Columbia Basin Health Association, a not-for-profit community health center in rural eastern Washington, has a fully implemented electronic medical record, or EMR, at its two established sites in Othello and Mattawa.
They are among the first multisite, multispecialty clinics to become completely paperless, and the CBHA also completed the process of implementing an EMR at a second site in Othello, which it recently acquired.
The health association wanted to identify barriers to the transition from paper to an EMR from a primary-care provider's perspective. The goal was to create an action plan to overcome barriers identified by end-users--the providers.
The CBHA found that getting this feedback before the EMR is ready and having a plan to deal with those barriers is an effective strategy in the successful implementation of an EMR.
A questionnaire was used to gather information on perceived or known barriers to a successful implementation
of an EMR. The survey was sent to 15 providers; 10 have been using an EMR for more than a year, and five have been using it since March.
The results were obtained through confidential interviews.
The results of the survey were examined, and another survey consisting of 10 questions was created based on the responses to the first survey. The second survey was sent, and providers were asked to rate each identified barrier.
Based on the results of the second survey, the top five barriers identified were:
- Patient dissatisfaction (care is impersonal)
- No financial incentive for providers
- Loss of jobs for some support staff
- Lack of a proper plan for implementation
- Lack of solid IT infrastructure
The goals required 95% of patient exams to be completed (saved and finished) within 48 hours of the patient encounter, 100% of labs to be ordered electronically and 100% of medications to be prescribed electronically. Additionally, there is an incentive plan for providers meeting the above goals on an annual basis. We found financial incentives to be powerful motivators, and in just two months all of the providers met or exceeded the goals.
There are four full-time information technology personnel to maintain the IT infrastructure, and many employees have had advanced training to troubleshoot the EMR and designate them as expert users.
Misbah Keen, M.D., is an attending family physician and medical information officer at Columbia Basin Health Association in Othello, Wash. He is also pursuing a graduate program in medical informatics at the Oregon Health & Science University in Portland.
Joe Brandenburg is a senior biology major at St. Martin's College, Lacey, Wash. He also works on medical projects at Columbia Basin Health Association. He is interested in pursuing a career incorporating medicine and IT.
Tom Yackel, M.D., an internist, is associate medical information officer at the Oregon Health & Science University. He also teaches courses on clinical information systems in the department of Medical Informatics and Clinical Epidemiology.