Organizational overhaul

MGMA Connexion, May/Jun 2006 by Bair, Lyn, Swallow, Charles T, Erickson, Julie, Jacobson, Craig

Case study: Implementing an electronic medical record in an integrated health care system

reader take-away

* Find out how a large integrated health system structured an electronic medical record (EMR)

* Learn the analyses leaders conducted to assess the organization's readiness to adopt new technology

* Understand why the organization incorporated patient education into the EMR roll-out

* Learn the benefits that the health system gained from adopting the new technology

A visitor from Salt Lake City is found unresponsive and is transported via ambulance to the Logan (Utah) Regional Hospital emergency room. The patient is Identified by a driver's license. An emergency room employee enters his name into the computer and finds his longitudinal electronic medical record (EMR). The emergency room physician reviews the man's records and identifies the probable source of his unresponsiveness - leading to accurate diagnosis and prompt treatment.

Intermountain Health Care (IHC) is an integrated health care system in Utah and Idaho with 21 hospitals, 95 physician clinics and a commercial health insurance plan. Six times in seven years, IHC has been named one of the nation's 100 most-wired health care systems in an annual study published in the American Hospital Association's Hospitals and Health Networks.1

IHC has developed an enterprise data warehouse (EDW) that pulls medical, financial and claims data together from its hospitals, physician offices and health plan information systems. The clinical data repository is part of the EDW. The repository, a posting and retrieval system, allows online transactions. The clinical workstation is the window into the clinical data repository, containing patients' longitudinal medical records, best-practice protocols and patient education sheets.

The EMR technology allows immediate access to inpatient and physician office records in any IHC, hospital or IHC physician office. Complete patient information facilitates diagnosis and treatment in both care settings.

Preparing for the conversion

The Cache Valley Physician Group is a 50-physician multispecialty practice in Logan, Utah, that is part of the 470-member IHC Physician Division. Physician leadership in the Cache Valley Group set 2005 as the year the medical group would convert completely to the IHC EMR. This was an enormous organizational change for our physicians and their staff members. It required careful preparation and ongoing attention to make the transition succeed.

A SAS white paper, "Evolving the Enterprise,"2 describes the dimensions of a business, which includes people, process, culture and infrastructure. It details how these dimensions need to move in tandem through levels of information evolution. As the IHC Cache Valley Physician Group implemented the EMR, these dimensions coordinated and synchronized the effort. The table (page 40) represents a partial copy of the strengths, weaknesses, opportunities and threats (SWOT) analysis of the information technology readiness assessment we performed before implementing the EMR.

Considering each of these dimensions prior to the implementation helped us address potential problems. The SWOT analysis also allowed the implementation team to define the forces driving change and those resisting it.3 As a result of these analyses, the team identified the meetings needed to roll out the change and what the organization had to do to make the effort succeed. The team also formulated a plan to facilitate physician and staff EMR competencies.

Communication, oversight keep the ball rolling

The Cache Valley Physician Group has a physician representative who delivers feedback from the practice to the IHC corporate physician team that addresses design and functional issues in the EMR. The local EMR group project leader meets monthly with the individuals who support the hardware and software. This person also meets regularly with the educators who provide ongoing physician and staff education for the implementation.

The EMR group implementation team meets monthly with a physician user group. Its members identify quality issues associated with EMR documentation. For example, the user group:

* Reviews electronic medical records and ensures that documents are filed under the same tabs in the record throughout the region;

* Makes certain that medical record abbreviations are appropriate and used consistently;

* Reviews the quality and types of scanned documents in the KMR; and

* Looks at documentation templates to determine if they are appropriate for each diagnosis and accurately reflect standards of care for the patient's diagnosis.

Staff involvement and engagement are crucial to the implementation effort. The FMR group implementation team meets monthly with key stall members in each physician office to assess progress and/or barriers. We have defined the staff competencies related to the EMR; it is the responsibility of each clinic manager to ensure that each employee demonstrates competence in all areas related to the EMR.