A Template For EHR Meaningful Use?

Siemens Healthcare has introduced a set of relatively standard HIS (health information system) deployment procedures with its Soarian® AIM (Agile Implementation Methodology). In this HTO exclusive, editor Ken Congdon takes a closer look at this templatized approach to determine its viability in accelerating EHR adoption and meaningful use.

By Ken Congdon, editor in chief, Health IT Outcomes

The meaningful use incentives that are part of ARRA (The American Recovery and Reinvestment Act) provide hospitals and healthcare facilities with a set timeframe in which to meet a specific set of EHR usability requirements. As a result, healthcare organizations across the country are currently racing to comply with these mandates. However, implementing an EHR system or enhancing an existing EHR's capabilities in accordance with ARRA standards is no quick and easy task. While the federal government may have outlined EHR requirements for escalating stages of meaningful use, no one has offered up an outline, roadmap, or template that provides healthcare facilities with universal step-by-step instructions on how to successfully deploy EHR software to achieve meaningful use. The reason for this is simple - EHRs are not plug-and-play technologies. A great deal of customization is typically involved with any EHR implementation because hospital ‘A' doesn't manage its data in the same way as hospital ‘B.' Even so, wouldn't it be great if someone stepped up to the plate and at least introduced a standard technology adoption model geared toward getting healthcare organizations to meaningful use at an accelerated pace? That's exactly what Siemens Healthcare is attempting to do with the launch of its new Soarian AIM (Agile Implementation Methodology).

Repeatable Processes And Lean Concepts Key To Accelerated Deployment

It was a little more than a month ago that Siemens announced that it will begin deploying Soarian AIM for all future Soarian HIS (health information system) installations. According to the press release, Soarian AIM is based on a deliverables-based framework that organizes projects in a structured way and is designed to help a healthcare facility achieve "meaningful" outcomes in less time and at lower costs. So, what exactly does that mean? I recently spoke with Mike Long, senior VP of global services for Siemens Healthcare and one of the primary architects of Soarian AIM for more insight. "The Soarian AIM approach is the culmination of best practices and methods that Siemens has learned from its live deployments to date," says Long. "Through past experience, we've been able to establish standard repeatable and prescriptive processes that nearly any healthcare facility can apply to their environment to help them achieve target outcomes."

The repeatable processes Long references above include lean concepts such as continuous flow (completing one piece of the deployment at a time using a continuous series of processing steps) and just-in-time training (i.e. training as each phase of the deployment is completed rather than training the team on the entire system once it's live). Soarian AIM also includes some strict quality gates and stage management to enhance the governance side of the HIM (health information management) equation. The methodology also comes complete with a Soarian Infopedia portal that mimics the Wikipedia concept ? providing Siemens consultants and internal IT personnel with an information repository complete with application deployment configurations, best practices, and troubleshooting advice.

The entire process begins with an Implementation Readiness Assessment (IRA) that is conducted by Siemens consultants with each healthcare facility. At this stage, key metrics and outcomes are defined and the template is tailored slightly and applied to achieve the desired deliverables of each client. Siemens consultants offer ongoing support throughout the deployment process with the intention of taking the burden off a healthcare facility's internal IT resources while keeping the project on task.

"While a certain level of tailoring is still involved in Soarian AIM, we've taken a technology deployment that used to involve several A-Z-type decisions and simplified these options down to A, B, or C-type decisions," says Long. "As a result, we've been able to reduce the timeframe for a clinical HIS install to nine months, with CPOE (computerized physician order entry) going live four to five months after that. This is approximately half the time it took us to implement a clinical system prior to AIM."

Beta Site Evidence Of AIM Merit

This all sounds good on paper, but does Siemens' Soarian AIM really accelerate HIS deployment? Moreover, do the repeatable steps actually produce a robust, high-quality HIS infrastructure? Well, being that it's new, I don't work for a healthcare facility, and I didn't have nine months to kill; I couldn't test Soarian AIM firsthand. Instead, I can only rely on the feedback I received from Champlain Valley Physicians Hospital (CVPH) ? one of the beta sites for Soarian AIM.

CVPH was a long-time user of the INVISION® Clinicals system, Siemens' legacy HIS. The hospital was coming to the end of its contract with Siemens and knew it needed to enhance key areas of its system in order to achieve EHR meaningful use.

"Our INVISION system was built to the hilt and the idea of us moving from INVISION to another platform was imposing," says Kelly Ahern, manager of applications, support, and development at CVPH. "We couldn't afford to hit the brakes and develop another system over the course of multiple years. If we were going to convert, we needed a system that would allow us to continue business as usual by rapidly building a new system on top of the one we were already using. Siemens Soarian AIM provided us with a roadmap in which to do this."

AIM enabled CVPH to convert to the Siemens Soarian HIS within the nine-month timeline keeping the deployment moving through its repeatable processes and lean concepts. And, according to CVPH, the conversion was not only fast, but high quality as well.

"We knew the AIM process was effective when we did our next-to-last conversion of data and produced 5 million results with only three errors," says Rosemary Miller, VP of information services and support for CVPH.

The newly installed Soarian HIS system has CVPH in position to capitalize on meaningful use incentives through increased electronic management of clinical documentation. "Soarian has helped move us from a paper-based environment to a workstation-based environment," says Miller. "We've reduced the amount of paper that needs to be associated with a patient record and are now working with real-time work lists. This is helping us meet the meaningful use requirements for data archiving and exchange."

Moreover, the Soarian platform has been well received by CVPH physicians and IT personnel alike. "Our clinical informatics manager compares Soarian to using GPS instead of a map because of the level of automated guidance it provides," says Miller. "Our physicians have also become comfortable with the system with minimal training." With all the positives, the Soarian AIM deployment for CVPH didn't come without a downside. As a beta site, CVPH was a guinea pig for the new process and fully admits there were instances where the process briefly stalled because kinks in the process were identified and needed to be corrected. For example, during the deployment, Siemens realized CVPH was understaffed from a consultant and internal resource perspective for the scope of the project. Furthermore, since CVPH was the fist site to leverage AIM, internal project leaders weren't always able to prepare staff members for what was coming next. This led to some trepidation of the unknown and control concerns internally. However, CVPH states that Siemens was quick to identify these issues and corrected them in the AIM model. CVPH expects future AIM clients to benefit from these adjustments.

While successful, please note that CVPH is but one hospital's experience with Soarian AIM. Plus, being that they were an existing Siemens INVISION customer may have made some of the data conversion processes easier to navigate. For example, moving data from an older Siemens platform to a newer one should be easier than moving data from a competitive HIS platform to Soarian. Furthermore, while CVPH is currently up and running on Soarian, they have only scratched the surface in terms of expanding the HIS system to its full potential. Continuing to refine and enhance the HIS system will still involve a fair amount of software customization. However, as far as providing a model for getting a core infrastructure in place to meet several meaningful use directives, Siemens Soarian AIM seems to have some legs.

Ken Congdon is Editor In Chief of Health IT Outcomes. He can be reached at ken.congdon@jamesonpublishing.com.