The federal economic stimulus plan provides unparalleled support for health information technology; however, anxiety still runs high for those embarking on an electronic medical record venture.
With an impending deadline to become a “meaningful user,” EMR transformation remains a high-risk proposition. As an early adopter of the EMR strategy, Sentara offers four major lessons learned: (1) EMR implementation requires a poignant approach to change management; (2) flawed clinical and business workflows must be re-engineered; (3) the complexity and duration of an EMR rollout demand a sound implementation strategy; (4) the stimulus plan challenge to “play now or pay later” requires a strong business case.
Sentara is a 120-year-old. not-for-profit healthcare system located mainly in southeastern Virginia. Sentara comprises seven hospitals totaling 1,729 beds, six outpatient campuses, 10 long-term-care facilities, 380 physician medical group, and 19,000 employees. Sentara offers a 380,000-member health plan and 2,500 community medical staff members as well as other services. Operating revenue exceeds $2.8 billion, with assets of $2.7 billion.
In 2003, Sentara had many disparate legacy IT systems for managing business and clinical operations. In 2004, Sentara successfully completed the systemwide installation of a picture archiving and communication system, voice recognition, and radiology information system applications. Based on this accomplishment, senior leadership challenged IT to put forward an EMR solution to transform care delivery by integrating data electronically across the continuum of care. With the strong support of top management and the physician community, the EMR vision was to be an enduring transformation of care—not simply an “IT project.”
In 2005, after a rigorous search for a suitable IT solution and conducting a thoroughly validated total-cost-of-ownership analysis, Sentara launched its largest, most complex IT initiative ever, called “eCare.” This year, eCare applications will be installed in six hospitals and hundreds of physician practices. In 2010, eCare will include linkages to home health and long-term-care environments.
ECare encompasses a 10-year, $237 million total cost of ownership. In the baseline year, cost savings were to be $30 million in hospital efficiencies, $2.7 million post-acute efficiencies, and $2.8 million for the health plan. The return on eCare was to be 12.3 % payable in 7.4 years; less return than the threshold of 15%, and the projected positive cash flow was 2.4 years beyond that expected for capital acquisitions. Nevertheless, the board understood that to be a national top provider of choice, the “standard of care” had progressed to the point that eCare was warranted. At the height of the project 190 staffers were engaged in a “dual rollout” that accelerated the implementation by six months.
The eCare EMR provides a single-view access for integrated results retrieval across all environments of care. Its features include computerized physician order entry, access to protocols, decision support tools, and clinical documentation built on architecture to facilitate patient record integration.
The new installed eCare software applications include inpatient and physician practice EMR, pharmacy, medical records, emergency department, oncology, bedflow management, scheduling, and computerized physician order entry. Supplemental software applications include bar-coding, faxing, patient health record. These applications required multiple interfaces to current applications such as radiology, laboratory, surgery, PACS, and medication dispensing. Other resource requirements included upgrading personal computers, printers and increasing the available of computers on wheels.
No doubt, eCare is improving patient care delivery and providing significant benefits. For example: At three hospitals in first quarter of this year, about 20,000 potential medication errors were avoided when nurses canceled medication administrations because of bar-coding alerts; inpatient lab tests have been reduced by 5% because of elimination of duplicate orders; the readmission ratio at our first go-live hospital has been reduced by 18%; the time to assign a bed has decreased 90 minutes; documentation, transcription, medical records, and malpractice premium costs for Sentara Medical Group cost $1.4 million less; Sentara Health Plan achieved $643,000 in benefits in 2008 through reduction in severity-adjusted length of stay for patients at our first go-live hospital; and through the first four months of 2009, four hospitals live on eCare realized $16.2 million in annualized benefits.
Sentara has a four-point strategy for seeking funding from the federal American Reinvestment and Recovery Act. Our foremost strategy is to ensure that all of our hospitals and physician practices are “meaningful users” in time for the 2011 Medicare incentives. Moreover we will assist non-Sentara entities in meeting “shovel ready” status in order to maximize the Medicare and Medicaid incentives. Sentara also will make policy recommendations that will enhance the efficiency and effectiveness of the information technology efforts and ensure the security of patient’s health information. Furthermore, we plan to affiliate with the federal Health IT Research Center and the state Health IT Extension Program to provide technical assistance regarding best practices to accelerate the adoption, implementation, and effective use of health IT throughout the country.
Unique IT system features and configurations, cost of ownership, recruitment and retention of a talented team, as well as unforeseen requirements are common to all EMR implementations. Yet, all lessons learned will point to the need for poignant change management, significant workflow re-engineering, a sound implementation strategy, and a well funded business case. Based on the recovery act dictates, healthcare providers are limited to two options: play now or pay later.
Bertram Reese
Senior vice president and chief information officer
Sentara Healthcare, Norfolk, Va.
