HIT Goal Setting

Section1.2Adopt – Plan

Section 1.2 Adopt – Plan –HIT Goal Setting - 1

HIT Goal Setting

An important step in health information technology (HIT) strategic planning is to establish specific, measurable goals that are communicated to all. Specific goals play an important part of many of the aspects of planning, selecting, implementing, and realizing benefits of HIT.

Momentum is building for acquiring HIT—especially electronic health record (EHR) systems—under the federal stimulus legislation (American Recovery and Reinvestment Act of 2009/Health Information Technology for Economic and Clinical Health (HITECH)). Some chiropractic offices anticipate acquiring an EHR in a short period of time, possibly without thorough planning.If decisions are made hastily, they may not align with the office’s culture or readiness. Establish a realistic timeline and goals for each phase of acquiring HIT to assure thoughtful decision-making and progress.

HIT Goals . . .

Objectives

EHRs are not new, and the need to use EHRs to achieve value is as critical today as ever. The Institute of Medicine, in its first study on improving patient records in light of new technology (The Computer-based Patient Record: An Essential Technology for Health Care, National Academy Press, 1991), identified several broad objectives for EHR systems:

•Access data

•Improve quality of care

•Enhance patient safety

•Support health maintenance, preventive care, and wellness

•Increase productivity

•Reduce hassle factors and improve satisfaction for chiropractors, consumers, and caregivers

•Support revenue enhancement

•Support predictive modeling and contribute to the development of evidence-based health care guidance

•Maintain patient confidentiality and exchange data securely among all stakeholders

These are laudable statements, but they do not help in distinguishing between products, and they cannot be used to test for success. Each organization must evaluate what it wants out of HIT, and define its own goals.

Writing Goals

Writing effective goals is not easy. Many organizations recognize the importance of SMART goals, described below:

Specific. Goals should identify who, what, where, when, and why. They should be well defined and clear to anyone who has a basic knowledge of the way your office works.Goals not only need to be Significant enough to make the investment in achieving the goal, but they need to beStretchingso the office can push itself to continuously strive for improvement.

Measurable. “If you can’t measure it, you can’t Manage it.” Goals should answer the questions, how much and how many, so you can determine when a goal has been accomplished. To be measurable, goals must contain specific Metrics, be Meaningful, and Motivational.

Attainable and Agreed Upon.In addition to the need to develop attitudes, abilities, skills, and the financial capacity to reach the goals being set, gaining consensus on Acceptable goals and commitment to Achieving the goals is critical as well. Goals need to be Action-oriented if they are going to guide youroffice to success.

Realistic, Relevant, Reasonable, Rewarding, and Result-oriented. Goals must reflect the availability of resources, knowledge, and time so they can be achieved. Set the bar high enough to be meaningful in light of the investment made to Reach the results, yet not so far afield that you become frustrated in attempting to achieve them.

Timely, Time-based,Tangible, and Trackable.Allow enough time for staff to learn to use HIT in support of achieving goals. Applying milestones to each goal helps make their achievement more realistic. However, allotting too much time to attain goal achievement may suggest that the goal is not important or meaningful for your organization. Specific metrics make the goal tangible and enableyour organization to track its accomplishments. If a goal is achieved within the timeframe established, celebrate it. If it is not accomplished, analyze why it has not been achieved. If your office is planning to earn federal incentives for making meaningful use of certified EHR technology, align your goals with the specific criteria in the incentive program.

Following is an example of a well-stated SMART goal for a transcription scenario:

Utilize structured data collection templates to reduce transcription expense by 30 percent within three months of adopting an EHR system, 60 percent within six months, and 85 percent within one year in order to support clinical decision alerts andreminders.

Goal setting for the EHR should not focus on general objectives for the project.Acquiring an easy-to-learn system or implementing it by the end of the yearare goals for the project, not for the EHR. Consider specific, measurable goals, such as the following examples:

Improved productivity:every chiropractor will have completed charting by the end of the day and will go home on timeeach day after two months of using the EHR
Enhanced quality of care: the EHR patient recall function will improve regularity of treatments and patient reports of lowered pain measured by standard instruments by 20 percent improvement after one year of using the EHR
Assured patient safety:health information exchange capabilities will enhance sharing of radiographic studies resulting in a 10 percent reduction in repeat studies after one year of using the EHR
Reduced hassle factors: every returning patient will be seen with a complete health recordafter two weeks of using the EHR
Increased revenue:improved scheduling and wait time management will enable open access appointments and generate increased business through word-of-mouth after six months of using the EHR

These examples may not all apply to your office, the type of EHR you acquire, or your own interests. Focusyour goal setting on what your office wants to achieve with the EHR once it is implemented and learned.

When broad goals are proposed that are not measurable, rewrite them as specific actionable goals. For example, the EHR steering committee at one office identified improved productivity as a goal. When asked what this meant specifically, they identified reduced transcription expense. When asked by how much, they suggested by 80 percent. When asked if they expected all users to start using templates for at least 80 percent of their notes, they understood the connection between using templates and no more dictation. After recognizing this connection, the merits of templating to achieve structured data for use in clinical decision support and external reporting were discussed. They then recognized that considerable upfront work would be required in skills building and initiating the use of practice guidelines. The group suggested that paper-based charts start to incorporate templates so chiropractors could become accustomed to using structured data forms.

Template for Writing and Tracking Goals

Don’t be concerned about writing SMART goals because you do not have baseline data, or because you fear results will be difficult to achieve. These issues are actually a part of the problem. The adage “you can’t manage what you can’t measure” is true in health care organizations and reflects one of the main reasons pay-for-performance and other incentives are being adopted. If baseline data are not available, now is the time to start collecting data for the most important functions. Baseline data are essential for setting realistic goals. For example, if a recent coding audit revealed you could increase revenues by three percent with better coding, do not expect to achieve 10 percent improvement with an EHR.

Even for a difficult measure, you can estimate baseline data or create scenarios. Cultivating a culture of quality measurement, reporting, and improvement is vital to achieving positive results from HIT. Engaging end users in setting expectations, providing the commitment and support to achieving expectations, then measuring, reporting, and celebrating success is essential.Monitor goal achievement and make adjustments in training, workflows, the application, and goals as needed.

Use the template below to help write your goal statements. Start out with a general statement, such as the example in the objective column. As you dissect the goal to determine how HIT and EHR can help you achieve it, you will be describing the intended action.Identify the sources of data and which application will enable you to make improvements. Define the metrics so you have a clear understanding what data to collect. Record your current baselinedata. Then set your goal by summarizing the improvement you think can be made within a realistic timeframe using the new HIT or EHR application. Record the rationale for setting the goal and any obstacles to achieving it thatyou see. An example of an obstacle may be the imaging center you work with is not yet usingdigital images (i.e., picture archiving and communication system [PACS]), so you may not be able to fully achieve a specific goal until they adopt the technology. Finally, use a table like the one below to periodically record results until the target date for achieving your goal is reached. If you wait until the targeted time, you will not know whether you are on course to meet the goal and you will not be able to implement corrective action to meet your deadline. While the deadlines are self-imposed, timeliness is a key motivator.

In some cases, the goal may be set for you by regulation or contract. Describing the rationale and obstacles may help you communicate the importance of the goal and find ways to overcome the obstacles. Record the results regularly.

Template with Samples for Writing Goals

Objective / IntendedAction / Source of Data / Application / Metrics / Baseline / Goal / Rationale/ Obstacles / Results
Improve revenue through better E&Mcoding* / Prompts for appropriate E&M code assignment / Structured data collected via templates / EHR visit note / # of outliers on coding audit / 3% of visits are coded too low / Use structured data entry templates to record visit infoimprove E&M coding so 100% of visits coded at right level / Recent coding audit/ Potential for medical necessity questions / 1% outliers, including one case exceeding medical necessity, at three months post golive. Check that LMRP guidance is part of E&M coding support

*Evaluation and management (E&M)coding

Resources for Goals

Identifying all the goals for a given HIT project may take some time. To help structure your goals, consider the major functions your organization performs. The following table lists many of these functions in ambulatory care, hospitals,and health information exchanges (HIE). Knowing how the hospitalcaptures information gives you a better understanding of how informationmay be shared with your office through HIE, and supports the continuum of care. Add to or delete as your functional descriptions vary. Focus on the functions that need HIT support.

HIT Related Functions

Ambulatory Care Functions / Hospital Functions / HIE Functions
Pre-visit patient registration, appointment scheduling, patient identification/registration, insurance verification, chart preparation / Patient identification, record location (MPI), admission/discharge/transfer, patient access, utilization review, insurance verification / Patient identification, record location
Health maintenance/preventive services reminders, chronic care registry alerts, and call-back lists
Automated self-history by patient or caregiver, personal health record information retrieval, standing orders for advance diagnostic studies / Automated self-history by patient or caregiver, personal health record information retrieval, pre-admission testing / Personal health records
Consent management / Consent management
Manage workflow and wait times / Nurse staffing, triage, bed control, census
Patient intake (reason for visit, vital signs) / Nursing assessment and clinical pathways
Validate patient history, physical examination, diagnostic studies review, previous visits review, referring physician and patient-supplied information review / History and physical examination, diagnostic studies review, previous admission review, referring physician information review / Data collection
Problem list management / Problem list management
Medication reconciliation / Medication reconciliation
Care planning, clinical decision making, clinical practice guidelines, documentation at the point of care, level of service (E&M) coding / Care planning, clinical decision making, clinical practice guidelines, documentation at the point of care / Data mining
Provider order entry for internal office tasking, diagnostic studies, surgery, referrals, admissions; prescription writing / Provider order entry for nursing services, medications, procedures, therapies, diagnostic studies, consultations / Data transmission
Diagnostic studies operations: anatomical pathology, blood bank, lab, microbiology, radiology and other imaging (picture archiving and communication system [PACS])
Diagnostic studies results retrieval and management / Diagnostic studies results retrieval and management
Medication administration
Operating room management
Patient monitoring and care charting
Medical devices information capture and display / Medical devices information capture and display
Care coordination and scheduling across sites of care: hospital admission, long term care, home care, referrals to specialists / Care coordination and scheduling across sites of care: triage, ED, ICU, surgery, recovery, step down, specialty areas, long term care, behavioral health care, home care, assisted living, migrant care
Care communication, continuity of care, medication instructions, health education / Care communication, continuity of care, discharge instructions, health education / Release of information, health education
Charge capture / Charge capture/coding / Purchasing, pay-for-performance
Quality measurement, reporting, andimprovement; revenue cycle management; productivity; general accounting; supplies management; human resources / Quality measurement, reporting, and improvement; revenue cycle management; general accounting; supply chain management; human resources / Quality improvement, public health reporting, population health, bio-surveillance
Patient follow up and prescription refills
Health information management and document archiving; release of information; privacy and security, including data breach notification / Health information management and document archiving; release of information; privacy and security, including data breach notification

Setting Goals

The process of setting goals helps individuals understand the capabilities of HIT and builds interest.Once written, the goals form the basis for a performance-based request for proposal (RFP). The RFP is written to ensure that the application has all the functions needed to achieve the goals. In the example of improving revenue through better evaluation and management (E&M) coding, the office seeks prompts for appropriate E&M code assignment.

During the selection process, evaluate whether products truly can help achieve your goals. Ask your references and staff at site visits how well the HIT has accomplished the outcomes that interest you. If a product is generally supportive of your goals but lacks one function, identify that function in the contract as something that must be provided by a certain date. Once you start the implementation process, your goals serve as the starting point for training and testing scenarios. Ultimately, your goals will guide your users to optimizing their use of the technology.

Adapted from Stratis Health’s Doctor’s Office Quality – Information Technology Toolkit, © 2005, developed by Margret\A Consulting, LLC. and produced under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.

For support using the toolkit

Stratis Health Health Information Technology Services

952-854-3306 

Section 1.2 Adopt – Plan–HIT Goal Setting - 1