WHATEVER IT TAKES CASE STUDY

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1 WHATEVER IT TAKES Success Story Implementing a New EMR at Port Huron Hospital in Only 12 Months! Building the New While Still Supporting the Old Port Huron Hospital (PHH), in Port Huron, Michigan, is a 186-bed medical complex with four community health centers that provide a full spectrum of inpatient and outpatient healthcare services to residents of the Port Huron and the surrounding area. As a result of the timeframes mandated through the American Recovery and Re-investment Act for achieving Meaningful Use of electronic health records, PHH was faced with a difficult choice. Having met the initial requirements, PHH could either continue to fulfill the mandate by extending the use of its original legacy system, or they could select, implement, and begin using a new system within 12 months all while keeping their legacy application fully functional until the cutoff date. Industry research had revealed that the usual timeframe for a full conversion to a new EMR of this size typically takes 18 to 24 months. Through a robust system-selection process that engaged the entire organization, the decision made by staff and supported by management was to move forward with MEDITECH as their new EMR vendor. Consultants from CareTech Solutions and MEDITECH suggested that the likelihood of success would be greatly increased by adhering to a number of best practice principles: 1. Utilize the MEDITECH READY build process that provides a partially built and configured application 2. Engage an overall project manager to coordinate the various schedules, resources, and activities of vendors, consultants, and staff 3. Limit the number of customizations and add-ons to the build 4. Obtain a commitment from PHH management to ensure the proper resources were available when needed. In addition to pursuing the READY methodology, a full-time project manager from CareTech was engaged to bring structure and to regularly manage and monitor project progress. A project management core team, consisting of PHH staff, physician representatives, CareTech, and the vendor provided the authority to manage all aspects of the project.

2 Why the Time Crunch? In addition to Meaningful Use implications, PHH had encountered instability with their previous vendor s technical environment. With no full backups and data redundant only within the server, the hospital feared that critical data could be lost, potentially devastating hospital operations. Maintenance could not be performed on failing equipment, due to the age of the hardware. With considerable work already done toward Meaningful Use attestation, the decision was nevertheless made to transition to MEDITECH. In order to reduce the risk of lost data during the transition period, PHH chose to implement Caretech s idoc Archive legacy decommissioning system to extract and normalize the data from the obsolete server for future migration to MEDITECH. This far-reaching decision would prove invaluable when the server eventually failed, since idoc provided a means to preserve and access this valuable information. The system s functionality and ease of use enabled the first users to be trained within an hour. Challenges and Barriers Faced In order to increase the potential for project success, a number of key risks, assumptions, and constraints were identified, with risk mitigation plans then developed to address each. These risks were regularly monitored and addressed. While the initial Meaningful Use year-one functionality needed to continue to work, the new year-two Meaningful Use requirements had to be built and implemented within the 12-month time constraint. There could be no interruption during the transition from the old system to MEDITECH. Physician engagement was minimal at the beginning of implementation. Physicians were resistant to using the system, and did not attend any of the four demo meetings. Since they weren t employed by PHH, there was no way to compel their compliance. Staffing was a concern, in that the budget did not allow for hiring additional hospital staff despite the extra workload laid upon the PHH employees. Project success required a large time commitment from end-user departments to configure and build the new system. It was essential to monitor the staff s workload and ensure that the increased duty was do-able. The team recognized the need to plan for unforeseen circumstances, evident in all large IT projects. PHH fully supported allocating a contingency fund to quickly address unforeseen problems and issues.

3 Planning the Project: Requirements and Approaches In order to ensure that their investment reaped the desired benefits, Port Huron Hospital utilized the requirements for Stage 2 of Meaningful Use, as well as the 2014 quality core measurement requirements, to establish several measurable goals for the project, such as: CPOE adoption rates, medication reconciliation thresholds, use of alerts and reminders, and capturing and communicating critical patient information. In addition to quality improvement measurements, Port Huron Hospital set a number of goals for fulfilling its financial strategy, including optimizing the use of resources based upon data, reducing operational costs through automation, such as transcription costs, and the cost of supplies. With an understanding that system reliability and speed are critical to caregiver adoption, Port Huron Hospital established metrics for enduser response time as well as for system availability that would support end users during the patient care process. Five Key Planning and Process Steps As the intensive project of transitioning to the new system got under way, CareTech s project management team instituted project management best practices to lay the foundation for the project: 1. A complete project scope definition 2. Clear resource roles and assignments 3. A comprehensive all-encompassing work plan that was: Segregated into specific easy-to-understand assignments for all resources Continually updated to track project progress 4. A comprehensive communication plan that included Weekly status reports Regular issues tracking A shared document repository Regular team meetings for all the project sub-groups Monthly executive updates Meetings with vendor management 5. Comprehensive testing, training, and go-live planning

4 The Project in Phases (2014) Phase I (June September) focused on complete data redundancy for disaster recovery. Phase II (September May) involved daily incremental transfer of newly created data in the still-active old system. Phase III (May) included the live launch of the new EMR system and idoc Archive. Key Activities that Were Done During Development of the System Included: 1. Mapping the current workflow in every department of the hospital 2. Mapping workflow improvements to the future state of the system 3. Builder training: nearly 30 MEDITECH sessions explained and taught the capabilities of the system 4. Building and configuring the system with a core team of roughly 100 people 5. Testing and refining, throughout development and system-wide integration testing 6. End-user education (100 sessions), with a Monday Magazine and white-board updates 7. An extensive internal marketing plan to facilitate effective project communication of key developments Three Essential Elements to Personnel Engagement Role of Marketing: Marketing cast a positive light on the whole process, answering the questions of why the compressed implementation effort was being done and why it was important. The communication initiative put the focus on better patient care, quick and easy access to records and to historical information rather than mandated requirements. Executive buy-in and staff engagement were helped by frequent informative bulletins, training, and personal involvement. Hospital leadership was fully supportive and engaged throughout the effort. Physician Champion: Dr. Sara Liter-Kuester, PHH s chief medical information officer, coordinated all the physician issues and also hired appropriate physician consultants throughout the implementation in order to engage the physicians. The physician perspective was a key factor in gaining acceptance from the physician users at PHH. A physician who had in-depth knowledge of the new MEDITECH system helped to gain the confidence and trust of the medical staff users. Incentive to attend training included providing physicians with their choice of laptop or ipad upon completion of their training courses.

5 Physician Incentive: The Dragon voice-recognition application, used for automating physician documentation of medical procedures, had been previously implemented in the Emergency Department. The scope of installing the MEDITECH application included expanding voice recognition throughout the entire hospital. This feature helped gain goodwill and support of the physicians by saving them significant time. It was instrumental in their adoption of the new MEDITECH system. A Last-Minute Complication An additional risk was encountered when in the middle of the implementation, the hospital was sold to a larger organization. As a result, a couple of key resources who had been instrumental in developing the system left the organization. The difficulties were somewhat alleviated because of the contingency money that had been set aside for unforeseen circumstances. By setting up a contingency fund, PHH was able to bring in specialists from a MEDITECH consulting firm who worked with designated staff in these areas to learn, design, build and test the areas of the system for which they were responsible. Outcomes Achieved: When reviewing the benchmarks that PHH had set as project objectives the following benefits were realized: The hospital went from 30%+ usage of CPOE to 88% as soon as the system went live. The amount of re-orders went down to almost nothing. Dragon voice-recognition system was successfully expanded from the Emergency Department to the entire hospital. Implementation was accomplished by existing staff without any new hires. The number of calls to the help desk during the first week after go-live went to half of normal: 380 the first day, then half of that the next day. During that weekend they continued to go down. The nature of the help desk calls went from problems that were fixed quickly, to just questions on how to use the new system, due to unfamiliarity. The goal of reducing paper reports to a minimum by utilizing real time and on-line queries resulted in the elimination of over 2,000 paper reports. Transcription costs went down to zero. Former transcriptionists were redeployed as support people and coders.

6 PROJECT STATISTICS 8 YEARS OF HISTORICAL DATA STORED 4 TERABYTES OF DATA 76 MILLION DOCUMENTS 2.3 MILLION RECORDS $500,000 IN SYSTEM SUPPORT ELIMINATED INITIAL USERS TRAINED IN LESS THAN 1 HOUR SOLUTION TIME-TESTED THROUGH13 YEARS OF USE STORAGE IN THE ONLY TIER 3 AHA-ENDORSED DATA CENTER QUOTES: Communication was key, and project management was a team effort. From MEDITECH project managers to Navin Haffty consultants, everyone was willing to collaborate on a methodology that would work best for Port Huron. Jim Deren, IT Planning Director CareTech & McLaren Port Huron EHR Project Manager Our order entry numbers are at 97 percent with MEDITECH higher than any other system we ve ever used because of the intuitive interface and big-bang rollout. Dr. Sara Liter-Kuester, CMIO McLaren Port Huron Our READY implementation included a strong partnership with Port Huron s executive team. Monthly meetings between our joint organizations ensured that areas of concern were recognized early and quickly remediated. Without this dedication by the leadership at Port Huron, the level of success would not have been achieved. Cathy Turner, Associate Vice President and Executive Sponsor MEDITECH

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