Evanston Northwestern Healthcare is the winner of the 2004 Nicholas E. Davies Award for achievements in implementing computerized patient records in hospital-based organizations.
The award, announced by the Healthcare Information and Management Systems Society, recognized the suburban Chicago multihospital healthcare system's implementation of a $35 million integrated system for electronic health records throughout its three acute-care facilities -- Evanston (Ill.) Hospital, Glenbrook Hospital in Glenview, Ill., and Highland Park (Ill.) Hospital -- and 65 offices of its medical group.
Evanston Northwestern "did everything right, from its leadership commitment, reworking of all of its processes and securing organizational buy-in to realizing tangible benefits in quality, safety and operating efficiencies," said Asif Ahmad, chairman of the task force for the award and vice president and chief information officer of Duke University Medical Center and its health system, Durham, N.C.
The Davies award, named for an Atlanta physician informaticist, was established in 1995 by the Computer-based Patient Records Institute and taken over by HIMSS in 2002 after the society acquired a successor group to the CPRI.
The physician champion of the Evanston Northwestern drive was OB/GYN Arnold Wagner Jr., M.D., chairman of the hospitals' medical informatics committee since 1999. His five-physician medical group in Evanston is affiliated with, but not owned by, the hospital system.
In August 2001, ENH decided to deploy the information technology system from Epic Systems of Madison, Wis. At the time, "Epic had a demonstrated track record in an ambulatory-care product," Wagner said, but "it was a big roll of the dice" that Epic's new hospital IT system could be joined to it to create the integrated system ENH needed. In effect, Wagner said, "We've been their alpha lab for the past 3 1/2 years."
ENH has 1,700 physicians, including 550 in the Evanston Northwestern Medical Group employed by the hospital system, and more than 1,150 affiliates, of which about half are hospital regulars, Wagner said.
"The training effort was huge," Wagner said, consisting of a mandatory 16 hours per person. "We had a training station of 13 bays of 12 computer stations per bay going double shifts for a year."
The total training time was "north of 140,000 hours," he said. There were no physician revolts, but that was not to say the installation was grumble-free.
"To be sure, this was painful. I was not a happy experience for anybody. It was like being a medical student again," said Wagner, who attributed a great measure of success to the steadfast support for the project from hospital President and CEO Mark Neaman.
For Neaman, "Failure was not an option," Wagner said. "It was job one. It was going to happen."
Complete access to patient electronic medical records is available throughout the three hospitals and in all of the staff physician offices. Wagner said the goal now is to extend the system to as many affiliated physicians as possible.
Wagner and his practice partners, who have used another vendor's EMR in their Evanston office for years, switched to the Epic system June 1. They will be conducting the IT equivalent of "tent revival meetings" with his affiliated-physician peers to convince them to use the system.
"The affiliated physicians, frankly, are waiting to see if I fall on my face," Wagner said. "That's not going to happen. We see this, as a hospital, as a marketing advantage, and we, as an affiliated physician's group, see this as a marketing advantage as well."
The hospital will offer the system to physicians for an installation, configuration and license fee of $12,000 per physician, payable over two years. That cost excludes training, hardware and network-support fees, which vary by practice size. But with projections of increased revenues of 10% per physician from improvements in charge capture, appropriate coding and shorter days in receivables, "we win the economic story," Wagner said.
The hard part won't be to make the business case for accepting the system, but rather to overcoming objections about trust and sovereignty, Wager said. "We have to get over the hump of 'I hate the hospital,' " he said.
"They deserve it. They really do," said Judith Faulkner, president and CEO of Epic. "What I hear from people who go there (they) come up to me and say, 'Thank you for changing healthcare.' That's what Evanston Northwestern has done. I think they've really raised the bar."
Two things were most unusual about the Evanston Northwestern project from Faulkner's perspective. First was the number of new products that were installed over such a short period of time. "That was very striking." Second was the culture.
"They make sure everyone is pulling in the same direction and then they do it," she said. "They said, this is what we're going to do to provide good patient care. Then they both required and helped the doctors, both employed and affiliated, achieve that."
Neaman returned the compliment to Wagner and other "strong physician leaders" who were the critical element in the installation.
In choosing Epic, Neaman said, "in essence, we were saying, we absolutely must have the physicians involved, so we said, "What system was best for physicians?"
Then, Newman said, "We found about a dozen physician leaders who, like Dr. Wagner, said that this was the right thing to do."
One of the critical moments in the history of the project came when the medical executive committee approved requiring all physicians to take 16 hours of computer training and pass a proficiency test on the system before they were given a password, which, when all orders at ENH are entered electronically, is tantamount to being able to practice in the hospital.
"That's pretty gutsy," Neaman said.
In addition to the hospital-based award, HIMSS has established a companion Davies award for primary-care facilities. Four practices were honored in 2004: North Fulton Family Medicine, Cumming, Ga., with two sites that see 51,000 patients annually; Old Harding Pediatric Associates, Nashville, a two-site pediatric practice employing 14 physicians and staff of more than 50; and two small pediatric practices -- Pediatrics at the Basin, Pittsford, N.Y., and Riverpoint Pediatrics, Chicago.