Why aren't more hospitals realizing the benefits of their electronic health records? And what are the organizations that are capitalizing on their EHRs doing well that others should try?

Those are questions asked and answered in a new report from the Chartis Group, which surveyed some leading health systems that are leveraging their IT systems to enable big improvements in length of stay, reductions of adverse drug events, boosts in nursing efficiency, fewer unnecessary lab tests, speedier cash collections, better preventative care and more.

WHY IT MATTERS
The report, by Douglas Thompson and Tonya Edwards, MD, shows that even five years after attaining Stage 4 on the HIMSS EMR Adoption Model, where the benefits of improved clinical decision support should begin to show up system-wide, most hospitals still haven't fully realized them.

Moreover, "increased costs of operating more sophisticated EHRs leave some further behind financially, leading critics to claim that EHRs have been a huge waste of time and money."

But it doesn't have to be that way. Indeed, the report shows how many leading health systems have realized big ROI on their EHR investments with improved patient outcomes and cost efficiencies.

"Texas Health Resources  saved an estimated $10 million from a greater than 60 percent reduction in adverse drug events at three hospitals one year after EHR go-live," for instance. "Sentara realized $57 million in annual EHR-driven savings, net of expenses, and a 50 percent reduction in hospital mortality ratio. And Memorial Hermann saved over $2 million annually from increased use of just six standardized electronic order sets."

What are they doing right that other health systems aren't?

Illustrated by a series of anecdotes from those organizations and others, Thompson and Edwards show that too few hospitals understand that extracting lasting value from IT implementations requires a "sustained, organized approach," bolstered by a "firm commitment from business leaders."

And beyond mere technology, effective deployments depend on those health systems understanding the enterprise-wider cultural shift and specific process changes that will be necessary from clinicians and staff.

It's key, they said, to stay focused on "benefits realization amid the distractions of the design, build and implementation process," not just until go-live day, but aftward, "when the next big change initiative comes along."

Based on its experience with and review of several hundred hospitals nationwide, Chartis found that the most successful ones share some EHR best practices in common.

The health systems gaining the most from their technology investments are those who have bought their EHRs with an eye toward using them for specific strategic outcomes – and know how important it is to steer system implementation and optimization toward those goals.

Those hospitals also know that the most beneficial aspects of an EHR don't happen just by flipping a switch and running the system, but when the new tool is used to help change how day-to-day work is done. It's the difference between "automation" and "innovation," said Thompson and Edwards.

They also said that "without a formal structure, benefits realization is left to chance – and benefits don’t happen by accident," pointing to the value of "dedicated resources, well-defined roles and robust governance."

It's also critical to measure the system's benefit after go-live through quality indicators, financial data and other key performance indicators, to ensure its value is manifesting itself, they said. "If you don’t measure it, you won’t achieve it."

THE LARGER TREND
The value of a properly deployed electronic health record system is hard to argue with. And even if some hospitals are struggling to show ROI after Stage 4 of the HIMSS EMRAM, the advantages that can be gained by pushing higher up that ladder can be substantial.

We've shown, for instance, how Los Angeles-based Martin Luther King Jr. Community Hospital joined just 6.4 percent of other American hospitals at Stage 7 by treating that goal as a formal project, with a prep team and a designated project manager to lead the charge. By optimizing its EHR, the hospital was able to make big gains on an array of clinical use cases.

The Chartis Group report shows the value of approaching EHR rollouts strategically, and part of that is a robust and clinician-focused training program. As we showed this week, physician dissatisfaction and poor user experience have less to do with software design and much more to do with the quality of system training. The better the training, the better the care delivered and the outcomes reported.

ON THE RECORD
"Health system leaders should be satisfied with nothing less than achievement of the strategic clinical and business objectives of their technology investments," said Thompson and Edwards in the Chartis Group report.

"While the majority of health system EHRs have not delivered on that promise, there is ample evidence that with clear goals, careful planning, good governance, and ongoing measurement and commitment, any organization can expect real, substantial benefits from EHR use," they added. "Organizations that have already implemented or upgraded their EHRs can use the principles and methods described above to optimize their EHRs to deliver measurable benefits."