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Eliminate These 3 Barriers to EHR Adoption
Electronic health record (EHR) systems can deliver major improvements in patient outcomes and provider performance, but they need to be implemented with care. As with any software, whether from a smartphone app or a global e-commerce platform, technology only works well when it’s aligned with the way people think, work, and consume information.
Otherwise, an application will meet massive resistance as well-intentioned users struggle to do the right thing, which may differ from what the software is guiding them to do. This dissonance helps explain why two-thirds of major corporate initiatives simply fail, as do half of EHR implementations.
EHR failures can critically undermine patient care and safety, workforce productivity, and financial success. Understanding common obstacles at the outset of an EHR project can considerably improve your outcomes.
Here are 3 common barriers to EHR adoption in behavioral or integrated care systems and tips on how to address them.
Barrier #1: Implementation Mistakes
Successful implementation of EHR software is a gradual process with many moving parts. It consists of creating a change management plan for your organization, migrating old system data to your new EHR, testing, going live, and training users until they’re proficient. Succinct project scoping and in-depth communication among stakeholders are critical. Key success factors include:
- Setting clear performance goals. Once such goals are set, specify actions to achieve them, and define clear success metrics like on-time payment rates, clinical process times, and patient data capture efficiency.
- Smart change management. There are many change management frameworks to adopt when it comes to EHR implementations. Kotter’s 8-Step Model of Change is a proven approach to producing lasting change when it comes to organizational transformations.
>> VIEW Kotter’s 8-Step Model of Change
- Process mapping. Document clinical and administrative processes in detail. Analyze them with stakeholders, and optimize them in the new EHR even if the processes differ from your old ones.
- Role-based architecture. Design your EHR system around the people who will use it the most: clinicians, claims experts, front desk staff, supervisors, program managers, quality assurance, compliance, management information system personnel, and human resources professionals.
- Data migration. This step deserves special attention given that research has indicated that 38% of large data migrations either exceed their budgets or run late. Ensure migrating data is validated by clinical, financial, and technical staff who can detect anomalies. Have a fallback plan should the migration take longer than you think.
- Train well. The best practice in EHR training is role-specific instruction delivered, managed, and customized through a learning management system (LMS). That training should start approximately 3 to 12 weeks prior to your go-live date. For clinicians, post-go-live support is likely to be the reality.
Barrier #2. Unclear pricing structures
Vendor relationships also affect adoption. Although your purchase contract may indicate one bottom-line service fee, buyers often fail to plan for hidden fees that can crop up for every adjustment, new feature, or special service. Nickels and dimes become tens or hundreds of thousands of dollars of unanticipated expenditures.
Ask your EHR provider to be transparent and forthcoming about its billing structure and outline the exact costs beyond the standard monthly fees. Organizations should consider negotiating all-inclusive pricing.
Barrier #3: Revenue cycle mismanagement
Revenue is the lifeblood of an integrated health organization, and revenue cycle management during a new EHR initiative is a source of stress. To get ahead of the challenge, a stakeholder group comprised of finance, claims, and clinicians should take an active role in designing workflows for the new software, from patient registration through patient exam, coding, claims billing, and revenue collection.
Managing reimbursements is another critical piece of revenue collection, and it takes effort to get right. Many don’t.
- Denials rates across the healthcare industry are ranging between 6% and 13% by region.
- The average cost of a denied claim is $31.50.
- Reworking denied claims costs in the neighborhood of $25.
To ensure your new EHR captures the maximum reimbursement to which you’re entitled, catalog your current revenue sources. Identify all payers, amounts, codes, and provider certifications required to complete a clean claim. Collect and organize all contracts—federal, state, city, grants, and private insurance—that include reimbursements. Ensure all claims and support data are in your new EHR system and ready to work on day one of your first pilot.
Next, perform a fresh audit of all government incentives for which you qualify and may have been missing. For example, opioid treatment funding may include incentives for adult day programs.
Now, shore up your clinical documentation process. Clinical workflows will change with a new EHR. Understand how new workflows, such as physicians using more templates, will affect charge capture. You’ll also want to sync up with your clearinghouse. Verify that existing billing codes are active and unique, and that fees are complete and compliant for all services provided. Ensure your new EHR technology is interoperable with your clearinghouse and validate all links.
Finally, use technologies that incorporate artificial intelligence to solve common billing problems. AI can help you manage/prevent denials, reduce the cost of collection on claims, and more efficiently manage prior authorization. It can also spotlight under-coding, reduce patient turnover, and assess adjudication confidence levels.
As you can see, there’s a lot of effort in EHR adoption, but also a commensurate amount to gain from it. Be methodical. Getting things right doesn’t require more work, it just shifts your time to the planning and execution stages rather than troubleshooting. That’s one way to secure major value from your investment.
Khalid Al-Maskari is founder and CEO of Health Information Management Systems (HiMS).
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
References
The Change Healthcare 2020 Revenue Cycle Denials Index. Change Healthcare; 2020.
How Much Denied Claims Cost Providers. Change Healthcare; 2022.
