Enacted as part of the American Recovery and Reinvestment Act of 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act aimed to "promote the adoption and meaningful use of health information technology" in clinical practice. Nearly a decade on, HITECH has succeeded in at least one respect: According to federal data, by 2015 some 84% of hospitals surveyed reported they had adopted at least a "basic" level electronic health records (EHR) system — more than an eightfold increase from the less than 10% level of EHR adoption reported in 2008, before HITECH became the law of the land.
And yet, despite winning widespread adoption, the usage of EHR still remains in its "infancy," reports the Association of American Medical Colleges — and still hasn't been fully "optimized for improving quality of care." A decade after EHR became commonplace, healthcare professionals are still searching for the best ways to use EHR to improve the provision of medical care.
Why is that?
One reason is that, despite initial high hopes that EHR would prove a "silver bullet" to improve patient outcomes, the truth is that EHR is just a tool, not a solution in and of itself. Like any tool, EHR works best once one has developed proficiency in using it.
That's where clinical optimization comes in. In our view, identifying the best way to use EHR to improve a medical practice involves four distinct but connected steps:
Step 1 is to establish a baseline against which to measure progress — a "current state assessment." Through workshops, interviews, and firsthand observation of how the medical practice operates, you need to identify which systems are in place already, who is using them, how — and how effectively.
Step 2 is to put someone in charge of improving this current state. Once you know who is doing what already, you should be able to identify the key stakeholders interested in optimizing these procedures. These persons should be recruited into an "optimization governance structure" that can oversee the implementation of improvements.
Optimize how? That's step 3: Defining the optimized future state of the medical practice. Where can costs be cut? Where can workflows be streamlined? What is the best tool — hardware, software and workflow — to accomplish this? With the optimization governance structure in place, key stakeholders can identify the best practices they would like to implement, and lay out a plan permitting the practice to operate at its ideal, most efficient level.
Step 4 takes this plan and executes it, optimizing workflows, eliminating unnecessary systems, and training staff in how to properly use those systems that have been identified as best suited to achieving the desired, optimized future state. In all likelihood, your practice's EHR systems will be a crucial part of this optimized future state. But first you need to go through these steps to make that happen.