Strengthening Your ELR Strategy

With the recent publication of CDC’s guidance for public health agencies for Meaningful Use Stage 2, InductiveHealth’s Director of Professional Services, Stephen Macauley, shares his perspective on why now is the time for jurisdictions to rethink their ELR strategy.

Why Now?
CDC just released guidance for public health agencies for MU Stage 2, and jurisdictions are in the process of applying for the ELC ACA FOA which has specific ELR performance measures.

Further, with shrinking state budgets and reductions in federal grant dollars, jurisdictions have to identify how to drive down costs associated with ELR while simultaneously maintain the existing ELR infrastructure and expanding the the number of electronic trading partners.

What is the role of Key Performance Indicators (KPIs)?
Simply, you can only assess what you can measure. For the last decade a few KPIs have dominated ELR assessment discussions — primarily the “% of Laboratory Reports Received Electronically” and “Timeliness of ELR versus Paper reporting” metrics. We agree that these historical measures should continue to be used for assessment, especially at the national level.

However, just as ELR has evolved over the last decade, so should the KPIs used for assessment. Ultimately, no one set of KPIs are right for every jurisdiction. When we sit down with a jurisdiction we focus on mapping the jurisdiction’s ELR maturity to the right mix of KPIs. By aligning KPIs to maturity, jurisdictions can set a multi-year roadmap for advancing ELR capabilities.

Further, we stress that jurisdictions should adopt no more than 2 to 3 new KPIs as part of their strategy. We have found that this helps jurisdictions focus their efforts across the year.

What is one KPI that should be a part of any ELR Strategy?
With the above said, if I had to recommend one KPI, it would be Cost Per Transaction.

While fairly self-descriptive, this KPI measures the total cost of your ELR infrastructure and activities at a per laboratory report unit.

Say for example your jurisdiction spent $200,000 on ELR in 2012 and received 20,000 individual ELRs in 2012, the Cost Per Transaction would be $10.00.

Understanding the per unit cost allows the jurisdiction to rethink their ELR strategy from two angles:

1)  How to lower the Cost Per Transaction for existing operations through process optimization, technical infrastructure, and the targeting of high volume, mature electronic trading partners.

2)  Assessing the impact of MU Stage 2 on Cost Per Transaction by focusing on how to drive down the incremental cost to onboard a new electronic trading partner measured against the incremental increase in the number of new ELRs to be received.

While your KPIs are important, it is also important to put these in context. When I discuss Cost Per Transaction with jurisdictions I am often reminded that not all ELRs are treated equally. For example, a Pertussis culture for an unvaccinated 5 year old can be of higher epidemiological value than an annual Hepatitis C Chronic panel test.

Ultimately, KPIs such as Cost Per Transaction help to focus jurisdictions on driving down ELR costs which allow savings to be re-invested in resources that increase epidemiological capacity.

Where does Scalability fit into an ELR strategy?
At the center.

For the last decade, public health jurisdictions focused on transitioning from paper to electronic laboratory reporting for a relatively small number of electronic trading partners, including key national laboratories, state public health laboratories, and high volume regional / local laboratories. Having worked with many states to execute this transition, it was a multi-year marathon that some state are still running.

Now, with Meaningful Use Stage 2, the number of trading partners is expected to grow exponentially in a condensed time frame measured in a months versus years. Further, jurisdictions will have to also support the Syndromic and Immunization population health measures of MU.

So if your strategy cannot scale, you will have problems down the road. In addition to this influx, it is important to remember that jurisdictions also have to continue to work with non MU electronic trading partners.

How Can InductiveHealth Help?
We have series of offerings that are tailored based on the ELR needs of a jurisdiction. For example, a jurisdiction may leverage our ELR consulting services to assist in rethinking their ELR strategy including defining KPIs. Or a jurisdiction may engage our ELR Managed Service offering whereby InductiveHealth handles all aspects of the ELR infrastructure and onboarding for a fixed monthly fee.

Continue the dialogue with Stephen at