Robert L. Murry, MD, is a family practitioner with Hunterdon Health, which includes a 140-bed community hospital in western New Jersey, a rural part of the state near Amish country. He is leading the implementation of electronic medical records for 180 physicians – about half of them employed by the hospital.

How you are approaching meaningful use at Hunterdon Healthcare?

We have two separate meaningful use initiatives. There’s an inpatient initiative that we’re not trying [to attest for] in 2011. But we are more involved at this point with the outpatient initiative. We have an enterprise NextGen installation that is set up by our IPA. It is a combination of private practices in our community as well as hospital-owned practices. There are 180 doctors slated to go live so far by the end of the year. We’re about 75 percent done with that already. All the doctors who are live for a 90-day window this year should be able to attest to meaningful use this year. So that will be the vast majority of them. There are 35 practices total – a combination of primary care and specialty practices.

When did the upgrade start?

We’ve been rolling out practices in ones and twos since the end of 2007. The only thing that we had to stop rollout for was to do the upgrades to meet meaningful use. We’ve since done those upgrades and so as of April 11, we are on a certified product.

Biggest challenge?

Probably the biggest challenge was just the upgrade itself. We have 800 users, most of which have been using the system for a year or two, lots and lots of ingrained patterns and whenever you’re doing an upgrade of software, it’s very, very complicated. Medical software – HIT in general – everything has to be perfect, because, you know, people’s lives on the line. Everything has to change in general at the same time. That’s very challenging. Our IPA has been very much into coordinating clinical care and being very tightly integrated from a clinical standpoint. By far the best way to do that is for everybody to be within a single enterprise on the same software. You can make changes in a centralized fashion as opposed to having to deal with 10 different EHRs.

What about the meaningful use measures?

One of the core measures is to provide the patient a clinical summary. It’s a great idea. I love it and I love that we have to do it. The patients love it. The challenge is the doctors are not used to No. 1 wording things in patient-friendly fashion. No. 2, even though they are all experienced EHR users, it’s not the case that every doctor has finished every order, every plan, dotted every “i” and crossed every “t” by the end of that visit even though that’s our goal.

How did you overcome the challenge?

Any good EHR implementation team is very good at analyzing physician and provider and practice workflows. So, we applied that skillset. If the goal is the doctor needs to be at this point in the visit with the orders written, and the plan written etc., in order to get the clinical summary to the patient, then what kinds of workflow changes need to happen in order to make that happen?

Does the EHR aid the workflow?

We have the advantage that our EHR is very flexible. So lots of those workflow stumbling blocks that we come into or improvements that we see that we would like to make that are kind of unique to this practice or that practice, we’re actually able to change the EHR to make it work the way we want it to work in terms of a workflow standpoint, and that’s a huge advantage. What I try to do in my role is to sell to them the benefits to their patients of this clinical summary.  

What is the best thing you’ve done? What is your advice for others?

It’s tricky. There are almost two different answers for two different audiences. One answer for the audience that already has fairly established HIT that’s upgrading and trying to just tweak processes in order to meet the meaningful use requirements and another answer for people who are adopting EHRs for the first time in order to meet meaningful use. The transition from paper to electronic is less about technology than it is about managing change. 

For first-time adopters…

Definitely don’t skimp on training and preparation before the go-live. Do a very detailed workflow analysis. Either get your vendor in or another user that uses the software that you’re using or a consultant to come and help you analyze those workflows because you don’t want to take paper processes and turn them into electronic processes. What you want to do is look at how the EHR works and figure out how can I do the job differently using this as a new tool.

Upgrading…

For the people who are already live and who have to upgrade. No. 1 you have to make sure that the goals you’re trying to accomplish with an upgrade are very clear and are said upfront for everybody. There’s lots of mission creep possibility here when you’re going through a huge upgrade. If you try to stick to your guns then you’ll achieve what you’re trying to do. 

Interview by Bernie Monegain