Winter 2024 Issue

Industry Perspectives: Include the HIM Team to Maximize Your EHR Implementation
By Jason Handza, DO
For The Record
Vol. 36 No. 1 P. 30

Learn the reason behind it, the risk of not doing it, and steps you can take to ensure a successful go-live.

Throughout my career as a practicing physician and chief medical officer for a specialty-focused technology solutions company, I’ve seen firsthand the efficiencies and inefficiencies that come with an intensive EHR implementation. While there can be many benefits and long-term effects of moving from one EHR to another, the process of getting there is anything but simple.

According to the Health Information Technology, Evaluation, and Quality Center, the standard EHR implementation timeline looks like this1:

• Nine to 12 months before go-live: Internal meetings are held, priorities are determined, and vendor interviews are completed.

• Six to nine months before go-live: The EHR leadership team is assigned, workflows are mapped out, and hard questions such as “How is patient care going to be impacted” must be answered.

• Three to six months before go-live: EHR functionality is determined. Installation of hardware, customization, clinician readiness, and other factors are assessed.

• One to three months before go-live: Interfaces are built out. Go-live testing, timing, and other logistics are communicated to staff and any last-minute details such as adequate downtime are accounted for.

While the steps above are not incorrect or poorly thought out, the key problem lies in the fact that often HIM teams are left entirely out of the conversation. Decisions are made, processes are put in place, and expectations are set without some of the most integral voices being in the room. Unfortunately, many practices don’t realize this until it’s too late. Including HIM teams in your EHR implementations sooner rather than later is an absolute must.

Managers and Custodians of Patient Data
When the industry shifted from paper to EHRs more than 10 years ago, there was little to no regard for the end user. In recent years, significant enhancements have been made to shift away from a transactional-based system and prioritize a workflow-driven system. Instead of the application dictating the workflow, many technology companies have sought to optimize their solutions so workflows dictate the application. While clinicians play a big role in this development, it’s equally vital to include the HIM team in these conversations early on.

In today’s world, the real focus of health care must be to ensure providers, consumers, and payers have access to the right information at the right time. In Perspectives in Health Information Management Online Research Journal, HIM professionals are described as the “business managers and custodians of data and information in health care.”2 Much like custodians, HIM professionals have to clean, sort, and store data in the proper location so end users can access them when they need them.

The article further describes the integral role of HIM with the EHR. “With the digitizing of information systems in health care organizations, the roles of HIM professionals have expanded into IT and user support, which usually are the functions of IT supporting services. HIM professionals’ training and experience at the intersection of clinical and management sciences as well as their knowledge about data quality equip them with the capability to maintain the integrity and accessibility of health information, although they may not necessarily have the particular skills to support technical operations of a health information system.”

For these reasons and more, it’s paramount that IT teams and HIM professionals work together with clinical staff in a collaborative environment. Bringing HIM teams to the conversation from the onset of the project will leave less room for error and lend a level of consistency to the implementation that might not have taken place otherwise. This approach also gives the planning committee and EHR company an opportunity to hear firsthand what pain points were associated with the old system and ways to maximize the new EHR. Workflows are a critical component of these discussions because accounting for the right data and patient information ensures correct sequences and automation at every step of the journey. No one knows the intricacies of this better than the HIM team. Other areas such as quality reporting, analytics, administrative monitoring, employee access, and modification needs are also factors that should be considered.

Quality and Integrity Matter
It’s one thing to have data, but it’s a completely different thing to have data that works for you when and where you need it. When implemented well, the EHR is the foundational element that unites all of the various information streams coming in and out of the organization at any given moment. As previously stated, it’s important to ensure cross-collaboration between IT teams and HIM. The same is true for uniting clinical and HIM teams.

The clinical teams rely on quality data to drive decision-making that directly affects patient outcomes, and the HIM team is needed to do the work on the backend to ensure that the right data is available at the right place and time. The following are specific examples of the way HIM provides support. The reality is that each of these groups—HIM, IT, and clinical teams—can’t function without the other. The business of health care truly is a team sport.

HIM plays an essential role in the quality reporting side of the EHR implementation. According to CMS, “Quality measures are tools that help us measure or quantify health care processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care.”3 The goals outlined by CMS include effective, safe, efficient, patient-centered, equitable, and timely care. Quality reporting may not be a main concern in the early days of the EHR implementation, but failure to stay on top of it can result in hefty fines and legal penalties later on.

HIM teams can also ensure that the data going into the EHR is reliable and consistent, two essential themes that help with decision-making and logistics planning for implementation purposes. Data with integrity can be quality data, but not all quality data has integrity. Hospitals and health systems rely on data integrity for continuity and accuracy—to assure the information being assessed is useful for its intended owner. Data integrity means that regardless of change—updates, migrations, and modifications—the data is still intact and tells a comprehensive, accurate story.

A study published in the Journal of the American Medical Association examining eye health research from Michigan Medical School reported that only 23.5% of EHRs contain exactly the same information as volunteered by patients,4 putting the legitimacy of clinical documentation in jeopardy. Instances like this are not uncommon, further reinforcing the importance of HIM teams to keep the quality and integrity of data top of mind. AHIMA recommends the following four primary conditions for maintaining integrity of information5:

• desire and commitment to conduct business and provide care in an ethical manner;

• purchasing systems that include functions and capabilities to prevent or discourage fraudulent activity;

• implementing and using policies, procedures, and system functions and capabilities to prevent fraud; and

• inclusion of an HIM professional such as a record content expert on the IT design and EHR implementation team to ensure the end product is compliant with all billing, coding, documentation, regulatory, and payer guidelines.

Tips for Getting Started
There’s a lot to consider when implementing a new EHR, both inside and outside the four walls of the organization. The following are several points to help you take the first step:

• Don’t fear the data. Clinicians often hesitate to ask HIM professionals questions for fear of not being able to easily connect the clinical outcomes from the physician side with the data-driven metrics under consideration by the HIM team. It’s easy for physicians to assume the mindset “I just need to care for this patient” without getting granular with the data. Remember that data should drive decision-making, and the EHR should be the source of truth.

• There’s an update for that. Often, I refer to clinicians as using the EHR in second or third gear. They’ll come to our team and say “I wish we could do X, Y, or Z” when in reality they can—they just didn’t know the full capabilities of the software. Paying attention to system updates and new releases can greatly increase efficiencies and reduce burden for the clinician. We recommend assigning a lead technician on the clinical side as well as someone on the admin side to communicate software updates to the rest of the team as they are made available. It’s also a good idea to stay in close contact with the customer success manager or account manager at your EHR company so you’re in the loop on what’s current.

• Leverage your workforce. Gone are the days of having one or two specialists who were trained in a certain skill. Just as no single person should be expected to do everything, it shouldn’t take a year or more to train someone on how to use the new EHR technology. With most systems today, training can happen in 24 to 48 hours. Make sure your EHR partner is a good one and don’t delay hands-on training for your employees. Regardless of whether training is in-person, remote, or hybrid, allowing for time to work through any issues and become familiar with the EHR is critical for a successful implementation.

— Jason Handza, DO, is a vitreoretinal specialist and chief medical officer at Nextech, a specialty-focused technology solutions company.

 

References
1. EHR implementation timeline for health centers. The HITEQ Center website. https://hiteqcenter.org/DesktopModules/EasyDNNNews/DocumentDownload.ashx?
portalid=0&moduleid=625&articleid=1422&documentid=245. Published December 14, 2017.

2. Zeng X, Reynolds R, Sharp M. Redefining the roles of health information management professionals in health information technology. Perspectives in Health Information Management. https://bok.ahima.org/PdfView?oid=92516. Published Summer 2009.

3. Quality measures. U.S. Centers for Medicare & Medicaid Services website. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures. Published April 14, 2022.

4. Beaton T. Mismatched symptoms call EHR data integrity into question. Health IT Analytics website. https://healthitanalytics.com/news/mismatched-symptoms-call-ehr-data-integrity-into-question. Published February 2, 2017.

5. Integrity of the healthcare record: best practices for EHR documentation. AHIMA website. https://library.ahima.org/doc?oid=300257#.ZEhByOwpA-R. Updated 2013.