Question

The activity

An EHR was implemented at the General Hospital one year ago, before you were hired. The implementation process did not go smoothly and now there are strong EHR advocates and strong EHR-dissenters on the team. The CEO wants to move forward with an implementation of the bar-coded medication administration feature of the EHR, but the director of nursing does not. You have been asked to manage the implementation and see that it is successful. You will first need to review the case history of the EHR implementation and the best practices documentation available from national HIT organizations.

The CEO made the EHR selection on his own and told employees when the EHR would be implemented. It is his belief that people “perform better” with clear direction and strong leadership. The Chief Medical Officer (CMO) believed the EHR selection decision should have come from the staff following a vendor fair where they would be able to try out different systems and receive hands-on demos. The Chief Operating Officer (COO) would have preferred to form a representative committee of staff to work with the leadership to make the EHR selection. She believed a small representative committee of peers would work as a go-between with the staff and the leadership and would bring their knowledge of the day-to-day staff needs to the decision-making process.

Don’t Leave Change to Chance when Implementing an EHR By Jay Eisenberg, M.D., CMIO, PeaceHealth; Keely Killpack, PhD, Change Management Strategist and Author; Marie Weissman, Senior Advisor, The Chartis Group The implementation of an electronic health record (EHR) is one of the most significant cultural changes a health system can experience because it fundamentally alters the work processes and habits of nearly every individual in the organization. Historically, health systems have focused their efforts and resources on the technical aspects of the implementation, giving minimal attention to strategically managing the cultural transformation. Oftentimes, this leads to dissatisfied end users and organizations failing to realize the full benefits of their EHR. A successful EHR implementation can no longer be defined as the installation of the technology on time and on budget. Organizations are increasingly recognizing that adoption is a better initial measure of implementation success, as it is a foundational requirement for long-term success in EHR value realization. It is only when the technology is embraced by end users, embedded into the culture and integrated with streamlined operational processes that the groundwork is laid for organizations to leverage their EHRs to achieve the next level of efficiency, cost management, quality and experience. And, the best way to secure adoption is by approaching it with the same rigor applied to other aspects of the EHR implementation - through an effective change management plan that engages clinicians and wins their support. For PeaceHealth, a large not-for-profit healthcare system, the implementation of a single enterprise-wide EHR was the catalyst for transforming organizational culture and laying the foundation to transition to a clinically integrated network. To ensure success, PeaceHealth employed a structured and deliberate approach to lead and manage the system’s transition based on proven change management principles and methodologies. PeaceHealth: A Case Study PeaceHealth is a not-for-profit healthcare system comprised of medical centers, critical access hospitals, medical clinics and laboratories in Alaska, Oregon and Washington. PeaceHealth Medical Group is comprised of more than 900 physicians and healthcare providers caring for patients in PeaceHealth’s clinics and hospitals. Like many not-for-profit healthcare systems, during its initial formation, the system’s facilities were loosely affiliated with PeaceHealth as the holding company. In 2014, the organization began transitioning to an integrated network, strengthening the relationships between its facilities and standardizing medication formularies, care processes and policies. Administrative operations were centralized in Vancouver, WA, and the decision was made to transition all ambulatory, inpatient and business office functions to a single EHR. PeaceHealth’s clinical operations are organized into three geographic networks: Columbia, Oregon, and Northwest. The EHR implementation plan called for a three-phase rollout for the hospitals and critical access hospitals, starting with the Columbia network, which went live on August 1, 2015. In parallel, PeaceHealth Medical Group’s clinics were placed on a rolling implementation schedule between May 2013 and March 2014.

PeaceHealth’s Columbia network is comprised of PeaceHealth Southwest Medical Center, a 450-bed community hospital located in Vancouver, Wash. and PeaceHealth St. John Medical Center, a 346-bed community hospital located in Longview, Wash. Both facilities provide a full range of acute care services, including emergency services, surgical and medical specialties and subspecialties, and women’s and children’s services. PeaceHealth Southwest Medical Center also serves as the region’s trauma Don’t Leave Change to Chance when Implementing an EHR https://www.healthcare-informatics.com/print/article/ehr/don-t-leave-cha... 1 of 6 6/18/2018, 12:32 PM center. Combined, there are over 1000 physicians, nurse practitioners and physician assistants on staff. Thirty-four percent are employees of PeaceHealth Medical Group, with the remainder in private practice. PeaceHealth Southwest Medical Center had an existing EHR, and its physicians were accustomed to electronic ordering and documentation. Over the years, there was extensive customization of the legacy product; physicians were concerned that functionality would be lost with the new system and that it would not be as easy to use. In contrast, PeaceHealth St. John Medical Center did not have an electronic clinical record, so for their physicians, it meant transitioning from paper to electronic ordering and documentation. To effectively navigate change, PeaceHealth invested in the development of a new Change and Adoption Team. The 10-member team is dispersed across all locations, and its members are seasoned, experienced change management practitioners. The Change and Adoption Team is part of the operation and system service group, which also includes the Project Management Office, Process Improvement and Enterprise Intelligence. The team’s focus is to develop change leadership capabilities and help the organization achieve measurable value from large, strategic initiatives that impact culture such as the implementation of the new EHR. Principles and Key Components of a Proactive Change Management Strategy Change management is the discipline that guides how individuals are prepared, equipped and supported to successfully adopt change in order to drive organizational success and outcomes. For more than 60 years, change management practitioners have designed strategies, plans, tools and activities to support stakeholders through the change process and minimize the adverse effects of changing behavior to a business (e.g., attrition, productivity loss, shareholder doubt, etc.). Change management methodologies vary moderately between experts and across industries, but all contain the same core fundamentals for communication and leadership engagement. Communication fundamentals include tailored messaging for the audience, clearly articulating the change and why it is important. Leadership engagement fundamentals include helping leaders demonstrate their knowledge, support and confidence in the change to drive momentum for adoption within their teams. Key success factors for PeaceHealth’s change management strategy included: Branding the change effort “Change and Adoption” to promote the desired end state of adoption Simplifying planning and tool documentation to make certain all leaders, program team members and employees understood the methods and tools used to support adoption; Creating Readiness Teams for inpatient, outpatient, lab, revenue cycle and providers. Members of each team were leaders in their areas and became decision makers for the EHR design and implementation; and Measuring leader and employee readiness for adoption at regular intervals. These measurements were shared broadly to help identify units requiring additional support.

QUESTIONS

1. a Centralized data repository exists between General Hospital, where the medication orders are placed and the medications are dispensed, and Lakeview Pharmacy, where the medication orders are filled and barcoded. After reading the resource Health Information Exchange, explain how a Centralized data repository may impact the eMAR selection and implementation process.

2. barcoded medication carts were scored by end-users for workflow, ergonomic, and durability. Based on the end-user score, which system would you recommend?

3. What components of the Overview should be included on the personal health portal dashboard?

4. Make a list of five pre-implementation questions the General Hospital needs to address prior to moving forward with a patient health portal implementation.

Answer 1

ANSWER

EMR (Electronic Medical Record)/ EHR (Electronic Health Record) provide an effective way to solve the problem of managing clinical data. EMR has in fact been playing a minor role in the industry for many years but has yet to be implemented successfully end-to-end because of the many hurdles it has faced such as privacy concerns, cost and simply the lack of technology. In recent years a lot of progress has been made in terms of legislation, technology and innovation in information technology all of which has helped clear out some of these hurdles. With recent advances in IT; intelligent software, advanced processors, high-speed networks and seemingly limitless storage capacities have all revolutionized the industry. Add to that excellent data processing tools and we have a whole different dimension on how we extract and use meaningful data.

Electronic Medical Recording – All the data in a doctor’s office is usually collected in the form of charts and forms on papers. Using the paper record creates piles of papers and it is difficult to manage and utilize these records. Electronic Medical Record is the term given to medical record of patients collected in electronic format. Electronic records are easily portable and accessible anytime and from anywhere. It is easy to transfer electronic records to several different entities at a time. With the extensive growth in technology it is now possible to maintain the data in electronic format and this electronic data can be utilized for analysis of business, patient care, and physician performance and for various other researches. EMR/ EHR is a step towards a world of healthcare where all the processes related to clinical data will be automated and well structured. This will help patients to get better health care, physicians to get timely information and thus improving the overall medical system.

MAR can produce a 50% to 75% reduction in staff labor hours associated with month-end record keeping and charting procedures. Most importantly, while staff members concentrate on resident care and safety, eMAR eliminates paper-based record keeping and enhances the security of medication inventories and staff identification procedures.

In residential care facilities, eMAR dramatically reduces time spent on medication distribution and the chance of medication-related errors. The system also automates record keeping and notifies nurses when it is time to reorder certain drugs, which streamlines the communication process with pharmacies. Bar code technology verifies current quantities and dosages of every medication. Also, a resident’s photo is associated with each medication pass pertaining to their doctor’s orders, which helps support consistency and accuracy in medication distribution.

eMAR also tracks remaining medication quantities and can automatically place refills when necessary. This automated procedure is a time-saving tool for both facilities and pharmacies. This system supports a paperless environment and no longer requires care facilities to manually fax re-orders to the institutional pharmacy.

Because all medication and treatment information is stored in a central database, eMAR will instantly generate routine information including Physician Order and Medical Administration Reports (MAR). This reporting system replaces manual data entry. The reporting mechanism also offers improved efficiency related to controlling expenses associated with ordering and refilling medications from pharmacies.

Electronic Medication Administration solutions meticulously track every action involved with safely giving and receiving medication.

Bar Coding Leads the Way

In a typical eMAR process, a physician writes an order for medication, the pharmacist dispenses bar coded single doses, and the doses are delivered to a mobile medication cart. Before rounds, a staff nurse reviews the administration schedule.

At the patient bedside, a nurse scans both the patient’s and the medication’s bar codes before administering the drugs. The bar code on the patient's wristband accesses the patient's electronic health record (EHR) to verify the order for that medication. (Patient wristbands and EHRs can also contain information on allergies, drug interactions, duplicate therapies, and potential dosage errors.)

Verification at the Point of Care

The nurse reviews any warning messages that result from “Five Rights” verification and determines if further actions are needed before proceeding. As he or she completes medication administration, every action is recorded, and data is added to the patient’s EHR. All of this greatly reduces the risk of giving a wrong medication or dosage to a patient.

Carts Play a Strong Supporting Role

Mobile carts work very well for electronic medication administration. They have become lighter and stronger, with better battery life, and cart vendors customize the equipment to fit the unique needs of their clients.

Caregivers can load a mobile cart with medications for multiple patients. It’s also a convenient place to keep wireless barcode scanners handy for wristband scans. The cart set-up enables nurses to work through the hospital’s medication administration software in real-time and have an active work list on screen while administering meds.

Carts are more costly than mobile devices, which has motivated some organizations to explore replacing carts in various acute care departments with small notebooks or tablet PCs. However, mobile carts currently remain the preferred medication administration solution for many. Nurses like having a larger screen with bigger fonts, a mouse, and spot to place items when administering care.

More Time to Observe and Interact

Since they have a functional mobile work area, nurses spend much more time face to face with patients, which is reassuring for the patients and their families. Instead of jotting down notes and then documenting activities at a nursing station, nurses are making observations and inputting data real-time at the patient’s bedside, which gives them more time to interact and observe. As a result, clinical notes are more thorough, and documentation is timely.

A Checkup for Your Fleet

Ensure that your technology is optimized to work properly the first time—every time—with cart management, wireless, and workflow assessments. Our assessments help you understand the strengths and weaknesses of your network, increase productivity, and discover opportunities to improve clinician workflow.

Without proper maintenance, carts can break down, disrupting patient care and frustrating clinicians and staff. Our Fleet Management Assessment includes a multi-point inspection of your cart fleet, a prioritized list of carts and recommended service, a thorough analysis of cart fleet performance characteristics, cart health rating, and recommendations for enhancements and improvements for better performance.

• Healthcare environments are unique—they require fine-tuning to achieve an optimal workflow with the correct mix of technologies, policies, and resources. Our Clinical Workflow Assessment enables you to address patient service demands and reduce constraints on your infrastructure and staff

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