budgeting for EMR

Notes from the Arch Collaborative Summit - EHR Success on a Small Budget

In most cases, the leaders of healthcare providers who are struggling with the EHR realize that there is a problem, but many of them think they can’t afford to do anything about it. Fortunately, they’re wrong. Dozens of organizations in the Arch Collaborative have made huge improvements in provider satisfaction with the EHR. In fact, of 2019’s 72 Arch Collaborative case studies, 25 are about low- or no-cost efforts!

The 2019 Arch Collaborative Summit even had a breakout session specifically about achieving success on a small budget. It was led by David Kaelber, CMIO at MetroHealth Medical Center, who has plenty of experience with working with few resources and gathering more of them.

Humble Beginnings

10 years ago, Kaelber was hired as MetroHealth’s first CMIO. He spent only half of his time on that role and had only one direct report: a .5 FTE physician informaticist who functioned more or less as a shield. The “team” had no budget to speak of.

Today, Kaelber is a .8 FTE CMIO with 58 paid team members (including 11 direct reports) and 75 volunteer staff members. This clinical informatics team now has a total of 30 FTEs and a $5 million budget. What happened over the past 10 years?

The short answer is that MetroHealth’s clinical informatics team achieved low-cost victories early on and proved that their work was worth a real investment. The remainder of this post shares a few more details from Kaelber about his team’s strategic journey.

Achieving Low-Cost Victories

It’s impossible to make improvements without capable people. Attendees of the breakout session knew this, and one of them asked, “What’s the key to keeping people engaged?”

“They have to start engaged,” Kaelber answered. “We find people who are already yearning for the keys to the kingdom.” These kinds of staff members are passionate about making positive change and won’t need prodding. They may not even need payment—just the promise of being involved in something important.

“Physicians like titles,” said Kaebler, “and titles can be really cheap. For example, we’ve tried to get every specialty and every location to have one person volunteering their time as an Assistant Director of Clinical Informatics (ADCI).

“We ask the ADCIs to attend an hour-long meeting each month. By doing that, they save at least an hour per month in EHR efficiency, and when they pass on what they’ve learned to their peers, those peers each save an hour per month as well.”

The ADCIs are the perfect disseminators of EHR tips and updates. “It is very helpful when every EHR user has a peer to go to,” Kaelber noted. “Most people get information from peer-to-peer interactions. In areas that have strong ADCIs, our clinician satisfaction scores are higher.”

The clinical informatics team’s influence has led to more than anecdotal results. By successfully leveraging the EHR, MetroHealth has been able to engage their patients in innovative and effective ways. MetroHealth was one of the first ambulatory organizations to achieve HIMSS Stage 7, earned the HIMSS Davies Enterprise Award in 2015, and has one of the most successful MSSPs in the country.

Increasing the Budget by Proving Value

MetroHealth’s history has proved that it’s possible to spend little cash on informatics and get big results, but a clinical informatics team that can drive significant outcomes shouldn’t have to go without financial resources. Kaelber shared some things he and his team did to get and then expand their budget.

“It’s all about total value,” he told Summit attendees. “We have to provide tactical examples of physician or patient engagement. That’s the key to getting any amount of money.”

So how can a clinical informatics create the tactical examples that show value? One way is by focusing on fulfilling the Quadruple Aim of Healthcare. “The demand for our services far outweighs our resources,” said Kaelber, “so we look for and prioritize projects that will touch at least two of the four aims.” The clinical informatics team can then share project results with health system leadership using the lens of the Quadruple Aim.

Kaelber also works to speak the CFO’s language. “At least 50% of the clinical informatics team’s activities should be revenue impacting,” he said. “The CFO should be able to use a spreadsheet and see that the team is achieving a net gain.”

Over time, the net gain achieved by Kaelber’s team has grown enormously. “In 2018, our team had a $5 million budget, but our team goals made an $11 million revenue impact. I can tell our executives that every dollar invested in our team gives a two-for-one return. That helps them be willing to let us work on some different or extra things.”

Start with You

Physician leaders or CMIOs who don’t have much to work with may wonder how they can ever get to a place like MetroHealth’s. But Kaelber’s story is a reminder that a single person’s contribution is a promising start. “Think about the things you can control,” he urged. “I’ve created a habit of raising my hand and raising ideas that I know will have value for our organization.”

As your work helps improve the EHR experience at your facility, you’ll gain the necessary trust, support, and resources from your colleagues. As Kaelber succinctly put it, “Only by working together can we get things done.”




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