Attendees were hard pressed to find a session at the HIMSS10 conference of the Healthcare Information and Management Systems Society that was not focused on meaningful use or the HITECH Act. Some presentations, however, did demonstrate the more optimistic side of electronic health record (EHR) implementation.
Two hospitals discussed what they had learned through adopting health IT, and how they moved beyond a basic EHR implementation to use their systems for data analysis and improvements to workflow and patient care.
It wasn’t easy, according to Alison Connelly-Flores, clinical systems administrator at Urban Health Plan Inc. in New York. In fact, the hospital’s first EHR implementation from 2002 to 2005 was a failure: “It would take me weeks to teach doctors just to write a progress note,” she said during the HIMSS session on EHR.
Regrouping for a second round in 2006 proved more successful. The first round had taught everyone what they didn’t know about EHR systems and what the hospital needed, Flores said. During the second implementation -- with a new vendor and product -- support from hospital leadership increased, weekly meetings were held with the CEO, and there was a stronger focus on ensuring that the medical staff were trained on the new product and on new workflow processes at the same time.
In addition, the hospital took time to make sure staff felt comfortable with even basic computer skills because, as Flores said, “there were providers who didn’t know how to click a mouse.” In EHR training sessions, staff had to demonstrate that they could use the system’s functions before they were allowed to leave.
Having completed the EHR implementation and assured that providers, staff and employees are comfortable with the system, Urban Health now is able to turn its attention to the “bells and whistles,” Flores said.
For example, one area the hospital focuses on is reducing medical identity theft and insurance fraud. To help with that, the hospital turned to its health IT. Because many patients in the community have the same name, Urban Health added iris recognition to patients’ identity information. Patients look into a camera, their eyeballs are scanned, and the electronic record is retrieved. “The first time I saw it, I thought I was in a James Bond movie,” Flores said.
Effective EHR implementation tracks key metrics
An EHR implementation is not just about cool technology, however. The system allows the hospital to provide feedback to providers and ensure they are meeting metrics in productivity, quality, patient satisfaction and organizational participation. Willing providers can participate in an incentive program that tracks those metrics. Urban Health has paid an average bonus of $22,000 to doctors through the program, Flores said. Without the EHR implementation, tracking metrics “would have been impossible,” she added.
That feedback component of electronic systems has helped Heart of Texas Community Health Center improve on specific metrics as well. The hospital, which has been using EHR systems for 12 years, decided it wanted to increase its child immunization rate. Considered a hospital performance quality indicator, Heart of Texas’ rate had been trending lower than the national rate of 77%, said Timothy Barker, chief medical officer for the Waco, Texas-based hospital.
There were providers who didn’t know how to click a mouse.
Alison Connelly-Flores, clinical systems administrator, Urban Health Plan Inc.
Following its EHR implementation, Heart of Texas began to determine automatically which children needed immunization updates during visits and to send monthly reminders to their families. Nurses were responsible for ordering and administering the immunizations, and could see at a glance in the electronic system when a shot was due -- or overdue. In addition, nurses were held accountable when they missed an opportunity to provide an immunization during a visit. “That was really key, giving that feedback to the nurses,” Barker said.
The electronic monitoring worked well; however, after a year of the program, the hospital’s immunization rate fell again, according to Barker. The reason turned out to be fairly low-tech -- during a job turnover, the nurse in charge of immunizations left, and the hospital did not train her replacement in the program. Once that was fixed and the nurses began again to receive feedback reports, the hospital’s immunization rate increased again, and is now higher than the national average, Barker said.
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