommendations on how to improve their configurations:
- Note optimization: oftentimes, this is its own category, whether trying to move from v10 to v11 to ACN, or merely looking to improve the amount of time it takes to sign notes by tweaking existing notes or retraining.
- Meaningful Use, PQRS, ACO (other regulatory initiatives): reviewing if by simply altering a minor workflow or configuration, you could reduce clicks or improve attestation statistics. More importantly, this could reveal an opportunity to participate in an incentive program that you were previously missing out on or unaware of.
- Specialty focused: is there a certain specialty within your organization that could benefit from some type of optimization?
In working with clients over the years, we have developed a variety of optimization projects with a proven track record of results-driven metrics, such as reducing the number of notes left unsigned by a certain time of day for a provider group, or decreasing the time it takes to complete a task, such as verifying results or renewing medications. One optimization project we performed demonstrated an overall reduction in task completion time by 18%. A decrease in the time it takes to complete a task can lead to improved patient care as well as the ability to see more patients. These types of optimization projects not only add value by improving patient safety and quality of care, which is key in the healthcare reform arena, but also mean less time in the office and more time enjoying summer and getting out for that ice cream or round of golf!