How single sign-on within EHRs can save clinicians time, reduce hospital costs & improve patient care

To effectively meet CMS' meaningful use requirements, hospitals must ensure health information stored in the EHR is secure and HIPAA-compliant. However, in the eyes of the clinicians, who have to remember numerous passwords for daily use and repeatedly log into patient care systems, this is easier said than done.

To combat password confusion and reduce time wasted on password management, Imprivata, a health information technology company, developed a single sign-on product that works in conjunction with EHR software to facilitate expedited access to the system and other applications that clinicians use.

During an April 29 webinar hosted by Becker's Hospital Review and sponsored by Imprivata, George Gellert, MD, health informatics adviser at Irving, Texas-based Christus Health, described how SSO can help save hospitals time and money.

It is simply what makes passwords effective that also makes them a challenge. To have a successful password it must be complex. And for the password to stay effective, clinicians must often change it. Try telling a busy clinician to remember a password that was created three months ago. The "reset password" function ends up being used often, Dr. Gellert notes.

Clinicians on average must remember anywhere between eight and 20 passwords for the various software programs their health system uses for patient care, Dr. Gellert said. With Imprivata's SSO product, clinicians are just required to perform an initial log in, and following that, clinicians need only to tap or swipe their respective identification proximity badge on workstation card readers to re-log into the EHR. An SSO session lasts 12 hours before the user is prompted to re-log in.

Dr. Gellert, former associate system and regional chief medical information officer at Christus Health, and a team of the health system's researchers performed a study to determine how much time was actually saved by clinicians that used SSO. The team implemented Imprivata's SSO product, Imprivata OneSign Version 5.1, at 19 Christus Health hospitals in April 2018.

Over the course of the week-long study, 12,903 active clinical participants used SSO. The total number of EHR logins was 184,606, and the total number of first-of-shift logins came in at 24,742, Dr. Gellert said. Christus Health uses a Meditech EHR.

Time savings

Dr. Gellert and his research team found that with the SSO product, re-login times significantly decreased following the initial EHR login at the start of the 12-hour shift. Prior to implementing SSO, participants' first-of-shift login time was an average of 34.6 seconds, with the reconnect time averaging 29.3 seconds. The post-SSO implementation initial login time averaged 29.3 seconds, with an 8.9 seconds average re-login time, which equated to a 69 percent time reduction per re-login for the remainder of the 12-hour shift.  

Across the 19-hospital enterprise, weekly time savings from SSO totaled 943.4 hours, or 78.6 shifts. The average weekly keyboard time reduction at one hospital was 49.7 hours, or 4.1 shifts.

Financial savings

Time is money, making SSO crucial for hospitals looking to cut costs. To evaluate hospital cost savings from SSO implementation, Dr. Gellert and his team determined an average hourly wage for three clinical groups: physicians, nurses and mid-levels. The researchers used various sources to compile compensation data, including national averages from the U.S. Department of Labor, Salary.com and establishing rates based off compilations of various physician specialties.

Ultimately, the team settled on an hourly average of $138, which Dr. Gellert said is a "conservative" estimate and that the specialties observed likely earn more than the rates considered.

Financial savings after SSO implementation across all 19 facilities in total were as follows: $2.03 million for physicians, $964,703 for nurses and $205,352 for mid-levels. Total savings topped $3.2 million. Comparatively, the collective savings among all three levels of participants at one facility averaged $168,474.

Enterprise-wide, the total SSO implementation cost was $1.23 million, and annual maintenance cost for SSO is $296,000, according to Dr. Gellert.

With yearly savings from SSO totaling $3.2 million, adjusting for equipment costs, the net total annual recurrent value and savings is $3.3 million across the 19 facilities. Ultimately, adding in SSO helped the health system achieve substantial recurrent annual return on investment, value and net cost savings.

Winning with SSO

Dr. Gellert and his team concluded that SSO not only improves cybersecurity, but it also helps save clinicians time and increases their productivity and workflow satisfaction.

"[Time saved by SSO] is not going to be going into something wasteful. It's going to go into patient care," Dr. Gellert said. "It's going to go into clinicians thinking about their patients' problems, assessing their patients and formulating the best possible care plans for their patients as well as actually communicating with patients, engaging them and their family members."

Dr. Gellert's study will be published in the American Health Information Management Association's Perspectives in Health Information Management summer 2019 edition.

To listen to the webinar, click here.

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