Integrated EHR Transforms Community Hospital Operations
By Erin Harris, Editor, Health IT Outcomes
When Iowa’s Henry County Health Center implemented an integrated EHR solution, its days in AR decreased from 110 to 38.
In a perfect world, every community hospital would have a foolproof roadmap to guide it on its journey to a successful EHR implementation. The answer to “What’s in it for us?” can vary dramatically from one hospital to the next. Some community hospitals view implementing EHR as merely fulfilling a government mandate and not much more. Others, such as Henry County Health Center (HCHC) in Mount Pleasant, IA, envision its EHR implementation as a robust set of outcomes, such as streamlining access to patient information, reducing medication errors, capturing correct charges, and simply enhancing the community’s perception of the hospital’s capabilities. Stephen Stewart, CIO at HCHC, found that replacing the hospital’s inefficient EHR system with an integrated, established one enabled this rural hospital to reap benefits for providers and patients alike.
HCHC is a 74-bed hospital, featuring 25 acute care beds, along with a 49-bed long-term care facility known as Park Place. The hospital employs approximately 325 people directly, but that number increases to approximately 500 when its independent clinics and the dialysis company are included.
Why A Mature EHR Tool Matters
Stewart states that the hospital began its EHR journey in 2002 but experienced issues with implementation. “Simply put — we picked the wrong tool,” laments Stewart. “At the time, our health information system was nearing the end of its life cycle. Part of the problem was that we were trying to integrate a disparate EHR system onto our existing health information system rather than looking for something that was natively integrated. Second, the EHR product we chose was very early — too early — in its life cycle.”
Stewart explains that the EHR system’s functionality was cumbersome, and users found it difficult to both input and extract data. “Charges were lost, and we weren’t billing for things that we should have billed for. I don’t believe we were billing for anything we shouldn’t have billed for, because we didn’t have issues with fraud or abuse,” says Stewart. “But, overall, it was really quite a mess. Even our laboratory results weren’t viewable in the EHR. Our goal is to provide the right information to the right individuals at the right time, to provide the right service, and produce the right outcomes. That sounds simple, but it’s very easy for those ‘five rights’ to become skewed along the way if the right systems aren’t in place.”
Choose An Integrated EHR Solution For Optimal Outcomes
Despite the various issues, the hospital’s board of trustees, senior leadership team, and particularly the medical staff and clinicians believed that having an integrated EHR was in the patients’ best interest. They also believed that an integrated EHR would improve results and quality outcomes and would ultimately lead to a reduction in cost. Therefore, Stewart and a team of dedicated medical staff, clinicians, and users began an EHR redeployment in 2004. “The truth of the matter remains that if you don’t implement an EHR system by 2015, you’re going to have a reduction in your Medicare payments, and there isn’t a hospital out there that can afford to do that,” states Stewart.
Given what Stewart and his colleagues learned from the original EHR system, the new system needed to have two core qualities — it had to be integrated, and it had to be stable. The new tool needed to be a proven product and not something that had just emerged onto the marketplace. The new tool also needed to integrate with the health information system’s core functionalities, such as pharmacy, radiology, laboratory, and nursing functions, as well as with ancillary departments including rehabilitative therapies, cardiopulmonary, etc. The EHR needed to be not just proficient in one or a few of these areas, but in all of them with regard to data (i.e. patient data, drug lists, problem lists, allergy lists), and the data needed to be visible from everywhere — the application could not be divided into individual silos but needed to be an integrated tool that could be accessed across the platform. On the financial side, the new tool had to provide multicompany support.
“We developed a detailed checklist of all of the things the EHR had to include,” says Stewart. “The chosen tool would have to inherently address these issues, or the vendor would need to explicitly explain how they would configure the tool to address these issues.” Because integration is such a critical component for small facilities due to the lack of resources to support both an ERP and a clinical system, HCHC crafted a lengthy RFP and spent a great deal of time documenting the hospital’s requirements. Seven vendors responded to HCHC’s RFP.
“We invited the vendors in for a product demonstration, and then we narrowed the field to two,” states Stewart. “We did additional product demonstrations in great detail and then requested site visits for each of the hospitals. Finally, we analyzed the 5- and 10-year total cost of ownership potential, and as a result, we chose the EHR system from CPSI, including all clinicals and ERP. CPSI had a strong solutions for all critical areas.
The CPSI system also includes Point of Care, which is the nursing application. HCHC also uses the tool’s laboratory, radiology, and pharmacy systems. While Stewart acknowledges that some community hospitals prefer to host their electronic medical records in the cloud, HCHC chose to host all CPSI applications on site, as he firmly believes in having records live on in-house servers.“I’ve been doing this for a long time, and I’m a believer that your core applications need to be on-site,” explains Stewart. “It would be hard to persuade me to move my electronic medical records to a cloud environment, yet I realize there’s a great deal of that going on in the marketplace.”
Extensive Training Critical To EHR Implementation Success
Considering the enormity of the CPSI implementation and its effect on the HCHC’s staff, considerable emphasis was placed on training. “We sent a large group of people to CPSI to do the planning and training in order to set the system’s parameters,” says Stewart. “Then we conducted another round of training, which involved assigning and training ‘super users.’”
With any major software implementation, questions persist after the training is completed, which is why HCHC designated super users in every department (i.e. a department director and a designee). Super users had to embody specific qualities in order to earn the title, and they were compensated with an additional hourly stipend for filling the role. When choosing super users, HCHC chose people who were interested in taking on the role. “The person didn’t need to be the most computer- literate employee on staff, but did need to be a good communicator so that they could teach others and pass on their knowledge,” advises Stewart.
During go-live, representatives from CPSI were on site for approximately 6 weeks to help employees work through issues and to reinforce training. Whenever the hospital hires a new department manager or department director, that person is sent to CPSI for a week for training.
Stewart deems the new EHR project a success, evidenced by the long list of benefits HCHC has experienced since the tool was implemented in 2004. “Thanks to our EHR, we’ve had more than a 99% reduction in administration errors (e.g. giving the wrong medicine to the wrong person, or giving it to them at the wrong time),” says Stewart. “Even though our error rate wasn’t bad before, we implemented CPSI’s bar-code medicaladministration system right away on day one, and our error rate fell from one or two per 1,000 administrations to 0.01 per 1,000 administrations. It was just a phenomenal increase.”
When the hospital installed the new EHR, its days in accounts receivable were 110. Today, the hospital’s days in accounts receivable are 38. “That’s a drastic change in cash flow,” says Stewart. “That’s the difference between an integrated system, an interface system, and a truly sophisticated billing system that enables us to get claims coded and out the door in a timely fashion. Make no mistake, however; the system supported a truly great staff to make this happen” Finally, Stewart states that the hospital received $1.75 million in stimulus dollars from the government last year, and its charge increases are below the CPI (Consumer Price Index) for healthcare.