Pam Arlotto began her book, ”Rethinking Return on Investment: The Challenge of Accountable Meaningful Use“ with the recognition that healthcare transformation requires not only changing how care is delivered but changing the mindset of those charged with delivering it. Patient care value is described as how technology is used and the meaning of that use as measured by the change it creates.
For the most part, healthcare providers have not realized any significant return on their investment by adopting electronic health records. Probable causes can be linked to a series of observations related to EHR adoption:
- Value requires management
Executive leaders are at the challenge to oversee the continuous planning and execution of value related processes.
- ROI or value is not limited to the budgeting process
It requires ongoing planning, management and measurement to realize benefits.
- Technology is a means to an end, not the ultimate goal
Many organizations continue to focus on implementation rather than how clinical systems align with and enable business strategies such as clinical integration, quality improvement and performance management.
- Clinicians and healthcare business leaders must be accountable for value realization
EHR deployments are more than IT projects—they are organizational change initiatives. Physicians must own and lead the change in care delivery redesign and standardization of clinical workflow. ROI and value realization are tied directly to outcomes improvement, patient safety and resource consumption. However, most clinicians have not been trained in performance improvement techniques. IT is often in the driver’s seat, and value returns have been limited.
- New governance structures and leadership skills are needed to drive transformation
Medical statistics committee structures, IT Steering Committees and Physician Advisory Groups and traditional health system management structures are not designed to drive high-value healthcare. IT may “own” the information systems, but not the information or its impact on clinical care or the business of healthcare. As care delivery and reimbursement models change, new clinically integrated decision-making structures will be necessary to evaluate the meaning, use, policies and strategies to turn data into knowledge and action.
- Value is patient-centered
Historically, ROI and value realization has been the organizational level. In the future, we must shift our thinking to an interoperable world, where data are exchanged across a community, region, state and possibly the nation. Coordination of care and cross-venue quality measurement will drive value creation. New reimbursement models are beginning to create the incentives to move from provider-centric to patient-centered care, creating a new definition of ROI.