Optimization: More than Just a Buzzword

Positioning Optimization as a Strategic Imperative

In a climate of rapid electronic health record (EHR) implementations, it is not uncommon to hear, “That can wait for the optimization phase.” However, in today’s environment of regulatory and budget restraints, the optimization phase often does not occur or gets pushed to the back burner.

Despite a general acknowledgment that optimization should be included as part of an organization’s EHR budget and strategic planning process, oftentimes, optimization becomes the catch phrase for all manner of initiatives. As a result, optimization has become more of an industry buzzword than a verb that describes the process of making an EHR, “...as fully perfect, functional, or effective as possible.”

Getting Back to the Meaning of Optimization

How do we choose where to focus our efforts to achieve the perfect functional and effective optimization? The key is to understand where the organization’s “points of pain” are post-implementation and focus on those using technology as a lever. As part of the governance and change control process, many organizations have criteria for prioritizing optimization efforts post-go-live. For instance, typically patient safety issues are priority and rise to the top. Given Medicare Access and CHIP Reauthorization Act (MACRA)-related payment reform requirements, bundled payments, and the transparency of public-reported data, some additional areas to consider for prioritization include:

  • Quality Measure Capture: Are you documenting correctly to assure that you gain credit for the important quality metrics linked to payment, such as the physician quality reporting system (PQRS) and Meaningful Use requirements?
  • Physician Documentation/Clinical Documentation Improvement Post-ICD-10: Is it time to look at how your organization is performing with coding? Organizations often report a drop in Relative Value Unit (RVU) rates when new coding technology is instituted. Many organizations instituted computer-assisted coding (CAC) only to find that their match rate with documentation was 40 percent or lower. The standard is an 80 percent match rate. A review of documentation against accepted practice, as well as understanding how your CAC product pulls data from your EMR, can define optimization efforts that will result in quick returns on investment, such as a decrease in RVU rates.
  • Publically-Reported Data: Today, there is a wealth of publically-reported information from groups like Leap Frog and the Medicaid STARS program. This data can be used by healthcare providers to identify opportunities for improvement that are specific to their organization. Improvement in the critical areas reported on by these organizations not only save lives, but can also result in improved reimbursements and increased market share due to improved market perception. Hospital-Acquired Infections (HAIs), such as C. diff, are widespread. A marked improvement in reduction has been shown through optimization efforts that include the employment of standardized protocols, clinical decision support (CDS), and hard stops for nursing documentation. The ROI from reducing these infections can be considerable. HAI prevention and reduction in length of stay due to early detection and intervention can result in five to 15 percent cost savings.
  • Vendor Upgrades: Often, organizations choose an approach that includes only the functionality that is current (“like-for-like”) in their vendor upgrade program. As a result, they miss key upgrades that support optimization efforts, such as patient engagement and interoperability improvements, as well as new dashboards and enhanced reporting functionality that support the overall use of the EHR and, in some cases, provide additional insight into optimization opportunities. A systematic approach should be taken to each upgrade in which all available features are reviewed, commented on, and prioritized by cross-functional teams made up of IT, business, and clinical stakeholders.

Performance Improvement and ROI Measurement is Key

Regardless of what the organization’s targeted optimization efforts are, it is critical to apply a Performance Improvement (PI) approach and measure ROI. This sounds simple on paper, but the reality is that efforts often fail. A few key steps to consider include:

  • Choose your optimization efforts carefully. Include clinical and business owners, as well as IT, in the planning process to make sure that the efforts all reflect true organizational “points of pain” and have the opportunity to drive measurable improvement.
  • Identify leadership optimization champions. It is critical that that leadership, at both the executive and operational levels, effectively communicates the importance of the optimization efforts. Whenever possible, utilize existing committees as optimization owners, pairing IT with operational workflow owners (e.g., nursing, physicians, pharmacy, ED, OR, HIM, quality, and infection prevention).
  • Hold stakeholders accountable. Consider including the support and success of optimization efforts as part of stakeholder-measured performance criteria.
  • Utilize your Lean and Quality teams to drive to “root cause.” These teams play a role by utilizing best practices in establishing baseline measurements, designing the improvement process, defining post-go-live measurements at key intervals (e.g., three, six, and nine months), and defining adequate reporting requirements. If a business intelligence (BI) system is in place, dashboards can be developed to drill down to support the team driving to root cause.
  • Plan your project go-live carefully. Treat it as you would any implementation; decide on pilot sites and engage champions to support the communication and serve as super-users.
  • Commit to a timeline. Utilizing effective project management will define timelines, due dates, and deliverables; support communications; and ultimately help ensure that the optimization project stays on track.
  • Execute a communication plan. Always link the communications around your optimization efforts to improvements in care and process with quality as the driver, and avoid the adage of “the government is making us do this.” Create a plan that supports the communications of your success and project ROI.

Reversing the Trend: Moving From Buzzword to Strategic Initiative

Optimization should never be just a “buzzword” in your organization. Instead, it should be treated as a strategic initiative by linking optimization efforts to organizational imperatives for safety and quality, efficiency, reimbursement, and provider and patient engagement. These efforts automatically rise to the level of strategic importance in today’s provider organization. Technology and process change, linked with evidenced-based practice, then become the drivers for optimization efforts. As a strategic initiative, ROI must be a part of all optimization efforts, with ownership from all levels of the organization, not just IT, and best practices around performance improvement should be adhered to. Finally, communicate and celebrate the results—what better message than improved outcomes, increased clinician collaboration, and streamlined access to data!


CTG is a recognized leader in the planning, design, implementation, and optimization of today’s leading healthcare information technology solutions and business processes.

We understand that organizations need to rapidly evolve to ever-changing customer, competitive, and economic dynamics, and have designed a comprehensive suite of solutions that are tailored to the unique needs of each client. Solution delivery by consultants who combine subject matter expertise with the pragmatic application of best practices accrued during our 50 years of experience, as well as CTG’s proven process redesign, workflow, and integration tools and methodologies, result in:

  • Documented value/benefits metrics and ROI
  • Maximum efficiencies from IT investments
  • Seamless interoperability
  • Discrete data to support data collection and aggregation
  • Improved physician efficiency, satisfaction, and engagement