Rural acute care and critical access hospitals face similar obstacles as their larger healthcare counterparts, but they also face unique challenges. Impediments range from aligning services to their communities’ needs and trying to stay independent amid heavy merger and acquisition activity to addressing value-based care and creating more efficient processes that optimize resources, lower costs, and support patient safety and quality of care goals. Most hospitals use some form of EHR technology to improve clinical efficiency, but dissatisfaction with current EHRs are leading many healthcare organizations to consider EMR/EHR replacement. Providers will often seek third-party consulting partners to collaborate with the EHR vendor and key stakeholders to conduct a rapid, efficient and streamlined implementation.
The two major vendors, Epic and Cerner, offer scaled-down implementation models and product packages to meet the needs of smaller hospitals. EHR technology designed for the critical access and community hospital market offers great benefit, but without proper planning and involvement of key stakeholders, it also can come at a price – long implementations, low user adoption, and hefty costs as well as the risk of clinician dissatisfaction.
Cerner CommunityWorks is an integrated prescriptive framework for hospitals, clinics, and revenue cycle. It is a web-based, multi-tenant domain version of Cerner’s Millennium solution, but like all enterprise software, it is not plug and play. To streamline operations, improve care coordination, gain improvement in external health data exchange with other hospitals, and yield savings, there are many factors to consider which support a clinically driven, and on-time, within budget implementation. Whether the hospital or ambulatory clinics elects to manage the transition to a new EHR internally or work with proven professionals that have built their careers guiding healthcare providers to effectively leverage technology for patient and provider benefit, paying attention to these factors can be the difference between success and failure.
Strategic Planning and Project Management
Have you ever read a choose your own adventure book? EHR software implementation and optimization is similar with hundreds of decisions. Do we go left or right? Make it blue or red? Text field or drop-down list? Visible to all or limited to a specialty practice?
Design documents and department-specific workbooks need to be populated with the future state in mind to educate clinicians and other healthcare professionals on how the system is intended to operate with the new functionality. A frequent misstep is having project management be an additional side role, with resources expected to complete their day job and manage the EHR project in tandem. Can project management be done with shared resources? Of course, but it’s more challenging. For better results, appoint a dedicated resource with deep internal knowledge and project management expertise or look to a professional organization for resources and guidance to avoid pitfalls and keep processes smooth.
Governance and the Decision-making Framework
Preparing for strategic decision-making requires a platform for stakeholder input, establishing goals, and accountability for decisions. Charters and policies that promote transparency, clear communication and detailed documentation set the stage for implementing later plans. Lack of governance is the number one pitfall, with most organizations bypassing it completely or failing to follow through with the recommendations of the vendor or consulting team. Want to drive a best practice approach to governance? Establish it early and hold stakeholders accountable for continuous monitoring and communication post go-live.
Like project management, dedicated resources are essential for a successful rollout. Good data stewardship, active commitment from senior leaders, clear reporting, a continuous feedback loop, and other best practices require oversight to drive successful outcomes. Physician engagement, a physician steering committee, a clinical steering committee and structured communication are all important. Whether moving from one system to another or from manual to automated processes, it is a big change.
Governance can be managed internally or working with an innovation partner. Our healthcare partnerships allow us to bring best practices and perspective from multiple engagements along with confidence that dedicated resources are focused on business alignment and project goals.
Training and Education
All training of end users is important, but physician training and personalization are noteworthy success factors, especially with physician burnout being a prevalent problem in the industry. A New England Journal of Medicine (NEJM) Catalyst spring 2018 report found that 83 percent of clinicians, clinical leaders, and healthcare executives found physician burnout as a problem at their organizations.
Physicians using the system in the most efficient manner can be the difference between a physician that can see more patients during office hours and those with a lower patient load and more evenings spent in pajama time updating the EHR. Focusing on setting up favorites, order set defaults and personalizing their view will go a long way with physicians being more productive and satisfied. The KLAS Arch Collaborative generated survey data that showed a correlation between physicians who have extra training in their electronic health record (EHR) and user satisfaction.
With peer-to-peer personalization training, EHR software can be modified at the local level to create specialty- or physician-specific templates. It may seem cost-advantageous to use clinicians, nurses, or other staff in training sessions, but they’re not the individuals with insight into greater patient population needs. Physicians learning from other physician experts who understand the day-to-day life of a physician and how work gets done will be the greatest influence on productivity, usability and success.
Order Set Clinical Content Review and Maintenance
Allow time for a systematic review and updating of order sets. Evidence-based best practices and care delivery change as new medications and procedures or regulations are released. What was built for the previous EHR may now require modification or be decommissioned. The Institute for Safe Medication Practices (ISMP) recommends that order sets be reviewed and approved every two years, with some order sets requiring more frequent review. Moving to a new system is an ideal time to conduct maintenance review. Keeping order set clinical content current is a burdensome drain on staff but waiting until after go-live can take a toll on operational efficiency with service requests often languishing in a queue. Working with an innovation partner can lighten the burden, ensure order sets are current, and support a seamless implementation.
As you consider moving to a new EHR, evaluate what your organization can take on and where outside help may be required. Working with proven professionals can facilitate a smooth transition, a clinically driven revenue cycle approach, solid methodologies, and an on-time and within budget EHR implementation.