CHIME Time: EHR implementers face new challenges

Here in Iowa, we like to get going early. That's particularly the case with my hospital.

We started our EHR journey in 2004. We came right out of the blocks with point of care documentation, bar code medication administration, and information systems for pharmacy, lab, radiology, PACS and cardiography.

We did CPOE in 2008 before it was required for meaningful use. We interfaced every piece of lab equipment we own, storing all lab results only as structured data, and we built HL7 interfaces to the reference labs and pathologists so that is stored as data as well. We did med reconciliation, problem lists and all the rest as they became available. We built HL7 interfaces to our independent physician clinics and their disparate systems. We marched through the process of interfacing virtually all of our medical equipment including vital signs, perinatal systems, drug dispensing equipment, IV pumps and just about everything we could think of.

We started early and were ready for 5010 transactions on day one, and we believe we're ahead of the game with our ICD-10 journey, as well as with implementing speech recognition, tuning our workflows and using health information exchange.

Even so, there's much that causes us concern about the future. We are beginning to ask ourselves questions such as what will ACOs do to our environment? What are the implications–IT and otherwise–of patient-centered medical homes? How are we going to mine and analyze data to manage the health of the population? That's an issue because there are at least five EHRs in our service area, since the vast majority of our medical staff are independent and on EHR systems other than that used at our hospital. The five dialysis centers in our service area are also on a different EHR system.

Long-term care is huge in our area. We own one center and manage another under contract. Both impact our population, and yet neither is yet on full-blown EHR systems. What do we do about chronic disease management? How do we prepare for bundled payment, and pay for performance, when it comes to rural America and has an impact on critical-access reimbursement? What is happening in the market around us that may impact us in any, if not many or all, of these areas?

While we are rightfully proud of where we are today and what we have accomplished, especially for a small rural facility, we are questioning whether we are in the right place for tomorrow and beyond.

In fact, there are more issues and questions than an organization our size can tackle at once. So we pick our targets carefully, and apply resources to those targets. The two we have chosen for the near term are data mining/analytics and a long-term care EHR.

These are not easy projects. Right now, we are exploring how we extract the data from our disparate systems, load it into a data warehouse, normalize the data so that we compare apples to apples, and prepare to mine that data. The extraction is not horrendous, as all parties have tools to do that, but getting all the systems to speak the same language is the challenge.

On long-term care, we are actively examining our needs as we prepare to roll out our EHR to the fullest extent possible. To do that, we are reviewing workflow differences in detail and doing a mini-build from our EHR to accommodate the real needs in long-term care.

Neither of these tasks is easy, but hard work often pays great dividends. It is work that needs to be done for the sake of the patient.

In a recent strategic planning session, I raised this question: From an IT perspective, are we where we need to be to best seize the moment and vault into the future? The unanimous answer was that we do not know. Now, that is an unnerving position to be in.

Given the state of flux in the industry, this is not the time to catch our collective breaths, bask in the glow of accomplishments or savor the outcomes. Many of you are wrestling with the same agonizing questions we face as we prepare for more change in our nation's healthcare system. Our job is to drive the evolution to a successful next resting point.

Stephen Stewart