Tackling 3 EMR Implementation Challenges: Martin Health System Case Study

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In December 2011, Martin Health System in Stuart, Fla., began implementation of a new electronic medical record system throughout the entire organization. The implementation followed more than a year of vendor selection and study of best practices for EMRs in healthcare systems as well as collaborative design of the system with a multispecialty team of clinical and business leaders.

Ed Collins, vice president and CIO of Martin Health, describes the implementation as a "forklift replacement" for the system's EMR and IT systems. This is because the technology involved financial systems, clinical systems — from outpatient to inpatient —as well as the system's ancillaries, labs and pharmacies. "The scope of this thing was front to back, end to end," says Mr. Collins.

Martin Health encountered challenges throughout the widespread EMR implementation. Here, Mr. Collins discusses three of those challenges and how the health system tackled them to reach success and optimization.

1. Challenge: Staffing for implementation. A major challenge for this large EMR overhaul was securing the staffing resources to complete the work, says Mr. Collins. Many organizations hire consultants to help implement software. They then stick around in a support capacity following the go-live. Other organizations may recruit and hire additional information technology professionals specifically for the implementation. Whatever the approach, acquiring the necessary staffing resources is no easy feat.

Martin Health System's approach: Build a team internally
According to Mr. Collins, Martin Health decided to pursue a third option: choosing current employees and training them to be system analysts for the EMR implementation.

"We took a third approach. We chose to grow our own people. The decision involved two major factors: we needed to [implement] fast and did not want to spend a fortune. It is a lot cheaper to teach someone from your organization a new skill than to hire someone with 20 years of experience in that skill," says Mr. Collins. "We also wanted to own [the initiative]. We wanted it to be ours. With the proper skills and training, we knew we could build a successful system. We really felt that nobody could do it better than us."

When Martin Health signed the agreement for an EMR, its IT department had approximately 50 people. When it completed recruiting internally, there was an IT team of 115, and less than 5 percent of the individuals were external additions.

"I wanted to use internal staff because we were able utilize the expertise of individuals who had been with Martin Health for 10, 15 or even 25 years. They knew the system and were committed. Second, I knew that the training would make them marketable. Since they were committed to Martin Health — had families and houses in the area — they would be more likely to stay with the system going forward," says Mr. Collins.  

The process
Martin Health spread the word by holding a job fair at one of its hospital locations and a few town hall meetings. "A lot of individuals were interested in the 65 open positions. So, we were very clear about the expectations and requirements for the openings. We really told them what it would be like to work in IT for this initiative. 'If you are on the implementation team, here is what your life will like over the next 18 months," says Mr. Collins.

Making sure that employees understand expectations is crucial, especially since being part of an IT implementation team for a major EMR overhaul can involve many responsibilities. Martin Health laid out the following requirements:

• Trips to Madison, Wis., in November, December and January to undergo training.
• Tests on training sessions.
• Minimum vacation time during Thanksgiving, Christmas and New Year's Eve.

"We basically told the interested individuals that if they were planning major events over the next 18 months, the job was not for them. Of the 200 to 300 people that initially came forward, we were left with 100," says Mr. Collins.

After the initial information sessions, Martin Health conducted human resources screening sessions and final interviews, until the final candidates were selected.

2. Challenge: training. After the implementation team was built and trained, the next big challenge for Martin Health was training all of the employees and physicians — approximately 3,200 employees and 400 physicians.

"[The biggest concern] was the commitment we needed from physicians and nurses. We requested nurses take 16 to 24 hours of classroom training and that physicians attend 9 hours of classroom training. The training would be on their dime because it would take them away from billable hours. It was not easy to convince the medical staff to give up 9 hours of their valuable time," says Mr. Collins.

Martin Health System's approach: Work with medical executives to share training expectations
Martin Health relied on the medical executives to share the training expectations and encourage the medical staff to attend.

According to Mr. Collins, the medical staff put the pressure on anyone who resisted, but the majority of physicians and nurses were receptive to the training.

"They understood it. They realized if they did not know the EMR, they would not pass training to receive a login. Without a login, they couldn't practice at our hospitals," says Mr. Collins.

Although Mr. Collins believes the system's approach was largely successful, he would advise other healthcare organizations to train physicians and nurses simultaneously.

"We split them because we feared the physicians would not be engaged unless we gave them very special attention. We had two teachers for every five physicians, which ended up being a resource hog," says Mr. Collins. "We focused so much personal attention on physicians that we neglected running them through workflows with nurses, which caused problems on the go-live."

Physicians and nurses did not understand each other's screens, causing delays and difficult workflow transitions. Although Martin Health had the implementation team as support throughout the go-live, they were not always there at the right moment. While the workflow eventually adjusted and all parties are now up to speed, Mr. Collins recommends training physicians and nurses on each other's EMR screens so they can help each other during the transition.

3. Challenge: Moving toward EMR optimization. According to Mr. Collins, since Martin Health implemented its EMR overhaul with a "big bang" go-live, moving forward to optimization became a challenge.

"There is this period of time — a few weeks to months — where you are just fixing stuff. At first, you need to fix kinks and problems because it could be a patient safety issue. However, it is easy to become stuck in the mode of 'if something is broken, fix it,'" says Mr. Collins.

Martin Health System's approach: Draw a hard line
According to Mr. Collins, there is a point where a health system or hospital needs to draw the line and say the implementation phase for an EMR is over. Otherwise, the EMR will never be optimized for the best workflows. Optimization is a key piece of a successful EMR system.

There may be no perfect time to conclude the implementation phase, but it needs to be done. According to Mr. Collins, it is mostly a moment of recognition. The system needs to think about controlling change with the EMR rather than fixing problems.

"You have to draw the line somewhere. There is this point where you have to say — this is it. The implementation phase is over. Now we start to prioritize new work. Here is a piece of the system we should optimize. Let's put a team on it," says Mr. Collins.

Results
Martin Health System took on a big challenge when it decided to implement a widespread EMR overhaul. In addition, the system completed the process almost entirely on its own. Going into the initiative, Mr. Collins knew there would be challenges but he took a systematic approach which proved effective. So far, the system's EMR results have been solid. This year Martin Health was named a "Most Wired" Hospital by Hospitals & Health Networks magazine, and in August it was accepted by the state of Florida as an early adopter to the Florida Health Information Exchange.

"Ultimately, we viewed the entire process as not just an IT upgrade, but an opportunity to engage all of our stakeholders and enhance the way we provide care, perform our operations while improving efficiencies and reducing waste," says Mr. Collins

More Articles on EHR Implementation:

University of Iowa Hospitals and Clinics Reaches Stage 7 in EMR Adoption
5% More Missouri Hospitals Adopted EHRs Since Last Year
3 Solutions to Improve EHR Training, Outcomes

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