Rome wasn’t built in a day, and the same could certainly be said for an EMR system. It’s a journey rather than a project – but the most difficult part of the process isn’t the EMR implementation. Rather, it’s building the business case, identifying the benefits, defining the key performance indicators (KPIs) and establishing governance around it.
Anyone who has been through the process will know that it’s quite difficult to get sign-off on a business case for an EMR. It can take ages to get board approval with a number of iterations around the soft versus hard benefits. Ensuring that benefits are delivered is no piece of cake, either. So I thought I might share some lessons that I have learned.
Start your benefits realisation on day one
It’s important to embark on a benefits realisation programme for the EMR right from day one. Request business cases from various local and international sources, although many may not be forthcoming. If that’s the case, use third party consulting groups to assist you with developing your framework. You’ll also need a dedicated benefits realisation manager role to be responsible for creating an appropriate governance structure and the collection of baseline data. If you can’t baseline data, then how are you going to measure it?
An essential step to measuring your data is researching and validating your KPIs. Make business unit managers responsible for collecting baseline data so that you can model potential KPIs. Develop a benefits framework with internal modelling of around 70 KPIs. Then narrow that down to the 25 that are relevant for your healthcare facility and then cut that number down to the 19 that you think are achievable. Ask: Are these 19 reasonable? How are we going to cost them? Can we really meet them? Then engage a third party for further modelling and research to validate your KPIs.
Give benefits realisation enough time
I recommend having a benefits realisation model that is mapped over a 10 year period. This ensures that it complements the business case and allows for certain benefits to be achievable over the short, medium and longer terms. While the percentages to achieve your KPIs will be lower in the early years, in the latter years you can hope to get 100% of the expected savings. However, benefits realisation also depends upon the method of EMR implementation (staged vs big bang), and the experience and relationship developed with your vendor.
It’s important to remember that benefited realisation needs its own governance. Have a formal governance framework for benefits realisation and ensure that all executives are accountable for delivering the benefits, while business unit managers are responsible for the collection and reporting of the data. Reporting must happen once a month and there must be a special focus on reviewing KPIs. Where hard cash savings are to be realised, these savings should be automatically deducted from departmental operational budgets at the appropriate time.
Remember, it’s not about the money
Once you have followed the above steps split your KPIs into three categories: quality and safety, service improvement and direct financial. Whilst the Board may focus on direct financials, cash saving benefits are difficult to realise because the EMR is all about clinical and patient service improvements – particularly in the area of quality and safety. And that’s where it should be, because at the end of the day improving patient outcomes should be at the core of any healthcare improvement strategy and business case for your EMR.
Bruce Winzar’s original blog post can be found here.