Maximizing Your EHR Investment

1. Maximizing Your EHR Investment David Reitzel Partner Grant Thornton Jamie Morisco Manager Grant Thornton

2. Table of Contents • Health IT Market • Defining Health IT • Health IT Market • EHR Introduction • Key Fact and Trends • Regulatory and Spending Considerations • Interoperability • Challenges • EHR Implementation • Analytics vs Informatics • Leveraging Informatics • Improve Physician Performance • Data Governance • Using IT Services to Maximize ROI • Key Activities • Implementation vs. Adoption • IT Management

3. Defining Health IT Maintaining day-to-day IT operations and deliver patient care, it is critical for individuals and organization to better understand how technology is leveraged and integrated into day-to-day patient care and business Organizational Strategy and Alignment Portfolio Spend ORGANIZATION TECHNOLOGY Strategic Planning Project & Delivery Management IT Value Fiscal Management Organizational Strategy and Governance Application Architecture & Infrastructure Emerging Technologies Business Continuity Planning Staffing Data Management IT Organization Mobility Network Improvements Infrastructure & Data Center Operations Service Levels Principles & Practices Application Management Standards User Outlook Governance & Policies CyberSecurity

4. Health IT Market The growth of the health IT market will continue to be a challenged due to the high costs of healthcare IT solutions, high maintenance, interoperability challenges, shortage of healthcare IT professionals and poor standards and protocols • Includes: • Software • Infrastructure • Mobile Health • Cybersecurity • Professional Services CARS AVE: 7.4% CN: 7.7% US: 7.2% Note: Published by Healthcare IT News USA North America Canada

5. Questions • What is the average annual spend of hospital IT? • What are the components? • What is the cost of implementing a new IT system? • Does it require new hardware? New Interfaces? What are the compatibility issues? • Is it a challenge finding qualified candidates to staff a hospital IT department?

6. EHR Introduction • A digital way to document health information on a patient • An electronic version of a paper chart • Demographic data, medical history, medications, test results, etc • Facts: • 97% of hospitals have a certified EHR system in 2014, up from 71% in 2011. • Only 34% of hospitals have a Comprehensive EHR • all med orders, image viewing, decision support, advanced directives • There is no 'standard' solution for EHR • Disparity among vendor technology limits communication between hospitals and physicians across healthcare networks • Lack of interoperability and protocol standards • Most physicians report • 85% - 90% of all clinical documentation has errors Source: ONC and HIMSS

7. EHR Statistics

8. Top 20 IT Capital Budgets • Hospitals are now investing into a "Post-EHR era" by expanding their IT infrastructure • Investing in products including big data analytics, patient engagement, and cybersecurity • IDC Health Insights conducted a survey of around 200 hospital IT decision makers • 37% stated their increased spending was focused on big data analytics • 32% recognized the need for patient engagement • 29% begun to focus on cybersecurity • According to Definitive Healthcare, over 350 hospitals and health systems have experienced a data breach in the past

9. US EMR Adoption Model

10. Question • Where are the challenges in having so much disparity in vendors? • Why is the IT portfolio so complicated? • Why has the US been slow in adopting this technology?

11. Healthcare Reform Objectives & Key Provisions • Affordable Care Act (“ACA”) • Provisions • Reform Objectives – • Better health at lower cost • Decrease number of uninsured • Better prevention and improved outcomes • Lower cost of care • Incentives for higher quality/lower cost • Incentives for collaboration – hospital/physician/ provider /payor partnerships • Better use of technology • The right care at the right time in the right setting • Commercial and Medicaid eligibility expansion • Value-based purchasing for hospitals and physicians • Penalties for readmissions and hospital-acquired conditions • Lower Medicaid reimbursements per encounter • Accountable Care Organizations and alternative payment methods established • Subsidies for IT investment to support care management "Healthcare reform continues to evolve. Our advisers, who are on the ground in Washington, are monitoring and analyzing legislation daily and communicating this information to our firm. This way, we can provide solid, accurate and prompt advice to our clients." - Anne McGeorge, National Managing Partner, Health Care practice

12. EHR Regulatory Programs/Initiatives Promote Adoption • Specific initiatives include ways to standardize documentation, incentivize effective use of technology, or penalize for not reporting critical values to public health agencies: • Meaningful Use • HL7 • PQRS • ICD-10 • HIPAA • Cybersecurity • Data Warehouse / Informatics • These are all individual initiatives and cannot be performed under one umbrella

13. Interoperability • Athenahealth, Epic, eClinicalWorks, NextGen Healthcare and Surescriptssigned on to be the first to implement Carequality’s framework for interoperability and data sharing principles • Focus on query-based exchange of clinical documents • Eventual expansion to other cases • Key benefits of interoperability • Allows physicians to focus on patients and less on coordinating care • Increasing patient safety, security, and well-being • Decreasing costs associated with legacy non-integrated healthcare systems • Increasing employee productivity • Improved patient experience • Major issue of Interoperability • Amount of time and resources require to go live • Outlining process, testing, legal review • Successful installation by both parties

14. EHR Technology Challenges Two surveys show that physicians see challenges when adopting/using EHR technology

15. Critical IT Management Capabilities Program Value Management focuses on accomplishments, not activities, and success is measured by the benefits organizations realize. To maximize the likelihood that large IT-driven business initiatives will deliver expected value on time and within budget, focus on four key capabilities Health IT Initiative(s): Project Value Realization 3 4 1 2 program strategy & secure stakeholder support deliver proven solutions that serve the business build effective teams and align efforts business need excel at core delivery management practices • align initiative with strategy and stakeholders • establish clear vision of initiative benefits/value • build robust business case, focus on objectives • engage leaders to align business and IT solutions • define and maintain initiative scope stability • employ standardized, proven, IT solutions • engage business and end-users to shape solution • use frequent feedback to progressively elaborate • align release plans with business priorities • use Lean to deliver the greatest business value • access benefits/value realized and adjust • ensure common scope understanding, up front • establish short cycle-times for value delivery • establish disciplined, standard mgmt. practices • establish rigorous QA/QC processes and procedures • improve quality through process standardization • establish performance standards and measure • establish common vision, high-performance culture • engage teams with proven ability to execute • deploy leveraged SMEs who understand IT & VOC • engender IT and business SME collaboration • facilitate stakeholder and team communication • use Kaizen to improve incrementally

16. Analytics vs. Informatics Analytics is the discovery and communication of meaningful patterns in data. Informatics uses this data, linking financial, quality and clinical data to make health care decisions improving the overall quality and cost of care. • Health Care Analytics • extracting, collecting and storing discrete data in an Enterprise Data Warehouse (EDW) • data mapping; the determination of how data is identified and stored • Metadata – data that describes other data, it summarizes basic information about the data • Analysis reporting in a single dimension. i.e. looking at only clinical data or only financial data • Health Care Informatics • using analytical data to identify patterns in clinical, financial, quality data, etc. • algorithms for analyzing large amounts of data generated in public health, clinical research, or genomics/proteomics • data gathered in the clinical research process that can inform clinical decisions • analyzing Big Data – data sets so large or complex that traditional data processing applications are inadequate • Analysis reporting in multiple dimensions. i.e. looking at data across functions such as clinical and financial

17. Leveraging Informatics as Core Evolution to Maximizing Investment • Acquire and implement a business intelligence/data warehouse environment as soon as possible if one does not exist • This will be instrumental in helping to measure the clinical metrics identified for tracking and calculating ROI. • Maximize the use of the reporting tools inside your EMRs - these tools are effective if just clinical data is needed or if immediate production of data reporting is needed. • Utilize a data warehouse and dashboards to track operational metrics • Track results on a daily basis and trend them over time • Tracking can become annual after a tangible ROI has been achieved

18. Capitalize on EMR Capabilities to Monitor and Improve Physician Performance • Monitor RVU's and compare to national and local averages • Monitor coding & documentation for accuracy • This includes ensuring that physicians are appropriately documenting the services provided (under 30 min discharge vs over 30 min discharge code) as well as using the correct codes to support the documentation • Track physician encounter closing rates • Have physicians create a problem list from which tip sheets, optimizations, and additional trainings can be developed

19. The Right Amount of Control Too Little Control • Possible breaches and misuse • Low quality data • Reports are not useful for decision making • Non-users have access to restricted data Too Much Control Redundancies and inefficient data processing Clinicians/users restricted from information and cannot turn reports around quickly Inefficient use of data Not enough literacy throughout organization

20. Healthcare Data Governance Competencies The core competencies for successful Data Governance are similar to any other business unit or business process improvement initiatives with a lean towards data performance. Attaining these competencies, improving upon them, and reengineering theses processes towards Data Governance goals will determine whether or not Data Governance 'sticks.' 6 Benefits of Strong Data Governance 1. Improved business process efficiency 2. Increased business user productivity 3. Improved confidence in reports and analytics 4. Reduced cost of compliance with clear traceability 5. Better risk management, transparency and control 6. Support for growth and enterprise change

21. Delivering Healthcare Value Through Data Governance The Value of Data Data governance is the first step towards managing information as a key asset of a healthcare organization. The shift towards value demands compliance with more stringent governance standards. Alignment with Business Strategy Data governance objectives should align with business strategic planning to ensure that funds are made available for Data Governance initiatives. Once planners have defined the organization's Data Governance strategy, they can seek support from executive leadership.

22. Key Activities to Help Maximize ROI • Establish a baseline for measuring improvements • Any time span from a couple of weeks to a year before the EHR goes live • Metrics must be able to be measured at current state and future state • Revisit metrics at go-live and after optimization • Examples metrics include AR days, cash posting, elimination of paper char process, nursing efficiency, staff retention • Determine key areas of focus for each department that can aid in maximizing ROI • Example: Reducing LOS, streamline record completion (HIM) • Continue to drive EHR adoption to achieve higher stages of EHR capabilities • Set the right attitude to ensure buy-in from clinical staff and departments as well as IT • Establish an ROI task force with the above stakeholders to drive the evaluation process

23. Implementation vs. Adoption "Implementation happens when the application is installed and live; an important milestone from a technology perspective, but only a small step toward adoption. Adoption is the continuous process of keeping users informed and engaged, providing innovative ways for them to become proficient in new tasks quickly, measuring changes in critical outcomes, and striving to sustain that level of performance long-term. Adoption is not a snapshot at a single point in time; it is a motion picture" Source: Beyond Implementation: A Prescription for Lasting EMR Adoption

24. Achieving Adoption • A successful go-live does not translate to end users embracing the technology • Singular focus • Negative feedback is good • Shows users are in the system finding issue for optimization and making an effort to adopt new workflows • IT not being the primary owner of the EHR project • Engaged leadership • Clinician involvement • Engaged and educated end users on EHR capabilities • Focus on post go-live workflow optimizations, continuing end user education, and metrics

25. Reducing risk and maximizing ROI from IT Our Health IT services offering helps clients achieve the value of their IT investment while addressing the business issues they continue to struggle against IT Strategic Services Grant Thornton uses a tested methodology to help clients develop an IT strategy that addresses the key elements impacting IT performance: Health IT systems A collaborative approach to planning, developing and implementing health IT systems drives willing adoption of new technology and ensures ROI. Areas include: • Organizational strategy & alignment • Application architecture & infrastructure • IT organizations and governance • IT portfolio spend • Clinical information systems • Informatics (Oracle, Allscripts and McKesson) • Revenue cycle • Operational systems (Lawson, Oracle, & PeopleSoft) • ICD-10, 5010 and HIPAA • Health Informatics • Grant Thornton understands that providers need to be able to securely share information across the care domain and we are prepared to assist: • Extend existing Clinical Information Systems (CIS) • Implement an existing 3rd party solution • Internally develop a customized solution A3 and RxIQ • CyberSecurity • Grant Thornton has expertise in Security and Privacy assessments and program development designed to meet requirements of NIST, HITECH and AT601. Our teams can help: • Assess readiness • Implement a privacy and security program • Ensure sustainability of the program Revenue enhancement IT services Finance and strategy Operational transformation Physician solutions