Technology continues to drive mankind forward in ways unheard of from when the great millennium occurred in 2000! Who would have thought that we would be tied to our smart phones, performing a myriad of functions that once took precious hours of our time? Now, we do online banking, book air travel, hotels, rental cars, and many other daily tasks regardless of where we are!
These same technological advances have, in so many ways, impacted the healthcare industry too. And, arguably, the largest invention has been the creation of the Electronic Health Record (EHR). So, it stands to reason that most of the healthcare institutions have either implemented, or are in the process of implementing the latest and greatest EHR system for clinicians to record, track and share critical medical record information regarding their patients.
The installation of EHR systems may run into the millions of dollars. Often, they are integrated, or interfaced with Billing Accounts Receivable (BAR) systems to provide the tools needed for submitting claims cleanly, and in a timely fashion, for prompt payment. After all, as the saying goes, it truly is all about the Benjamins; it is about healthcare institutions having the funds necessary to succeed and to carry out their Mission Statements.
So, if State of the Art EHR and Billing systems are in place to optimize patient care and outcomes, and if they are designed to bring in a steady stream of required cash to run the institution, how is it that so many healthcare institutions have less than desirable revenue cycle metrics to show for all of the financial investment in the implementation of an EHR system?
During the many system implementation projects that I have led across the country, the single most neglected component of a complex system implementation is End-User Training. Although institutions will invest millions today to ensure that they have the latest and greatest software available for its end-users, tomorrow (after the system installation) they will attempt to minimize costs with a meager training curriculum. In some cases, training is a minimal consideration at best, offering a series of online tutorials; in other cases, training may be a couple of hour sessions for a given application. Often, trainers are limited in their knowledge of the software, or even worse, have no operational background to marry operational tasks with the new system.
In particular, clinicians who ought to become experts on EHR software, are often given minimal instructions regarding the many bells and whistles of a system that contains many wonderful tools for precise, complex clinical data gathering. By the time clinicians grasp the basics on how the EHR works, they are, easily, overwhelmed by the new system and have little time or patience to understand that part of the patient’s record keeping entails the ordering or charging for services rendered. This is where the rubber hits the road, or in many cases, the tires skid along and never connect to the road!
Recently, I was asked to evaluate the revenue cycle performance for an institution that had implemented a new hospital billing and EHR system. The billing and EHR System were designed to interface seamlessly with an existing providers’ BAR system. Unfortunately, the implementation team did not perform a thorough assessment of existing tasks that included the charge entry process. Under the old charge entry process, providers would manually complete encounter forms, submit them to a coding unit (where validation and manual entry were performed) before going through the remainder of the revenue cycle process. Under the new system, provider orders (charge entry data) were generated from the new EHR application into charge work-queues for designated end-users to review.
The training offered to the clinicians who generated the orders (charges) was inadequate. It did not take into account that providers were used to having support staff (coders/billers) complete the charge entry process. As a result, providers didn’t understand how to:
- Open an encounter, enter supporting clinical documentation and close the encounter for the system to continue the path of sending those encounters into work queues for review
- Link critical, required documentation to orders
- Complete and send encounters without creating duplicate orders.
At the receiving end, the coders and billers were not adequately trained to work their designated charge router queues. The results:
- Aged accounts receivable over 90 days reached a whopping 30% of the total AR. Prior to the implementation, it was closer to 20%.
- Days in Accounts Receivable were around 40 days. Prior to the implementation, this metric hovered in the low-to-mid 30s range.
The moral of this story is: The Best Implementation fails without a proper assessment of current workflows in order to design an adequate training curriculum. All stakeholders should be proactive, performing their due diligence, identifying the knowledge base required for a successful implementation, and developing a comprehensive training program to meet end-users and institutional needs.
Today, clinicians are being asked to perform many tasks that once were delegated to support staff. Let’s make sure we give them a fighting chance!