Healthcare Leadership and Innovation

EHR transition for rural, Critical Access

  • 1.  EHR transition for rural, Critical Access

    Posted 10-17-2019 20:01
    I am a second-year graduate student working on my Masters of Science in Health Information Management. I'm in the development phase of a research proposal/project and would love to generate some discussion here from those with experience in rural health, specifically, Critical Access. I would love to discuss your experience with switching to a new EHR, specifically from one that was not "semantically compatible" with larger facilities to which you sent your patients with chronic conditions for more specialized care. I'm thinking explicitly about those who decided to piggyback off a larger healthcare facility's EHR contract.

    Any discussion generated here will help me to narrow and focus my research topic, so please feel free to reach out with any and all experiences. Thanks for your time and I hope to hear from many of you!

    Candace Abraham
    Health Information Technician
    Graduate Student @ CSS

  • 2.  RE: EHR transition for rural, Critical Access

    Posted 10-18-2019 08:56
    Fascinating topic!  I have a lot of experience implementing EHRs from a PMO perspective, but nothing really in critical access hospitals.  Good luck!

    Lynette Czarkowski
    Chief Operating Officer and Exeuctive Consultant

  • 3.  RE: EHR transition for rural, Critical Access

    Posted 12-02-2019 14:08
    Hi Candace,

    I live in rural MN and work for CentraCare. There are a lot of facilities, including critical access hospitals, in the area who piggyback off our EHR contract. We call them "affiliates". I am not sure where you want the discussion to go but I can tell you that one of the challenges is that we can see the affiliate records in our EHR so it is imperative that our policies clearly state that these records do NOT belong to us and we cannot release them.

    Lauren Reyes
    Manager, Health Information Management - Carris
    CentraCare Health

  • 4.  RE: EHR transition for rural, Critical Access

    Posted 12-03-2019 04:13

    Some of the issues I've seen stemmed from the affiliates not utilizing the EHR appropriately. For example, not performing workflows through to completion and adding unnecessary work to work queues, etc. It's tough to follow-up with them and enforce the correct use of the system. This is compounded every time there's an upgrade.

    Sent from Gmail Mobile

  • 5.  RE: EHR transition for rural, Critical Access

    Posted 01-23-2020 23:59

    I'm not sure I can meet your criteria exactly, but I can hopefully help give you some insight into the difficulties we often see when transitioning EHRs. I work for a management services organization that is a branch of a large regional hospital. Our main function is actually not directly with the hospital, but instead with the local ambulatory practices that are joining the hospital network under its management. Each year we bring in about 6 new practices and are always faced with the transition from various EHR systems to the hospital's contracted choice, Cerner. The actual switch takes place on a determined "Go-Live" date, but there is a lot of prep time and post-implementation support. When a new office signs on, we begin the project management process of setting up billing, ordering, credentialing and other various important aspects of healthcare. The project management aspects that you're probably interested in are with the IT team and the training team.

    From an IT standpoint, the most common difficulties are upgrading the hardware infrastructure, networking with the hospital servers, and creating the interface between various systems. Interface issues are almost always a guarantee and it is often difficult to transfer all patient data. In these cases, we have to maintain support for the legacy EHR for a number of years even though the system itself is not being utilized. When an office is coming from paper charts, which is surprisingly far more common than you might expect, we have to employ data abstractors to manually input patient registration and chart notes. All of this needs to be done prior to a Go-Live date.

    The training team has the task of getting the office staff up to speed on their new EHR system. Additionally, they are often the ones who help train on the new IT hardware as the IT team tends to provide remote support after installation. By far the hardest part of this is the various levels of computer literacy new employees have. People often don't like change and our training team gets the brunt of those complaints. This too needs to take place prior to Go-Live. We almost always have at least a month period of essentially doing double work; doing everything in both a legacy EHR workflow and also Cerner's EHR. We reduce the office patient flow by about 40% for this month and we've found this to be the easiest and most efficient way to transition.

    Post Go-Live, representatives from training, IT, billing, and compliance are onsite to help out for a period of time. This period varies based on the office size and their overall capabilities with the new system workflow. We may have a rough project management template for every office, but every single office presents its own challenges that we need to adapt to. Currently, I am the point man on a new office location that actually has two separate companies sharing the same space; a husband and wife who each have their own specialty and their own practice. The office is literally split down the middle with each side being dedicated to one practice. They have their own computers, their own printers, their own medical equipment, etc. The only thing they share is the physical office space. They are both joining our network, but we're treating them as two entirely separate entities. Needless to say, this is going to be a new challenge.

    Also just to note, I want to reflect on other comments:
    Lauren's challenge of being able to view every affiliate record is partially something we also have to contend with. The hospital itself is actually on its own dedicated Cerner domain, so we do not see those records. We do however see every record from every one of our ambulatory practices as they are all on the same domain. Adding more difficulty is the fact that we are multi-specialty. So a cardiology office can see records from an endocrinology office that is 30 miles away, and a gynecology office that is even further away. This helps with patient care when a physician wants to view a progress note or plan, but it adds another level of training and compliance headache.

    Victoria's challenge is the real struggle. This never ends. You can train and train and train but somehow there are always mistakes being made by various practice locations and these are often not so simple fixes. Having various scattered locations sometimes over an hour away makes direct oversight impossible and our compliance and training teams find themselves babying some location. As difficult as many aspects of EHR transitions can be, I agree with Victoria that this is the biggest issue I would love to have disappear. This job would be so much easier.

    I speak more from the management perspective rather than from an office, but I hope that helps give you some insight. Good luck with your Masters.

    Steven Romano
    Emr Trainer