But it's a good question. It's essential to know whether your EHR will serve you well five years or 10 years from now, and there's no better time to ask than while federal incentive dollars are on the table.
Even so, no sooner had the words spilled from my mouth in a strategic planning session at our organization did I realize the terror of what I had just suggested. It would mean a total re-evaluation of where we were positioned, where we were going and the kind of medical organization we wanted to be in the future. And as chief information officer, I knew I would play a lead role in any such evaluation.
Even though we did not have significant dissatisfaction with our EHR, and we had achieved early attestation for meaningful use of our records system, we decided to embark on the evaluation of our EHR approach. While I did assume a leadership role in the process, several medical and clinical staff members agreed to chair the review and took ownership of the process.
However, it wasn't long before the discussion shifted to the notion of “perfect systems.” We talked at length about what would be the absolute best environment in which to deliver care. We talked about balancing the needs of both employed and independent physicians in any changes we contemplated. We talked about the security concerns of integrating into a single system, and the challenges of conversions, and what feasibly could be done and what would be difficult to do (with and without assistance from current vendor partners). We talked about converting all of some of the data from disparate systems into a single system.
We talked about what a perfect EHR system would look like, and if we were delivering care in a perfect world, what we would change in our existing system. We discussed this in the context of what would really benefit our patients, provide better-quality care and ultimately enable better cost management. In the end, we addressed just about everything that anyone would discuss when they considered starting the EHR journey in the first place.
What we all recalled was the investments we had made at the start of our respective journeys (the hospital's system dating to 2003, the major physician group pre-dating that by four years), not the subsequent investments. My role evolved so that I was the one providing the group with options. We invited several EHR players to the table—just about all the rest of the large vendor systems were considered.
Then, reality set in. We discovered that the total cost to make a change would rival a small building project—we could build a new MRI room for a lot less. That was a sobering moment of realization. However, we did not stop there, because we determined that, with incentive payments, we could afford to make the change.
The focus went immediately back to the patient and what was best for quality of care, better outcomes and manageable costs. The answer, for us became obvious: For the foreseeable future, staying where we are made the most sense.
So was the re-evaluation worth all the effort, angst, hard work and frustration? Yes, because it forced us to focus on patient care even more intensely, and evaluate where we truly stood. After deciding to stand pat, the real benefit came from a renewed focus on how to better use what we already have to meet our goals and serve patients. We moved to implement continuous improvement of what we have, refining processes to better serve, enhancing interoperability between disparate EHR systems, and continuing the journey already in progress.
It's possible that we might go through this exercise again. However, I'm grateful that I asked the fateful question because it forced us to pause, take stock, re-evaluate, rethink and ultimately re-energize our efforts. It was a huge amount of work to take on this evaluation during a time of enormous workloads, but it was the right work to do. I heartily recommend asking yourself these same painful, but helpful, questions about your own direction.
Stephen Stewart CIOHenry County Health CenterMount Pleasant, Iowa