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By Monica E. Oss

Do electronic health record systems (EHRs) reduce costs? It depends on who you ask. In a recent survey, 1,100 health care professionals were asked to assess the digital return on investment (ROI) in EHRs, and 61% of respondents responded with “terrible” or “poor” (see Survey: Healthcare Technology Pros See Poor ROI From Electronic Records But View Analytics As A Solution).

But I would take a slightly different view. First, the mandate for provider organizations to adopt EHRs—and their related meaningful use incentives—were never intended to save money for provider organizations. As Richard Hillestad, Ph.D., senior management scientist at The Rand Corporation, explained back in 2005 at the first OPEN MINDS Technology & Informatics Institute, it was expected that there would be “billions” in savings from reduced health care spending from EHR adoption—through increased system efficiency and productivity; reduced errors; better management of chronic conditions; and improved outcomes. But the majority of this savings would accrue to payers, with provider organizations bearing the majority of the costs. And now, 13 years later, this has proven to be the case (see his 2005 presentation, Can Information Technology Transform Health Care?).

But that aside, EHRs really can have a positive ROI by reducing organizational costs. I’ve led our team in the development of an ROI model for provider organization EHR adoption—and worked with dozens of organizations on both estimating ROI and assuring that their estimated ROI are realized (see Estimating & Achieving a Positive ROI From EHR Adoption: The OPEN MINDS EHR ROI Model and Increasing the ROI of Your EHR: Improving Efficiencies, Getting More ARRA Dollars & Beyond). These organizational cost efficiencies are realized by a range of factors—reduced record transcription time and records access costs; increased professional productivity and net billing due to reductions in record search and manual recording time; improved collections rate due to improved documentation; and decreased payment lag time.

After more than a decade of working on the ground with provider organizations, the big variable in realizing operational EHR ROI is the skill of the management team in tech strategy and deployment. Selecting the “best fit” EHR (or any other technology), including assessing the ease of use by clinical professionals and the operational fit for clinical programs (some EHRs are better than others). Reengineering clinical and billing processes. Redesigning report production and metrics presentation. These are key to achieving operational ROI. But, obviously, the current state of EHR deployment is not working well when you read headlines like these from the past four months: Electronic Health Records Contributing To Physician Burnout; Primary Care Physicians Spend More Time On EHR Than Face-To-Face Care, Study Suggests; EHRs Get Most Blame For Epidemic Of Physician Burnout. Poor strategic implementation is leading to the dissatisfaction of clinical team members.

But back to Dr. Hillestad’s 2005 presentation. It is important to remember that a national system of interoperable EHRs is meant to be more than an electronic file box. The goal was to connect health care data across organizations to improve decisionmaking. The resulting “actionable” analytics that can be derived from these systems are the big strategic ROI. From dynamic staffing models based on census trends and consumer acuity, to decreased clinical variability through transparent performance metrics, to improved insight-driven clinical pathways—these are the “big wins” that are possible with the data (see Achieving ROI From EHRs: Actionable Insights That Can Transform Care Delivery).

I think there is broad agreement that analytics are essential to success in a value-based environment (see Why Your Performance Reporting Should Include ‘Episodes Of Care’, The Evolution Of Successful Value-Based Contracting, and Making Your Clinical Team Data Driven). But, on the path to the information enlightenment, attention to improving operations and clinical professional interfaces will make the road less bumpy.

Need more assistance in gauging your organization’s progress on the road to strategic ROI? Over the past year, OPEN MINDS has collaborated with Credible Behavioral Health to develop a suite of resources on EHR implementation and functionality among behavioral health provider organizations. Central to the resources is a new assessment, Do You Have The Right EHR?: An OPEN MINDS Strategic Technology Assessment, designed to help executives of behavioral health provider organizations assess whether they have optimized their current EHR and if they need new EHR functionality. There is also the web briefing, Lessons Learned From Hundreds Of Agency EHR Implementations: Results Of The 2017 National Behavioral Health EHR Survey. In this briefing, OPEN MINDS Senior Associate, Joe Naughton-Travers and Matthew M. Dorman, Co-Founder and CEO of Credible Behavioral Health Software, discuss the results of 2017 National Behavioral Health EHR Survey; offer strategic insights on how organizations can improve their EHR selection and implementation plans; and provide their expert perspective on how executive teams can best position their organization to survive and thrive in a changing and evolving market. And, finally, The Future Of Behavioral Health EHR Systems: Beyond Billing & Scheduling, a white paper featuring the survey results.

For more, join my colleague Joseph Naughton-Travers, Senior Associate, OPEN MINDS on October 24 at The 2018 OPEN MINDS Technology & Informatics Institute for his seminar, “How To Make The Right Tech Investments For Your Organization: An OPEN MINDS Executive Seminar To Technology Budgeting & Planning.”

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