AnMed Health’s Christine Pearson & Julianne Dreon & Guidehouse’s Matt Onesko via HFMA
The initial intent of electronic health record (EHR) adoption has evolved beyond digitizing patient data, with hospitals now implementing new or upgraded systems to better integrate the clinical and revenue cycle aspects of the organization, unify the processes of a multicenter health system, and deliver more consistent service across the board. The changing goals for EHR implementations and conversions have shined a spotlight on their business risks and opportunities.
To date, the risk side of this equation has attracted the most attention. Some recent voices, however, have rightly emphasized how such large-scale projects open up new opportunities for optimization.
At this stage in the EHR evolution, it is no longer appropriate for hospitals and health systems to simply survive an implementation. Instead, they should make use of the lessons learned and best practices gleaned from past conversions. In November 2015, AnMed Health, one of South Carolina’s largest not-for-profit health systems, engaged in an EHR implementation, taking the opportunity to pursue greater efficiency and quality improvement via two main routes: by creating a centralized professional billing office and by developing a revenue integrity program that covered both the hospital and the professional services sides of the organization.
The initiative began with an assessment to identify gaps and opportunities associated with the EHR implementation. This assessment uncovered formidable obstacles to change, including decentralized ownership of professional billing and patient access processes and resistance to the project at the staff and management levels. But with ample time to carry out transformational campaigns aimed at showing staff the workings and worth of the professional billing office and revenue integrity programs, AnMed Health was able to win over its internal stakeholders—buy-in that contributed to impressive metrics for the health system.
Business office centralization. The health system started to unify billing processes and centralize control early in the conversion process, assigning staff specialized functions and consolidating roughly half of the organization’s physicians’ billing practices over five months prior to implementation. In allotting so much time to testing and practice, AnMed Health instilled individuals with confidence in their new functions and helped stabilize new departmental processes. This approach helped convince remaining practices that the centralized billing office was a benefit, not a burden.
Revenue integrity implementation. Rallying clinical focus on revenue cycle processes often is a tough sell. At AnMed Health, it was paramount for project leaders to explain to clinical operations managers the current state of charging workflows and how those would differ once the new EHR was live. Before the project, the organization’s reconciliation practices varied across departments and had no formal accountability structure or real source of education when staff had questions. To obtain and keep buy-in, AnMed Health implemented a system to communicate standard policies ahead of any changes.