To have your cake and eat it:Planning for a future EHR and meeting todays needs

Jonah Aburrow-Jones, Senior Vice PresidentThe HCI Group

3rd March 2015 eHealth Week

Starting in land far, far away

• Since 2009, the HITECH Act and Meaningful Use (Stage 1 and Stage 2) accelerated the implementation and adoption of EHRs in the USA.

• Phased journey to get healthcare more automated.

• Focus on using EHRs in a meaningful way, then with interoperability and data analytics truly use them to change the protocols of care.

• Rush to get automated has led to “What do I do with it now?”– Significant costs in optimisation– Longer time to realise benefits– Now trying to move from Meaningful Use to Meaningful

Care– Delivering care isn’t just about an EHR

2

EHRs: Market Drivers

• Data, data everywhere – every increasing amounts, detail and need for analysis

• Increasing population, particularly elderly

• Increase in chronic disease (COPD, Type II Diabetes, Cancer)

• Increased pressure on costs (↑Drugs, ↓ Tariffs, ↓ Budgets, ↑ CIPs)

• Clinical Staffing (↓ people entering healthcare, ↑ people leaving, ↑ mobility across geographies)

• Public Healthcare systems becoming unsustainable without significant change

• ↑ expectations for access to healthcare provision, ↑ access to healthcare information and growth in personal health devices.

• Competitive differentiator between Trusts

EHRs: The Benefits

• Focus should be on the patient• Most EHR business cases use non-patient care justifications

– Efficiency, productivity, communication, transparency and accountability

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The Future of EHRs in the NHS

• Integrated EHRs are here and more coming• In England, it is estimated that >40 Acute Trusts will start to

procure and implement new EHRs in next 24 months– The Paperless agenda– Integrated Care– Have to address a culture of workarounds and working in spite or

despite IT systems– Current systems are unsustainable

• Limited NHS generated evidence to support success of EHRs

• It takes at least two years to procure and implement an integrated EHR

• What happens to continuing to improve patient care during that period?

Technology Enabled Transformation

6

Process

Technology

People

CHANGE

EN

AB

LE

IMPLEMENT

Why a Transformation Project?

• By its nature, an EHR project isn’t an IT project. It is an organisational, change project on a large scale.

• Realising benefits has to start in pre-implementation of an EHR and doesn’t stop – in continues and system evolves.

• The ROI on a large integrated EHR can be >8 years.

• Benefits realisation, and therefore ROI, isn’t the job of IT departments – it is the clinical and business users

• Clinical ownership and accountability is critical

• Workflow redesign should be planned at the start point, not when the system goes live

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Advantage of EHR & Transformation

• Without alignment, one can become a limitation to the other• Reduces start-stop• Potential for sharing of budgets and resources• Creates a mindset that change isn’t a bad thing• Fosters “the art of the possible”

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Transformation Program

IT Project

Level of Benefit

Technology Enabled Transformation Program

Process Improvement & Technology

BENEFITS

+

++

£0

-

--

Project Starts

DANGER ZONE

Technology Only

Benefits Baseline

Strategic goals, results- focused process redesign, and effective change management to drive value to realisation and sustainability

Transformation (Technology + Process

Improvement)

Process Improvement Only

COSTS

The 3rd Element: People

• There will be very significant change management related to this transformation.

• Change impacts employees jobs and how they do their jobs• Three people related factors that can define or constrain an

EHR project:– Speed of adoption (how quickly employees make the change),– Ultimate utilisation (how many of them in total make the change) and– Proficiency (how effective they are when they have made the change).

• If managed ineffectively, employees are slower to make the change, fewer of them make the change and they are less effective once they have made the change.

• The vast majority of staff will be affected by integrated EHR.

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So what’s the problem?

• Trusts have to continue to improve care and cut costs in the 2 year gap between starting an EHR procurement and go live

• Every Trust has a list of tactical IT projects as well as keeping the lights on

• Every Trust has objectives setting out targets for care improvement (beyond statutory ones)

• Limited experience with large scale transformation and change projects

• Resources – financially and staff are limited

• Care for patients moves between providers

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Closing the Gap

• Develop clinical ownership and engagement at the earliest opportunity. Failure to do this will raise risk of failure.

• Evaluate and improve process but keep aligned with the long term goals.

• Baseline current state and identify the aspired future state

• Identify pain points

• Plan for short, medium and long term benefits realisation

• Invest in being ready– Governance– Research– Engage with vendors early

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Closing the Gap

• Analyse best use of current systems in terms of interim and likely EHR functionality.

• Consider interim solutions.

• Be ruthless in killing projects which do not align with the longer term goals.

• Do not overstretch with too many tactical projects eating into resources needed for a strategic level one such as an EHR.

• Have structured and ongoing communication with all stakeholders – internal and external.

• Don’t believe that you can do it all yourselves.

Summary

• Having a EHR as part of a transformation project has significant benefits.

• EHR pre-implementation planning can identify and prioritise solutions of pain points in the gap period.

• Utilise the mix of people, process and technology to help drive improvements.

• Don’t become distracted, stay aligned with goals and objectives.

• It is possible, with the right preparation and approach, to have your cake and eat it.

Thank youQ&A

Jonah Aburrow-Jones, Senior Vice Presidentjonah.aburrow-jones@thehcigroup.com