One year later, Rice Hospital in Willmar, Minn., looks back at implementation of electronic health records
WILLMAR — As morning dawned on Feb. 1, 2012, Teri Beyer was nervous.
In a single “big bang” changeover, Rice Memorial Hospital was going live that day with Epic, a new electronic health records system integrating clinical and billing information for patients.
“We wondered if all the preparation and all the training and all the technical pieces would fall together on the first day,” recalled Beyer, the hospital’s chief quality officer.
One year later, hospital staff members are looking back at a process that went more smoothly than they could ever have hoped. Now they’re moving to the next stage — optimizing the system to make the fullest use of all its features.
Spurred by a push to make information technology more widespread in patient care, U.S. hospitals are changing the way they manage their patients’ health records. Paper records and handwritten entries are disappearing, replaced with electronic versions meant to make information more readily accessible.
Proponents say electronic health records can enhance the coordination of patient care, improve communication among clinicians and make patient care safer.
“Our goal was to have the right information available at the right time in the right place for the right person to make the right decision,” said Kathy Dillon, director of information management at Rice Hospital.
Compared to other industries, health care has lagged in adopting information technology in patient care. As recently as 2009, a Massachusetts study found that fewer than 8 percent of U.S. hospitals had a basic electronic health records system, and only 2 percent used a comprehensive system.
Federal and state incentives, accompanied by the carrot of bonus payments and the stick of financial penalties, are slowly changing this. By September 2012, about one-fourth of hospitals had reached a level of use allowing for nursing documentation, computerized physician order entry and clinical decision support.
It’s daunting for hospitals to go electronic, however, and progress is often slow.
Cost and training are major challenges. Rice Hospital, for example, invested $4.7 million in its new Epic system. Months were spent analyzing various systems before making the decision. Implementation took another full year.
On a scale of one to 10, the magnitude of change was “a 15,” said Sharon Ratliff-Crain, clinical analyst for Epic optimization at Rice.
In the weeks leading up to the conversion, five classrooms were devoted to all-day training for Rice staff, from bedside nurses and physicians to pharmacists, therapists, the business office and even volunteers, she said. “It was for two solid months.”
“It was a major endeavor,” Dillon agreed.
The leap for Rice was smaller than at many hospitals, however. Rice adopted its first electronic clinical information system back in 1997, followed by implementation of another new system in 2002. The emergency room and laboratory had their own systems. Bar-coded medication administration was introduced at the bedside three years ago.
“Because they used other systems and staff was accustomed to using an electronic version, it made the transition better,” Beyer said. “While it was different, it wasn’t as different.”
Hospital leaders prepared for it by communicating early and often with the staff, she said. “I think that made a difference because people felt informed.”
Nevertheless, it was a big switch that literally happened overnight. In all, Epic replaced six disparate information systems used across the hospital.
“It truly was about shutting some things off and starting over,” Dillon said.
Recognizing that bedside charting would take longer while nurses grew used to the new system, hospital officials beefed up the nursing staff during the transition.
“We had a great team of people internally — super-users in every department who had more training and who were the first line of answering questions,” Ratliff-Crain said.
The biggest change was for physicians, who now are using computerized physician order entry instead of handwritten orders for patient care.
“It eliminates one potential step for error,” said Dr. Michael May, one of Rice’s hospitalists who also serves as the physician champion for implementing Epic.
But it also meant learning a new process, and for physicians who do not often admit patients to the hospital, it takes longer to become adept, he said. “That’s been tough. We are working on ways to help those providers.”
By the end of 2012, Rice’s adoption of the new electronic health records met all the criteria for stage 1 meaningful use, a federal designation qualifying the hospital for a $1 million bonus payment. Work is now underway on stage 2 of meaningful use, which includes enhancements such as the use of clinical decision support tools and ramped-up data collection for research and quality improvement.
Rice also is tackling ways to optimize how Epic collects and manages patient information.
MyChart, an online portal for patients to view portions of their medical record, was introduced last year for cancer, mental health and rehabilitation outpatients and was expanded this March to include hospital inpatients. Next month the Epic system will receive its first upgrade, with more training for the staff to learn new functions.
Dillon said there’s no turning back anymore to the old way.
“Work isn’t done,” she said. “In many ways it’s just begun.”