healthcaretechoutlook

EHR Implementation - The Anatomy of Success

By George Curtis, CIO & HIPAA Security Officer, Houston Healthcare

George Curtis, CIO & HIPAA Security Officer, Houston Healthcare

It is true that all of us who grew up in healthcare IT and often the newcomers are inundated with the easy, the turn-key, and the set-and-forget solution for a wildly successful implementation of an EMR/EHR offered for a nominal and sometimes astronomical fee from our vendors. Keystone elements: always include your physicians, tap key opinion leaders, involve your nursing staff, develop a steering committee, have a good communication plan, celebrate your wins, and so on and so forth through the realm of projects and into success.

“In the wake of ushering in the electronic, redundant, and interconnected new world of EMR/EHR’s, there are a string of broken careers that are scarcely owned by only the CIO’s” 

I am not discounting these important elements of a good project; however, asking our already time-strapped providers and clinicians to do a good bit more lands this project solidly outside the line of “common IT Projects” and hence has a higher failure rate and price tag than many IT projects. In the wake of ushering in the electronic, redundant, and interconnected new world of EMR/EHR’s, there are a string of broken careers that are scarcely owned by only the CIO’s. Moreover, these tattered and sometimes irreparably damaged careers belong to the CEO, CFO, CMO, and a few other C’s that have been developed over the past few years.   

Knowing that the EMR/EHR revolution is inevitable, too many of us who are at the helm of healthcare rush headlong into the oncoming storm blindly throwing limited resources, time and money at a problem we don’t completely understand. From it we have gained clunky systems that are dangerous to the patient, inefficient workflows that aggravate the most patient of providers, and inconsistent data that are a symptom of the two previous results. There is too much advice on how to do it right, too much reliance on the buzz-words of healthcare, and not enough out of the box practical thinking when addressing a solution.   

Given the complexity of EMR/EHR systems I dare not offer a solution for this overwhelming project that requires a tireless and unforgiving taskmaster, rather, I do want to share what we did and as a pleasant side effect; it became our anatomy of success.   

According to the American Association of Colleges of Nursing, nursing informatics is defined as: “Nursing informatics (NI) is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information knowledge and wisdom in nursing practice.” How you define it within your institution and however you deploy it within your institution, you may be overlooking the answer you have been searching for all this time. 

A few years ago we decided to update our EMR/EHR system to meet the looming requirements of Meaningful Use, HIPAA, and other regulatory requirements that were intended to help drive patient safety and interoperability of records. It was an understanding among our group that this project could easily take on a life of its own growing quickly beyond its scope as well as our control. From many hushed discussions inside the walls of IT, thoughts and suggestions from our IT leadership we redefined our nursing informatics team–rather than beat around the bush let me share our story.  

Our Physician Information Technology Team or PIT Crew as they are affectionately known throughout our system are required to participate in the development and design of all EMR/EHR applications from which they gain intimate knowledge of the said systems. They communicate and work with vendor implementation teams, they install and review all software applications, they analyze and develop the program to be customized as much as possible and to create and test the workflow for efficiency and functionality. Our PIT Crew is responsible for application installation on physician devices, they train the end users and they create current state mapping and develop future state workflows because they are in fact on the front lines with our physicians and clinicians. The PIT Crew are ALL RNs.   

All of our physicians know the name and numbers to our PIT Crew, as they have earned the respect and trust of our physicians and clinicians. Why is this important and why is this successful?  

The PIT Crew constantly rounds in clinical areas seeking out physicians and clinical staff who are having issues. In most cases, our PIT Crew member can fix the problem on the spot (sometimes they can’t and I’ll address that in a moment). PIT Crew members train physicians, physician office staff, and clinicians on all new software applications. There is a designated on-call PIT member that has remote access to all systems and can take over most physician devices to trouble shoot and resolve issues. We have a designated rotating System Administrator and system support tech whose job is to immediately respond to PIT member’s calls. Noting that our PIT is in front of our physicians and clinicians at that very moment and they cannot afford any delay in resolution–they have rotating technical backup dedicated to their requests.  

Our PIT members know where to find physicians so they round in the doctor’s lounge, medical records, the cafeteria, outside of the operating room, during early and late rounds. They know how and when physicians want to be contacted, updated, or trained. The PIT Crew are here on all releases, updates, and upgrades and will train physicians on nights, weekends, and evenings at the convenience of the physicians or nursing staff. Of the 10 PIT Members, I have 1.5 that spend their time rounding solely on nursing stations, going to nurse meetings, and providing on the spot fixes and providing training on applications as needed.   

I came across one member of my PIT about 9:30 am outside the cafeteria who had already rounded with 51 doctors that morning–his response was musing that “they have to eat.” The PIT Crew puts out a biweekly physician letter called the “PIT Stop” that contains relevant information on system changes and updates and it was so unexpectedly successful that we are considering going to a weekly version. My physician satisfaction with our EMR/EHR is above 90 percent and the meaningful use requirements were only numbers that our physicians achieved with relative ease–thanks to our physicians and our PIT Crew.