Inside an EMR Implementation

Many hospitals began their efforts to attest to Meaningful Use (MU) Stage 1 using older, even legacy, IT systems.

Facing the more demanding thresholds for Stage 2, some were encountering a very difficult choice. They could either try to meet the requirements with aging IT systems or begin anew by rolling out a new electronic medical record system that would allow them to achieve MU2 compliance and support future requirements.

While the second option may seem attractive, industry statistics show the move to a new EMR system for a mid to large hospital is an 18- to 24-month effort, making the timelines for completing a new system roll out and attesting for MU2 challenging to achieve.

Port Huron Hospital (PHH) in Michigan was facing this dilemma when they chose to engage with CareTech Solutions to find a creative solution to the problem. The hospital made a choice that would involve some risk and challenge their staff, the chosen vendor (MEDITECH) and the CareTech consulting team, by rolling out a new EMR system to meet MU2 requirements in just 12 months.

SEE ALSO: Outsourcing Meaningful Use

Step One: Risk Mitigation

PHH is a 186-bed medical complex with four community health centers that provides a full spectrum of inpatient and outpatient services to residents of Port Huron and the surrounding area. To significantly improve their chances for achieving their goals, the project team devised four guiding principles to form the basis for their ultimate success.

  • Utilize the MEDITECH READY build process that provides a partially built and configured application.
  • Appoint a highly experienced program manager with the responsibility to coordinate the schedules, resources, and activities of vendors, consultants and staff.
  • Limit the number of customizations and add-ons for the initial roll out.
  • Align with PHH executive leadership to ensure contingency funding to mitigate the risk of unforeseen circumstances.

Moreover, the team developed detailed risk mitigation plans by carefully analyzing all risks, assumptions and constraints.

Expect the Unexpected

In any large scale IT project, unpredictable challenges may arise – and this project was no different. Critical data in legacy systems became at risk when back-ups were no longer possible due to the aging technology. Fortunately, CareTech’s iDocs legacy data archiving solution was able to preserve and access this valuable information. When the old server ultimately failed completely, this decision proved crucial to the success of the project.

The contingency planning funds were also critical to success when the hospital was acquired in the middle of the project. The contingency fund served to replace and fund additional resources so the project could continue to run smoothly.

Plan for Success

PHH set forth specific MU goals and project objectives to define success, including clinical and efficiency goals. Project planning documented project scope definitions, roles and responsibilities for every department, team and individual. Communication is critical to every major IT project, and a detailed communication plan helped ensure all stakeholders received key information about the project. The project management plan also documented a comprehensive testing, training and go-live process.

During the system development phase, testing and training are key, but engaging physicians and staff to help define workflows for optimal efficiency and achieve buy-in is just as critical to success. The team employed a three-part strategy for engagement including, marketing communications, engaging with physician champions and incentivizing the staff. The detailed planning and project management led to the successful completion of the project – in the timeframe Port Huron required.

Some of the success metrics included:

  • The hospital went from 30 percent usage of Computerized Physician Order Entry (CPOE) to 88 percent as soon as the system went live.
  • The implementation was achieved without the hiring of any new staff.
  • The goal of reducing paper reports by utilizing real time and on-line queries resulted in the elimination of over 2,000 paper reports.
  • The amount of re-orders decreased to nearly zero.

Following best practices in project management, implementation, testing, training, staff engagement and effective project communication, all had a direct impact on achieving the goals that PHH had defined. The tight deadlines, aggressive business, regulatory and clinical goals made the project challenging, but by closely following time tested principles of solid IT project management and planning, all staff and consultants came together in a unified manner to succeed in what can only be described as a major win in a large-scale IT project.

Jim Deren is director of IT planning at CareTech Solutions.

About The Author