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Measuring early clinical and financial results in the United Kingdom

It’s important when healthcare organizations buy a new electronic patient record (EPR)* to truly verify that it made a difference for clinicians, the patients they serve, and the organizations themselves. Many look at the impact of Health IT acquisitions using only financial measures, while a few remain purely focused on clinical outcomes.

However most recognize the best way to measure the impact of EPR implementations should include clinical measures along with financial. The best is a balance. A lot of attention has recently been directed toward quantifying the early impacts of EPR acquisitions to ensure they were not just expenses, but genuinely good investments.

An example of that perspective applies to recent implementations in the United Kingdom. Our clients there use SunriseTM by Allscripts.

Examples: Length of stay and prescription turnaround times

One of many statistically proven clinically and financially pertinent outcomes is length of stay (LOS). LOS serves as a proxy for both better clinical outcomes for patients as well as better financial and operational management within the organization.

Using Sunrise, early quantifications of impact show reduced LOS for elective admissions by 10.3%, reflecting an average reduction of .45 days. Recent estimates of cost per patient, per day for the U.K. would project that reduction saved as much as £10.1 million per year (USD $16.4 million).

This client is also seeing reductions in LOS for non-elective admissions of approximately -.2 days, equivalent to about 3.4% reduction and about £7.2 million per year (USD $11.7 million).

Another important measure in the U.K. is the turnaround time for prescriptions, meaning the time from when a physician orders a medication to when the medication is ready for pickup. For inpatient prescriptions, the time fell by 20.7% within five months. That averages 3.34 hours less time patients spent waiting for medications.

The turnaround time for outpatient scripts fell by 29.9% within the same time period, or an average of nearly 8 hours fewer.

Measuring and proving the clinically pertinent impact of EPR implementations should be commonplace. Proof of impact is what converts expenses into investments.

Only possible with locally programmable EPRs

Leveraging local programmability, combined with ad hoc and systematic EPR searchability, organizations can consistently achieve improvements. They can achieve better outcomes because they can create any order sets and program those order sets to reflect best clinical practices and optimal financial approaches.

Then, they can search the clinical database to determine the utilization of the programmed order sets and the clinical and financial impact those local implementations have had on patients and for clinicians. To my knowledge, only Sunrise enables ad hoc questioning and querying of the clinical database to verify impact; No other EPR allows key personnel to ask critical questions and quantify impact.

As an example, this organization used order sets as the impetus for re-designing work processes, documentation processes and clinical decision support information to make better clinical and financial decisions commonplace and easy.

When we design EPRs to better assist clinicians, everyone gets what they need. That includes ever-improving outcomes for patients and their clinicians, and the healthcare organizations struggling to provide ever better care within continuously decreasing financial environments.

Editor’s Note: Professor Steven Shaha recently received the Don Walker Award for Efficiency for his abstract on this topic titled, “Immediate impact and ROI for EPR implementation: Early findings from the United Kingdom” at The Health Informatics Society of Australia’s conference, HIC 2014.

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