5 HIT Adoption Milestone Results

Section 5.4 Maintain

HIT Adoption Milestone Results

Use this tool to help measure the extent to which your electronic health record (EHR), health information exchange (HIE), and other health information technology (HIT) activities are adopted by their intended users and to determine whether your SMART goals have been achieved.

Time needed: 20 hours to establish, 1 hour a week thereafter
Suggested prior tools: Section 1.5 Goal Setting

Introduction

Health care organizations have several ways they may review goal achievement results at key milestones. Some organizations choose to conduct formal benefits realization (see Section 5.6 EHR and HIE Return on Investment Analysis/Benefits Realization) studies. Such studies are important, but they can be difficult to perform. At a minimum, determining whether all users are using the applications as intended is essential as a first step to your benefits realization analysis.

How to Use

1. Determine the tools your EHR, HIE, and other HIT provide to enable you to determine the status of use. These might include:

· Audit logs of users accessing EHR and HIE.

· Dashboard providing status of incomplete documentation, information on other quality indicators, or billing results (e.g., incomplete or inaccurate data causing denied claims).

· Results of reviewing data and reports generated from EHR and HIE, such as patient lists and numbers of mismatches as health information is exchanged.

· Quality improvement reports analyzed for inconsistencies against baseline data and benchmarks.

· External error reports or audit requests.

2. Review the metrics and timelines in the SMART goals you set for yourself. Use the tool immediately below to summarize these and collect data to determine how well you are meeting each metric and timeline for each goal. In addition, you may find it useful to collect the following information:

· Staff/Provider ID# should be based on the unique user ID that you assigned each user. You may choose to translate this into provider/staff identification numbers or names, if your applications permit. Dashboards often do not link incomplete data or other quality indicators to a specific staff person or provider. However, in order for you to take corrective action, you need that information.

· Number of log-ins (and ideally time of logs) enables you to determine if your staff or providers are logging on at the point of care, how much time may be spent on catch-up documentation, and other issues.

· Number of calls to the help desk is important during the initial go-live period. None could signal a work around; too many could signal a training problem. The number should go down over time.

· Printouts made from EDMS may be able to be collected by a count generated by the print queuing function. The amount should go down over time as users become more accustomed to reviewing information online.

· Alerts overridden should be tracked (including by type). These should be investigated thoroughly, as alert fatigue is a concern in EHRs, especially for new users. However, alerts and reminders, judiciously applied, are critical for safety and quality improvement.

· Monitoring HIE usage, if you are paying per transaction, should help you reconcile against bills.

3. For Quality Indicators (second worksheet below), record your baselines and goal metrics. This data also should come from your HIT application. Delete any columns that do not apply.

4. There is no point collecting data if they are not analyzed and used to identify and correct issues. They also should be used to celebrate success. When each individual or group achieves a milestone, there should be recognition. Even when you believe you have achieved your adoption milestones, you may want to periodically check adoption to ensure that no new problems have arisen, especially as you start to implement additional HIT applications. Use the Monitoring SMART Goal Achievement (see Section 5.3 Monitoring SMART Goal Achievement to Assure Value from EHR and HIE) flowchart to determine appropriate actions to take if goals are not being met.

Adoption Statistics: Documentation

Staff/
Provider ID# / Log-ins / Calls to Help Desk / Orders / Print-outs from EDMS / Assessments, Care Plans, Notes / HIE
Orders Placed / Alerts Over- ridden / V.O. / Errors / Use at POC / Errors
Omissions / Alerts Over-ridden / # Late / Data Missed / Log-ins / Content accessed
Baseline:
Goal:

Adoption Statistics: Quality Indicators

Staff/
Provider ID# / Clinical Outcomes / Potentially Avoidable Events / Clinical Processes / Utilization Quality
Baseline
Goal:

Section 5 Maintain—HIT Adoption Milestone Results - 3