It is 2018 and the electronic medical record (EMR) is no longer a novel concept. Most American healthcare providers have invested in an EMR and established some degree of use. The investment was a significant, challenging, and meaningful step toward the future of healthcare delivery.
Now, with the majority of organizations running with some level of EMR integration, most in our industry are grappling with the next major question: How can our EMR optimize quality and safety while improving the experience of our patients, physicians, and staff?
In order to maximize the value of this significant investment and establish pervasive adoption and use of the EMR, Rochester Regional Health embraced the Healthcare Information and Management Systems Society (HIMSS) Electronic Medical Record Adoption Model (EMRAM) as a roadmap. Over its eight-stage (0-7), multi-year process, HIMSS measures the transition from paper charts to full EMR integration at a level that improves quality of care and organizational efficiency. Along our journey to HIMSS Stage 7 certification, we experienced several meaningful lessons.
To achieve HIMSS7 goes beyond simply deploying and using the EMR. The true goal is to harness the technologyto optimize care processes in a way that makes life easier for physicians and staff while improving the experience for patients. It is a level of utilization most are still looking to attain—only six percent of hospitals in the nation have achieved HIMSS7, including 11 out of the 195 hospitals in New York State. As a result of our commitment last year, four of those 11 New York State hospitals are part of Rochester Regional Health.
Former competitors, now one health system
As a recently merged health system, we faced the common challenge of integrating multiple hospitals, each with their own processes, systems, organizational culture, and EMR platform. By creating a path toward placing our entire system on one EMR platform and committing to reaching a HIMSS7 level of organizational mastery with that same platform, we created a common thread across these hospitals. Instead of several hospitals—many of them former competitors of one another—defending their way of doing things, everyone saw a chance to build something new and transform together.
"The true goal is to harness the technology to optimize care processes in a way that makes life easier for physicians and staff while improving the experience for patients"
Making life easier for staff
We decided to pursue HIMSS7 because we saw it as an opportunity to improve quality, make care safer, and lower cost across our entire system. We knew that in order for these improvements to become permanently ingrained, what we implement must make work processes simpler and easier. It’s a simple lesson that can too-easily be forgotten: after training and transition, new technology and processes must make life easier for the people adopting them. Our providers, clinicians, and operations leaders built a user-friendly system and committed to developing a team of experts through constant training, constructive evaluation, and ongoing support. Before long, our team began to embrace our new system as the better, easier way.
Immediate improvement to patient safety
As we pursued HIMSS7, our team embraced the collaborative process because everyone understood the long-term patient benefits. What we did not anticipate was how quickly we would begin to see real improvement in key areas:
We reduced central line-associated bloodstream infections by 65 percent over two years.
• By streamlining clinical workflow according to new data from the EMR, our system reduced central line-associated bloodstream infections from 1.0 per 1,000 central line days in 2015, to 0.35 infections per 1,000 central line days in 2017. In fact, from July through September of 2017, the health system saw zero central line infections.
Our four HIMSS7 hospitals now barcode scan more than 95 percent of all medications.
• Medication administration is a significant safety concern in all hospitals. Legible and computerized ordering processes coupled with barcode-assisted administration can eliminate most risks because both the patient and the medication are linked with the appropriate order in the EMR. While our hospitals utilized these safety tools for years, HIMSS7 inspired us to improve our scanning utilization from the “very good” tier to the established standard of “excellence.”
• Because of its far-reaching nature and profound effect on patient safety, our team bonded over the challenge to improve our barcode scanning rates. Physicians, nurses, pharmacists, and IT team members collaborated across hospitals and clinical disciplines. Each took personal ownership as we measured our progress. These measurable goals aligned with our deeply held individual values and our health system’s strategy. In a matter of months, we reached 97 percent barcode utilization across all participating hospitals.
We have placed a greater system-wide emphasis on preventative maintenance, monitoring, and downtime drills.
• By conducting downtime drills as a system, we ensure a uniform-level of preparedness and consistent safety practices across the entire health system in case of technical failures or major incident scenarios.
With the need to unify comes the opportunity to improve
In this era of merging health systems, as your organization faces the challenge of collaborating with newly merged affiliates to integrate a unified EMR and create consistent quality and safety practices; consider using the HIMSS ladder as a road map. Your team will rally around some challenging and meaningful work that will strengthen your culture of safety improvement. Eventually, you will reach HIMSS7 and be proud of that achievement, but the real value for your organization—and your patients—will be gained along the journey.