EMR / EHR
Botsford's Big Bang
By Dr. Paul E. LaCasse, D.O., MPH, December 2010
A Michigan hospital counts down the days to its EMR system launch and readies for meaningful use.
In October of 2011, the staff at Botsford Hospital, a 330-bed, 2,300-employee hospital located in Farmington Hills, Mich., will experience its own version of a big bang. Full implementation of an electronic medical records (EMR) system will be complete, and the system will go live.
Our journey began in the fall of 2009, when initial discussions on the need for a comprehensive EMR system took place. And now, mid implementation, we have some busy months ahead to meet our final goal. Soon enough, Botsford will be fully operational with its EMR and replacement of core patient-management, financial and material-management systems. We're empowered to share what went into the decision and initial installation phases to help others, who are weighing the benefits of EMR, focus on what's really important: patients.
Dr. Paul E. LaCasse, D.O., MPH
The decision to transition to an EMR system was one of transformation — advancing the way we deliver care, bettering communication between staff and patients and improving patient safety. While there are stimulus and meaningful-use dollars on the table, I was careful to advise hospital leaders that we didn't want to rush into a decision. We were about to embark on a significant overhaul of our IT systems. While we all wanted a system to automate our processes, automation on a flawed system would only make things worse. With this in mind, we went to work on some of our existing processes to make them more efficient and effective before we got started. We established an Office of Clinical Process Improvement along with a steering committee to guide the process and develop objectives for a new EMR system.
We also turned to our long-time IT services partner, Affiliated Computer Services (ACS), a Xerox company, to help us with the strategic decision involved in selecting an EMR solution. ACS brought technical and strategic expertise that we simply did not have. Using their experience in EMR vendor selection and implementation, ACS staff members helped us to decipher our needs and match us up with vendors that could deliver on our organizational goals and cost objectives.
"Botsford was looking for a complete, integrated solution aligned with the hospital's mission to improve patient care and safety," says Paul Solverson, partner, strategic advisory services, ACS healthcare provider consulting. "[Botsford staff] didn't want best-of-breed products; they wanted modules that were integrated, not interfaced — a complete overhaul of what they had."
As an independent teaching hospital, we also work within a well-defined budget and have specific cost objectives. ACS made us aware of the requirements so that we will be able to capture critical stimulus and meaningful-use funding. We put these plans into place before the formal meaningful-use regulations were issued in July. We didn't need to make changes; we were prepared.
With help from ACS, our Clinical Process Improvement Office and steering committee, we completed a comprehensive request-for-approval process to evaluate potential EMR offerings. We opted to go with the McKesson Paragon solution, an all-inclusive and fully integrated hospital information system. We wanted a solution that would work seamlessly with our existing laboratory and emergency department systems. This decision also met our goal to improve patient safety. For example, adding barcode technology to our medication administration process will ultimately help us improve communication and reduce errors between physicians, pharmacies and patients.
Do it for the right reasons
Change of any kind is difficult. With EMR, the first step is to make the change for the right reasons. Then, you should reiterate those reasons regularly to your employees, so that your clear purpose is reinforced. If employees believe the implementation is being done only to take advantage of meaningful-use dollars, it sets the wrong precedent; it has to be done for the purposes of improving patient care, efficiency and patient safety.
We began by involving employees in the decision-making process. Physicians participated in product demos and were part of the team that evaluated our final choices during vendor selection. Even the steering committee was made of members from every department within the hospital.
And because it's a long time between vendor selection and actual big bang, we continue to keep our 2,300 employees involved with regular e-mail blasts to communicate progress and remind them of benefits. We even describe challenges and solutions to keep perceptions from being more rumor than fact.
Progress to date
Currently, we've completed much of the initial training, and now we're working with ACS and McKesson to design and configure the solution to meet end-user needs. Paragon's flexibility allowed us to use our current formulary in our pharmacy and match it with the formulary utilized by Paragon's computer physician-order-entry (CPOE) system. ACS and McKesson found a solution that enables us to develop order sets in a shorter amount of time, using our current tools. We're working from a timeline and project plan provided by ACS' project management office. The group is led by a program director, project managers and consulting staff and has implemented many EMRs. This is a critical resource that keeps us on track.
We're also on track to meet our financial goal for this endeavor. While we anticipate productivity improvements, we expect to fund most of our investment with the healthcare stimulus money and meaningful-use dollars we'll earn as a result of implementation.
October 2011 seemed quite far off when we first began this journey. Now that we're 10 months out, I'm enthused by the progress made and excitement building from the staff. We will celebrate new efficiency and better communication with each other and with our patients when the big bang comes to Botsford.
Tags: EMR / EHR