At Mercy health system, the technology hasn't always kept up with the vision—but leadership has felt strongly and been patient enough to watch closely, wait out the development process and move forward when the moment felt right.
For example, Mercy began thinking about converting to electronic health records in the mid-1990s but did not do so until about a decade later, says Lynn Britton, president and CEO, whose efforts to lead that transformation and others have earned him one of three CEO IT Achievement Awards
for 2012, presented by Modern Healthcare and co-sponsored by the Healthcare Information and Management Systems Society.
“We reached a turning point in probably 2005 and on into 2006, where we realized that the technology had moved ahead and that we needed to make a shift in commitment,” says Britton, 51. “I don't think it was a shift in core philosophy as it was a constant pursuit of making sure we had the right platform to do it.”
The rollout of the Epic system, which cost about $500 million to implement organizationwide, has represented a “major advancement” for patients, doctors and other staff, says Will Showalter, vice president and chief information officer at Mercy. “The key has been the support from Lynn to accomplish that,” he says. “That technology represents the fulfillment of our desire to make sure the quality of care is consistent in every institution where we deliver services.”
After choosing a vendor partner, Chesterfield, Mo.-based Mercy decided to go all in on the EHR and make the shift from paper to electronic systemwide, “rather than doing it piecemeal, one nursing unit at a time,” he says of the 2007 switch, which incorporated 3,600 users and 19 hospitals—and now connects 25 hospitals and 1,600 doctors in 220 locations—achieving a HIMSS Stage 6 designation for meaningful-use compliance (Stage 7 is the highest). Mercy later built a data center that's rated as tier 3—a measure of ability to withstand a natural disaster, with tier 4 being the highest—in 2010 to support the EHR and future technology initiatives.
Britton has seen his role as championing the vision, building organizational will around the necessary change management and execution, and ensuring that design and implementation were made a priority and adequately engaged physicians. “And to be the cheerleader, too,” he says. “I challenged them to think bigger and broader.”
After Mercy rolled out the EHR capability to all hospitals and physician offices across four states, officials moved on to the next challenge: how to transform care delivery, Britton says. “Once you stand it up, the question becomes, 'What do you do with it to make the difference?'” he says. “I certainly think you have to have a commitment to a financial investment. You have to make it a priority. It's the biggest thing we've ever done from a change-management perspective.”
Among the changes in mindset: the need for an “industrial-strength capability” around the reliability of the organization's electronic infrastructure. “If it's down, you can't deliver care,” Britton says. “Healthcare organizations weren't used to needing to have that kind of reliability. You have to make sure you have the redundancy. If (the EHR) worked great but was only up 80% of the time, you were in trouble.”
Britton says he's “really proud” of how well the massive change was accepted and embraced, with physician leaders convincing their peers, for example, why they needed to have 20 hours of classroom training and pass a competency test to use the EHR.
“There were moments of resistance, and unhappiness, and that sort of thing,” he says. “The organization had aspired to have this capability for so long, the technology had finally arrived—but it wasn't easy. There were many trips to many Mercy communities, a lot of listening sessions and things for people to go through the hard work of change.”
The entire organization has had to manage through a “paradigm change,” Showalter says. “At an industry level, with accountable care and being value-driven, we have to think differently and be something different than what we were,” he says. “And then at a more tactical level, it's the change management of moving from a cottage industry, where it was OK to have department IT (with separate systems), to a more shared-services model.”
To make the EHR system more affordable, Mercy limited the extent to which individual facilities could customize features such as data and workflows. But leadership did make sure that everyone participated and had a say. “We committed to providing what we called design, build, validate sessions,” Britton says. “People recognized it as part of their design work. It wasn't something foreign. They recognized pieces and parts of it.”
To build unity around the implementation, physicians and other staff participated in “go live” launches at peer facilities throughout the Mercy system. “Physicians from St. Louis and Arkansas went to Springfield” in Missouri, Britton says. “There was a lot of peer-level, at-the-elbow support—and then everybody had to pay it forward. That gave people a lot of confidence and a big sense of success.
“I sat in a lot of meetings where I heard war stories,” he adds. “They were slapping each other on the back, saying, 'Remember when you didn't know how to do this, and I helped you?' It was a culture-building exercise that helped to unify our culture across four states. It was hard work in change management, but it was worth it.”
Those relationships have continued during implementation of the EHR, which has helped to further strengthen cross-facility bonds, Britton says.
“It's amazing to me how the physicians—they have chart etiquette groups whose responsibility it is to maintain this information,” he says. “They've taken on ongoing change management. I don't think that would be well-received today if they hadn't gone community to community helping each other implement it.”
EHR implementation has produced results for the traditional bottom line, as well, with incentive payments of more than $30 million from Medicare and Medicaid for meaningful use as 90% of integrated physicians have met first-year meaningful-use objectives. Compliance with CMS core measures of clinical quality has skyrocketed from 44% to 100% for heart failure and also risen for heart attack (87% to 91%), pneumonia (85% to 91%) and surgical care (85% to 87%) pre- and post-EHR implementation.
Those relationships were even further strengthened—and the system's capabilities fully exploited—during the tornado that hit Joplin, Mo., in May 2011. The EHR—and Britton's leadership—helped to ensure the system's speedy recovery, Showalter says. Within three hours, Mercy was able to use the IT system to provide medical records for the 183 patients relocated from the destroyed St. John's Regional Medical Center, whose replacement will open in 2015.
“Obviously, the issue was: How do we manage through that short-term crisis?” Showalter says. “Then, Lynn's perspective was, '(Where) do we need to be when we come out of it,' and that constant, 'Where do we need to go? How do we provide the capabilities to be reborn and meet the next challenges?'”
Mercy has enjoyed other technological advances under Britton's leadership: a bedside barcode-scanning medication system that reduced potential medication errors by 40% from early 2010 to late 2011; the installation of more than 3,500 smart IV pumps that alert clinicians to inappropriate drug doses; the Mercy SafeWatch program, which monitors intensive-care unit patients through two-way cameras and an electronic network, leading to mortality rates 20% below expected results and cost reductions of 30%; and the launch of nearly 70 telemedicine projects, with two grants from the U.S. Department of Agriculture aimed at the most hard-to-reach rural areas, and plans in place for the nation's first virtual care center.
Successful leadership of and change management around IT requires a blend of personal qualities, Britton says.
“I certainly think you have to have the willpower to see it through, and the conviction,” he says. “There will be tough times. You have to be a really good listener, but you have to be willing to also hold people accountable. You also have to be persuasive: You need to be able to get out into the field and make the case for why this is so important. You have to be able to listen and support them.”
“Lynn always brings an excitement to the table related to what we can be and what we should be,” Showalter says. “That excitement often manifests itself around the vision and the change management that needs to occur to get to that next level. How do we better ourselves, not so we can beat our chest and stand in front of people and gain awards, but it's about how we can better ourselves so we can meet our mission and deliver transformative healthcare. … He's the keeper of the faith related to where that transformative healthcare experience will take us.” Ed Finkel is a freelance writer based in Evanston, Ill. Reach him at firstname.lastname@example.org.