What is the ROI for your Rehab Technology Investments?
Meeting the Expectations of EHRs
To begin, some may take offense at the description of Rehab Technology, which is tantamount to glacial melting when it comes to producing change in this sector of healthcare. I will acknowledge that surgical robots or medication dispensing R2D2s have not yet performed the automated functions of getting a patient out of bed and into the routine preparation for daily activity, and however appealing to ponder the potential of such innovation, rehabilitation technology cost, adoption and value remain “Orwellian” for most rehab providers.
Typically, investing in technology involves acquiring an electronic information system to capture, record, document and report the elements of patient care to justify what was done to the patient. These “systems” are software and depending upon the provider’s care setting, are referred to as Electronic Health Records (EHR) or Electronic Medical Records (EMR) and, as President George W. Bush predicted, all physicians, providers and hospitals should by now have one[i]. The associated costs of developing, acquiring and using this technology are high and have slowed the realization of Bush’s objective. Despite the financial incentives offered by the government, the rehab provider’s use of EHRs remains a wish list line item in budget considerations. These late adopters have had the benefit of watching others go through the learning curve and have recognized that there may be greater benefits than the mere justification of care and that communication, care coordination and clinical knowledge of what works best for whom may perhaps be improved in using electronic patient records. The expense may be worth the investment. Moreover, what else these systems could do to improve the value of patient care is now a pre-purchase consideration. Return on investment must acknowledge that the potential to improve efficiency and lower costs is demonstrated beyond traditional requirements of the medical record.
Those charged with making decisions about purchasing these technologies seek to answer three questions:
- “How much do the technologies cost?”
- “How much do they save?”
- “Are they worth the investment?”
The question “Should we buy this software?” is looked at in the same light as if it were an intervention that produces an outcome. Information technology is evaluated as if it were a procedure or treatment expecting to demonstrate a quantifiable effect. Richard E. Ward, MD, MBA, the CEO of Reward Health Sciences, Inc., proposes decisions to purchase and evaluate the return on investment be evaluated by its effect upon care processes. The meaningful use of these technologies results in measurable change in the targeted care processes that they support. Here is where the return on investment is demonstrated: Increased revenue and cost savings result from processes and management, not software. Software supports and enables process and management.
The ROI for technology investment for rehabilitation is best measured by changes occurring in the process of care and those who manage it. Start by asking what process needs improving and look to measure the capabilities of the information technology required to support and enable the desired outcome of that process. Success in the details like tracking three-hour therapy compliance, plan of care execution, care team member coordination, pre-admission assessment completion, post -admission assessment and care plan development all contribute to measurable effects to guard against payment denials for process failures. If the rehab technology is not addressing these care processes perhaps doing without is a better alternative while planning for retirement.
[i] Bush GW. Executive order: 13335: Incentives for the use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator; 2004 (http://www.whitehouse.gov/news/releases/2004/04/20040427-4.html).