EHR Implementation in Critical Access Hospitals: Providence Medical Center's Journey

The implementation of electronic health records proves to be a challenge for most healthcare facilities. EHR implementation results in changes to workflow and requires buy-in from staff and physicians. Smaller facilities, such as critical access hospitals, sometimes have to come up with creative ways to deal with the challenges.

Providence Medical Center in Wayne, Neb., a 25-bed critical access hospital, has successfully completed both the implementation process and stage 1 of meaningful use attestation. Here, Providence's Wendi Dwinell, the Wardclerk supervisor and project manager, and Brittany Peters, business office and medical records discuss how they overcame the challenges of EHR implementation, despite the hospital's small size and fewer resources. They also offer advice to other critical access hospitals that are starting the same process.

Question: What were the most challenging aspects of EHR implementation?

Wendi Dwinell: For our facility just going into electronics was challenging, because many of our staff members weren't familiar with the computer at all. So we started weekly workflow meetings. This helped us be in constant contact with our staff, which is necessary when so many changes are impacting every aspect of workflow. Also, having a super-user is important. A super-user is a staff member who goes through the whole process of implementation and is familiar with the system and can help train other staff members.

Brittany Peters: Workflow changes a lot when you switch to electronics. Also, our physicians found the change challenging. Some of the biggest complaints that we heard from staff members or physicians was "It takes too much time" or "It doesn't work." That usually meant that they just needed more time or training. For individuals who weren't familiar with computers, we started training them on the basics of computer use well before we implemented the EHR. Training is essential for a good foundation.

Q: What challenges did you face due to the small size of your facility?

BP: One of the things that we found a challenge was that because of our smaller size and because we are not a specialty hospital, we had to work harder to figure out how our doctors would be able to effectively use the system. The EHR system is geared toward an inpatient hospital setting. We have big outpatient volume. Also, inpatient documentation is different from outpatient documentation. We adapted the system to an extent to fit with our work processes, but there are some things we still just document on paper.

Q: How did your facility overcome those particular challenges?
BP: We had a core group of staff members who were committed to this. They worked long hours and extra hours and made sure that they were there for the staff if things weren't working. They helped staff members and physicians come up with workarounds when necessary. This core group knew the system inside-out and even helped raise morale.

Q: What advice do you have for critical access hospitals that have yet to begin the process?

BP: I think the key to having a successful go-live is preparing ahead of time. Have your core group be prepared and discuss the questions of workflow. Decide ahead of time what will go on the system and what will stay on paper, that is if you are going to be using a hybrid workflow for a while. Anything that you can do before going live to troubleshoot the "what if" questions is hugely helpful. Talk to staff about the changes that will come up, and discuss possible ways to make things easier on everyone. Another thing critical access hospitals can do is go visit some other facilities [that] are of the same size, and talk to them and see how they handled the issues.
WD: I think as a facility, we did great getting the equipment that we needed to go-live, but the workflow aspect is something that we didn't work on beforehand as much as we should have. But since the implementation, we have had three hospitals that have come here to ask us about the system and how things have changed.

More Articles on EHRs:

U.S. EHR Market to Hit $6B by 2015
HIMSS, IIA Launch First Benchmarking System to Gauge Analytic Maturity
How EHRs Can Measure Patient-Centered Care

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