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Long before you implement electronic health records in your hospital, build strong relationships with your physicians. Involve them very early in the process. It will enable you to work through the stressful times together, as a team.
That's a bit of advice from Brian Moreau, CIO at Marcus Daly Memorial Hospital, a 25-bed critical access hospital (CAH) in Hamilton, MT.
Moreau is well qualified to advise Executive Insight readers on IT. He recently transitioned Marcus Daly Memorial, along with its 10 outpatient clinics, to Cerner Millennium, using Cerner's Community Works delivery model. And, under his stewardship, Marcus Daly just achieved HIMSS Analytics Stage 6 status.
 His hospital's transformative IT journey offers some noteworthy dos and don'ts when selecting and implementing new IT.
"Project managing a large-scale EHR implementation turns the CIO into a CEO for a season," Moreau reflected. "Every problem in the hospital becomes an IT problem."
Timeline to a Contract
Marcus Daly's IT journey began in 2008. Here's its timeline:
- December 2008: Decides to replace its existing system.
- June 2009: Sends a 114-page request for proposal to five IT vendors. The request includes questions about each system's functionality in the lab, radiology and other departments, plus a description of its applications for physicians.
- September 2009: Based on those responses, narrows its search to two vendors.
- October to November: Holds demonstrations of both vendors' products.
- December 2009 to February 2010: Vendors conduct site visits.
- March 10: Chooses Cerner Millennium. "In the demonstrations and site visits, Cerner was the favorite," Moreau said.
- May 2010: Completes contract negotiations.
Why Cerner Won
What features won for Cerner Millennium? Moreau mentioned three: the depth of its clinical functionality, its user-friendliness, and its implementation methodology.
It helped, too, that Cerner is available as Software as a Service (SaaS) model, delivered through Cerner's Community Works division. The hospital didn't need to purchase its own hardware; the system is hosted at Cerner headquarters in North Kansas City, MO. "Also, Cerner offered a patient-centered chart between our clinics and our hospital," Moreau said. "Our providers see the same things when charting at the hospital or at the clinics."
The hospital kicked off its implementation in August 2010, and went live on May 1, 2011. In just 9 months, it had converted 32 applications across clinical, ancillary, and revenue cycle solutions in both the acute and ambulatory venues.
The first challenge was automating Marcus Daly's emergency department, which sees about 22,000 patients annually. "It's difficult because you can't control the flow of patients in the ED," Moreau explained. "In clinics you can say, 'Okay, we'll see half the number of patients we normally see.' You can't do that in EDs, which are chaotic by nature. You can have a couple hours of quiet followed by a rash of patients. In fact, when you reduce the number of patients you see in the clinics, it only adds to the volume in the ED. It's a huge challenge to go from paper to completely paperless in the ED."
When the ED got busy and physicians grew stressed, Moreau compromised. "If their patient census exceeded a certain amount, we allowed them to use dictation, but continued to require CPOE, medication reconciliation, ePrescribing, and management of the problem list," he explained.
Integrating Work Flow
Automating anesthesia also posed obstacles. "Again, it's the nature of the service," Moreau said. "When you're in the middle of an operation, everything must be perfect. We integrated medical devices to the Cerner solution so data would flow from the devices to the chart. We had some challenges changing the workflows of anesthesiologists, given the emergent nature of anesthesia. We asked them to be patient as we worked through it. Cerner also sent a specialist to help us."
The third most challenging aspect was moving physicians from dictation to a template-driven note, which they must operate themselves.
"This required special training sessions for physicians and resulted in mixed success," Moreau acknowledged. "One-on-one training is much better than group-training. In one-on-one, you can address their specific workflows and specific patient populations and customize it for them."
Meaningful Use Achieved
In September, Marcus Daly attested to CMS's 14 core IT-related meaningful use measures and five additional IT-related objectives. "We are the only hospital in the state of Montana to attest to meaningful use stage 1 and one of only a handful of critical access hospitals in the U.S. to attest to meaningful use in CMS's fiscal year 2011," Moreau said.
In August, the hospital achieved HIMSS Analytics Stage 6, the second-to-last stage in the HIMSS EMR Adoption Model (Stage 7 is a fully electronic medical record).
"Only 4 percent of hospitals in the world are at this stage; that's about 243 hospitals," a justly-proud Moreau said. "It's amazing that we are there, especially with us going live on May 1."
Next up is to implement a patient portal, and integrate fetal monitors, IV pumps and other medical devices into Cerner Millennium, as well as mobile devices.
"Work hard at building strong relationships with your physicians," Moreau reiterated. "This trust can be the difference between a successful implementation and an unsuccessful implementation."
Michael Gibbons is an editor at ADVANCE Newsmagazines, the parent company of Executive Insight.
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