CIOs Share 7 Best Practices for Reaching HIMSS Stage 7

Since 2005, HIMSS Analytics' EMR Adoption Model has tracked electronic medical record adoption in hospitals and health systems throughout the country. The eight-stage model culminates with stage 7, in which paper records are no longer used. Stage 7 organizations are also able to share patient information electronically and have advanced data analytics capabilities.

To date, just 160 hospitals in the U.S. have achieved the stage 7 distinction. Below, CIOs from four hospitals and health systems that have reached this milestone in the past month share best practices and advice from their own journey to stage 7.

1. Recognize stage 7 is more than an IT project. Round Rock (Texas) Hospital and Taylor (Texas) Hospital, both part of Dallas-based Baylor Scott & White Health, were awarded stage 7 distinction Dec. 19. Matt Chambers, the health system's CIO, credits making stage 7 an organizational goal as a main factor in the achievement.

In the design phase of the system's EMR implementation, Mr. Chambers, then the CIO of pre-merger Scott & White Healthcare, laid out the metrics he and his team would use to measure the success of the implementation, as well as the goals of the implementation, one of which was to reach stage 7. By bringing all leadership on board early, he was able to get the operational and clinical support needed to help the system achieve stage 7. "It has to be an organizationwide effort," he says. "If you're counting on the CIO to do it all by him- or herself, you will fail."

2. Involve physicians… On Dec. 12, HIMSS Analytics honored Lancaster (Pa.) General Hospital with the stage 7 award. Michael Ripchinski, MD, the hospital's CMIO, says a main factor in the hospital's success was early and full engagement with physicians and physician leaders. "Physician and hospital leaders have to support the change, prioritize its implementation over other projects and recognize the work as strategic and not solely as an IT project," says Dr. Ripchinski. "Physician department chairs and the physician advisory committee members are key leaders to accomplish this."

3. … but don't forget to involve administrative employees, too. Tampa (Fla.) General Hospital reached stage 7 Dec. 9. The hospital's senior vice president and CIO, Scott Arnold, says hospitals often overlook the necessity of including administrative and business stakeholders to ensure the EMR meets their workflow needs as well. "Having a good mix of clinical professionals, engineers and business professionals involved in the implementation of an EMR is critical," he says. At TGH, "everyone 'owned' it in their respective clinical, business and support settings."

4. Emphasize the benefits of stage 7. Bristol (Conn.) Hospital reached stage 7 Dec. 11. The hospital's CIO, Dave Rackliffe, explains focusing on the care quality and other organizational benefits helped secure the necessary buy-in from leaders across the hospital.

"The approach to achieving stage 7 should not be just to meet the criteria. You will never get consistent buy-in from stakeholders with this approach," says Mr. Rackliffe. "Stage 7 criteria focuses on the use of best practices as the organization pursues a safer, higher-quality environment for its patients. By emphasizing the stage 7 criteria as representing best practices, our organization embraced the efforts to achieve this designation."

5. Select the right EMR vendor. Both Bristol Hospital's Mr. Rackliffe and TGH's Mr. Arnold credit their vendor selection with helping their respective hospitals achieve stage 7. "We found that through the implementation of the Meditech 6.x platform, much of the [stage 7] criteria was achieved by enabling the functionality in the platform," says Mr. Rackliffe.

Similarly, Mr. Arnold says selecting Epic was one of the best decisions made during the journey to stage 7. "In retrospect, the best decision was the decision to invest in EMRs for our patients and the community as well as the technology choice being Epic," he says.

6. Dedicate resources to quickly identify and correct workflow issues. After the initial EMR implementation, Baylor Scott & White convened an optimization team named Project Evolve, branded to emphasize its importance to hospital employees, says Mr. Chambers. Including "the best and brightest" from the EMR implementation team, Project Evolve monitored specific metrics now available to hospital administrators through the EMR system. "They saw how many charts physicians were completing per day, how many patients they were seeing and even how late they were working," says Mr. Chambers.

The team was then able to identify the physicians needing the most help with the new system and intervene promptly to provide support. Just 90 days after go-live, virtually all of the system's physicians were using the system at meaningful use standards. "The program has been universally praised," says Mr. Chambers. "Our vendor, Epic, says they haven't seen results like this anywhere else."

7. Retrofit improvements. Hawaii Pacific Health in Honolulu was awarded stage 7 on Dec. 20, 2013, and 28 of the system's associated ambulatory clinics were awarded the Stage 7 Ambulatory Award. The system's executive vice president and CIO Steve Robertson says during the EMR implementation, his team worked by the motto "perfection is the enemy of good enough" to keep on time and on budget, and kept pressing forward to get the EMR installed and working in the system's hospitals.

However, Mr. Robertson says all the forward momentum meant the IT team didn't go back to the hospitals to first get the EMR to apply best practices and solutions discovered during subsequent implementations. "As a result, hospitals that received the EMRs later in the project tended to have better or different workflows," he says. To other CIOs, he recommends optimizing the EMR after every site implementation.

To all the CIOs who have helped their hospital or health system achieve stage 7, the award elicits a sense of pride. "As you might imagine, we feel privileged to have achieved this designation because we worked hard to improve our system and our processes to reflect best practices," says Bristol Hospital's Mr. Rackliffe.

It's not just the CIOs who feel the great sense of accomplishment at reaching stage 7. "When the inspector from HIMSS came, [Round Rock Hospital CEO Ernie Bovio] said, 'Now I get my lapel pin, right?' He received a stage 6 lapel pin but never wore it because he wanted the stage 7 pin," says Baylor Scott & White's Mr. Chambers. "He sent me a picture of it when he got it in the mail — it's as big as a belt buckle. But he wears it." 

More Articles on HIMSS Stage 7:

Cincinnati Children's Reaches HIMSS Stage 7
2 Hawaii Hospitals Reach HIMSS Stage 7
2 Baylor Scott and White Health Hospitals Reach HIMSS Stage 7

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