How one community hospital earned HIMSS EMRAM Stage 7
Martin Luther King Jr. Community Hospital recently earned a prestigious achievement, attaining Stage 7 on the HIMSS Analytics Electronic Medical Record Adoption Model – joining just 6.4 percent of American hospitals at the highest level of health IT use.
The hospital began preparing for HIMSS Stage 7 in early July 2017 and treated the exercise as a formal project, since the requirements to achieve it are so comprehensive. It convened a multi-disciplinary Stage 7 prep team and designated a project manager to lead the effort.
Martin Luther King Jr. Community Hospital is a new, 131-bed, acute care hospital that opened in May 2015. The hospital's vision is to be a leading model for innovative, collaborative community healthcare, and the health IT strategy was developed to support and enable this vision.
This also informed the guiding principles that governed the design of its EHR and its operating environment. Interoperability, clinical intelligence and bio-med device integration were among the key tenets of its technology plan.
This plan, combined with best practices for clinical workflow and care coordination, proved to be a winning combination, as evidenced by the hospital's achievement of HIMSS Stage 6 shortly after opening.
The hospital's HIMSS Stage 7 Prep Team viewed the preparation work as an opportunity to quantify the impact of its EHR design. The team met a variety of challenges to Stage 7 by leveraging resources and existing projects to prepare for the HIMSS Analytics evaluation visit.
"Once HIMSS Analytics set the date for the evaluation site visit, the hospital HIMSS Stage 7 Prep Team engaged our EMR vendor to help guide preparation efforts," said Tracy Donegan, chief information and innovation officer at the hospital, which uses a Cerner system.
"The hospital team conducted several meetings with the vendor to perform a detailed review of the Acute Care EMRAM Stage 7 Reviewer's Guide," she said. "Our EMR vendor also provided a sample client presentation so the hospital team could have a sense for the level of detail required for the reviewers on the day of the evaluation site visit."
To help the hospital team focus, a shell of the client presentation was created. Weekly team meetings were focused on a walk-through of the presentation deck, which served as both a quasi-project plan and a way for the team members to continuously refine their respective sections.
Finally, the EHR vendor scheduled a mock site visit 45 days prior to the evaluation visit and those findings were used to close minor gaps.
On another note, the hospital Stage 7 Prep Team collaborated internally with the hospital's quality, infection control, informatics and pharmacy departments to brainstorm on the case studies that best encapsulated the value obtained from its EHR in terms of quality and patient safety.
"Since the hospital opened with clinical best practices supported by state-of-the-art technology, there weren't many opportunities for dramatic improvement," Donegan said. "Over 15 Lean Six Sigma projects were completed or currently in flight to address operational efficiencies but none of these captured the extent to which technology was being leveraged to support high-quality, high-value care delivery because there was no baseline upon which to draw a comparison."
Yet this was the story that the team wanted to tell, so they ultimately settled on case studies highlighting quality in medication management, population health and proactive intervention in critical patient care – all in the name of patient safety.
"As an added bonus, the HIMSS Stage 7 case studies enabled our clinical leaders to present their achievements to a wide audience, in most cases for the first time," Donegan added.
Further, concurrent with the kickoff for the hospital HIMSS Stage 7 Prep Team was a hospital-wide initiative to achieve more than 95 percent compliance with barcode scanning for patient identification and medication administration. The pharmacy department already had been performing root cause analysis of why some areas were falling short of expectations.
The hospital team assisted pharmacy with developing and implementing solutions on their findings. The target barcode scanning compliance for patient identification and medication administration was achieved in 60 days.
"The team leveraged this success to fuel a new initiative on barcode scanning for blood products administration," Donegan said. "The team found that our current blood transfusion reporting capabilities did not accurately reflect or provide enough detail on our scanning compliance so root cause analysis was slow to gain traction."
To overcome the limitation, the team shadowed clinicians in various departments and found some scenarios where compliance with blood product administration scanning was being underreported and discovered opportunities to educate clinicians on the process.The hospital team developed a custom compliance report and conducted remedial training, which helped the hospital achieve a compliance percentage that was above the HIMSS Stage 7 standard.
"Our information technology is a foundational component of the hospital's ability to deliver on its mission to provide compassionate, collaborative, quality care and improve the health of our community," said Martin Luther King Jr. Community Hospital CEO Elaine Batchlor, MD.