EHR adoption has pretty much come down to a Centers for Medicare and Medicaid Services (CMS) coin-flip — heads you win, tails you lose. Heads, your hospital is pulled into EHR adoption by the financial incentives of Meaningful Use. Tails, your hospital faces stiff financial penalties for failing to meet Meaningful Use requirements. But what about the third option? The one where the proverbial CMS coin lands on its edge. That’s the case for Carrus Hospitals and other non-medical/surgery facilities.
In addition to hospitals like our long-term acute care and our rehabilitation facilities, behavioral facilities also fall beyond the borders of Meaningful Use — yet we are digging into our own pockets to fund the adoption of EHR systems, and it’s fair to wonder why. Why spend upwards of $1 million or more when there are no financial incentives or reimbursements heading our way from the CMS and its Meaningful Use program? The short answer — because it makes all the clinical, financial and staffing sense in the world.
EHR for All
Before deciding to transition from paper-based processes to an EHR, you could walk through our hospital and ask, “What’s wrong here that you would fix if you could?” You would find people in every unit saying they couldn’t wait to get an electronic record system that would enable them get rid of all the paperwork.
At Carrus, our clinicians wanted an EHR because it allows them more time at the patient’s bedside, it creates a transparent log that everyone can see, and it removes the time-consuming task of trying to decipher poor handwriting and the hours spent chasing down other clinicians to find out what their notes meant.
From the start, we democratized the EHR selection process. We wanted our clinicians and staff to be fully engaged in the EHR search. They provided input about systems they had used elsewhere, and things they would want to see in whatever EHR we chose. Everybody in the organization gave input, and they all had a stake in what we were doing. We went about the EHR project not as something we had to do, but as something we wanted to do. We, as a team of caregivers, wanted the EHR because we believed it would be better for our patients.
We had them vote on which technology would help deliver more efficient care. They voted on every facet imaginable — did they want workstations at the bedside, or computers on wheels? Did they want laptops versus regular computers or tablets? Their input helped customize our EHR selection and system to give our teams what they wanted, and thus, we had immediate and complete buy-in on the EHR and the implementation process to come; however smooth or bumpy it might be, we were going to take that ride together.
Patience for Payback
Rather than awaiting a lump-sum incentive payment from CMS for Meaningful Use attestation, our ROI comes in many forms, from fairly immediate benefits to longer-term gains. We were prepared and we were patient.
With the EHR, you are able to capture more comorbidities, and actually have better coding, which is going to increase reimbursement because the Case Mix Index is more accurately measured; basically, better documentation leads to better reimbursement. Also, better documentation leads to less lost revenue. By using the EHR, we can track the amount of supplies used at the bedside, medications as being given versus being not given. It creates better control on everything.
By controlling expenses better, you have tighter controls of clinicians’ work. You’re no longer searching through the medical records looking for one word to support your coding; when you do concurrent coding, the EHR helps the physicians to code as they are documenting. For example, if you have a patient with CHF or CHF exacerbation, there’s a difference in code right there. Basically, better clinical documentation will in turn increase reimbursement because it’s a better real picture of what is going on with a patient.
Committing to Technology
As clinicians and healthcare leaders, we use the term “clinical adoption” every day when discussing healthcare technology. I submit that we shift the conversation to “clinical commitment.” By doing so, we view technology as what it should be — a tool that helps make our care better. Having the EHR helps our nurses document quicker and gives physicians the ability to access patients and their health data better. It’s what we should all be about.
When you position it that way, people in your hospital get excited. Positioning the EHR as a way to get Meaningful Use dollars for something “the government is making us do,” automatically disengages the staff because they are not interested in any of that — what they want is to provide excellent care to patients.
The EHR focus should be on how you can use it as a tool to impact your patient care. Because if you have good patient care, then you will have more patients, some even more sicker than others, who want to choose to come to you, and if you can take care of sick patients more cost effectively and more efficiently, then you’re going to save money on expenses, and you’re going to increase your bottom line. In the end, hospitals are businesses, too. We provide a valuable service to the community, but why not choose the EHR to help provide better service in a more cost-effective way?
And, we need not always look for ROI on the P&L – it is also found in things like hiring and retaining the best staff who know you are committed to giving them the technology tools they need to provide the best care. Good staff are interested in going to places that have the best care, that are more technologically advanced. In that area, it just kind of proves you are the best hospital. You’re more organized. You’re more efficient. You don’t have nurses from one shift staying over four hours into the next shift trying to do paper documentation because with the EHR, documentation has to be done at the time of service, so you are saving incremental overtime. That means employees get out on time, and it increases their morale.
At the most basic level, moving from paper to an EHR helps from two perspectives: 1) it helps us provide excellent patient care; and 2) it helps us be an amazing place for the employees to work. First and foremost we care about our patients, their care and their satisfaction with our services and outcomes, but right after that we care about our employee satisfaction.
Happy employees make for happy patients and higher patient satisfaction scores, which helps drive the business of healthcare and the financial health we need to continue to provide care to our communities.
Jon M. Rains is system chief executive officer, Carrus Hospitals.