In the light of your experience, what are the challenges you’ve witnessed happening with respect to the EMR/EHR space?
One of the major challenges is around meeting the needs of all the stakeholders within the EHR. The stakeholders include the clinicians that need to enter and have access to patient information, the regulatory folks that are charged with meeting regulatory requirements, and the financial people that want to ensure we optimize the revenue cycle. Thus, it is a challenge for the vendors to develop products that effectively meet the needs of all stakeholders.For us, the focus has been around the workflow and on how to ease the burden on each of the stakeholders, especially our care givers. Another challenge around EHRs is maintaining a highly trained workforce so that they have all the knowledge they need to use the product. This takes time and investment to provide and maintain adequate training.
We at Gwinnettare taking the next step towards advancing our training programs to ensure that we have a well-trained workforce across the organization. Training and education can impact adoption technology. With employed staff and physicians, adoption is directly related to education of how to use the systems and expectations on when to use the systems. Our community providers or those that spend little time in the hospitals, are more of challenge for education and adoption. Our health system requires the medical staff to use our information technology but we will still have some providers that write orders as an example. This breaks our automated processes and creates a hybrid medical record situation. Adoption of technology for clinicians is very important to our patient safety focus.
We continue to look at innovative developments for EHRs. There are organizations that are ahead of the industry in leveraging innovation such as artificial intelligence and machine learning with their EHRs. In the last few years, many innovative products have come into the market. Widespread adoption is not there yet and I suspect we will see many products drop out of the market as the industry matures. We have around four major inpatient EHR systems that aren’t yet able to accommodate all the innovations. We are moving to a single platform soon. I would really like to see our EHR vendor implement innovations that would enable us in our continuous efforts around patient safety, streamline workflows and reduce training requirements. Today, on an average EHR training for a physician is a minimum of eight hours. It’s very difficult for us to get our physicians to dedicate the time required and especially our community physicians that will need to spend eight hours of unpaid time to learn how to use our software.
What is your recommended approach to identifying the right partnership providers from the lot of EMR/EHR vendors?
We use a formal system selection process which starts with governance over the selection process and a project team. From here we develop requirements; even before we look at the products. Our subject matter experts provide feature/functionality needs, complex workflows, data requirements, and finally what other systems we have to integrate it with. This information is combined with requests for company information, pricing, technical specifications and more to make up our request for proposal. We then prepare a summary of the responses and decide which one of the vendors we want to bring in for onsite demos. Onsite demos area key aspect of the process. Therefore, we invite many subject matter expects and stakeholder to participate to rank feature/functionality and ease of use. Technical reviews are also done at this time. These onsite demos are typically followed by a small group attending site visits to see how the product works in a live environment.
"We at Gwinnett are taking the next step towards advancing our (IT) training programs to ensure that we have a well-trained workforce across the organization"
As a final point, the steering committee takes all of the information, looks at company fit with our company’s corporate philosophy/culture, long term viability of the product and the technology. This is after we have done a detailed financial analysis of the project and traveled to the vendor’s corporate offices. We take all of these pieces of information along with the steering committee’s recommendation to our executive team and our board to then make a decision.
The Collaborative care model is another trend that has gained traction these days. So while carrying out the selection process do you look for the kind of partnerships and integrations they are embracing in their systems?
We’re going to provide them with any current partnerships that we have that require integration, but we don’t want to limit it, just because we don’t know what’s going to happen in the future. We want a partner that’s going to let us be as flexible as possible to add on technologies and data flows. We have a local health information exchange and connect community providers in a way that ensure that the data flow of the patient information is as smooth as possible. We also want to make it easy for community providers to send their patients to our facilities. This is important to us and it’s not just technology but a philosophy of the organization to be open to sharing patient information with all of the providers involved in their care.
What would be the single piece of advice that you could impart to a fellow professional in your field?
The most important lesson I have learned over time is that we have to include the subject matter experts and that as CIO I’m facilitating the process but I’m not necessarily the decision maker. Yes, I’ll end up being the one to make the recommendation but it needs to be supported by physicians, nursing, laboratory, pharmacy, revenue cycle and all other key areas that are taking care of our patients. Because we design a great care team (which we have) with a great workflow doesn’t mean the software will support it. We as an IT team can provide our expertise around what capabilities of software would look like and how we integrate with other products. But the subject matter experts need to tell us how they work and whether or not the software can support their workflow. Over the years of my career, the most success implementations I have experienced began with an inclusive system selection process. An inclusive system selection process results in widespread buy-in to the implementation and the resulting process changes. Without buy-in, implementation success is difficult if not impossible.