Lessons learned from an award-winning EHR system replacement
In 2012, ARcare undertook a fast-paced transition to a next-generation electronic health record system. Less than two years later, ARcare was nationally recognized, receiving HIMSS Analytics' Stage 7 Ambulatory Award, the highest HIMSS honor for EHR adoption.
ARcare, a private, non-profit corporation providing primary care in rural Arkansas and Kentucky through a network of clinics, pharmacies and wellness centers, is the first Federally Qualified Health Center – and was one of only two ambulatory practices not connected with a hospital – to receive a Stage 7 ambulatory award.
On the way to a successful implementation, ARcare learned a great deal about the relationship between ongoing physician involvement and final clinical training – information that may help our peers who are moving forward with similarly ambitious systems replacements.
Managing change during the transition
ARcare’s system replacement involved moving from comparatively basic EHR use to a more comprehensive system with clinical event functionality that would enable us to better manage patient conditions across multiple care venues. A primary goal was to have the system drive orders and events rather than merely document clinical activity.
Migrating to next-generation technology across an enterprise requires significant IT resources, training, management support and workflow changes. Our strategy was to tie these elements together with a carefully constructed change-management plan, in which a highly experienced, multi-disciplinary team with C-level support facilitated all aspects of system adoption. The change-management team was tasked with creating a continuum of sustained change with a primary focus on improved patient care, stripping away governance of information silos. In this spirit of change management, each identified issue was relevant to the team – rather than individual roles – without regard to reporting structures.
The importance of keeping physicians in the change-management loop
Although ARcare achieved significant success in the arena of change management from an IT perspective, and within an aggressive timeframe, we also found in hindsight that keeping physicians in the loop throughout the transition can simplify clinical training during the final stages of implementation.
While ARcare actively sought input and buy-in from physicians on the front end of the transition, our sensitivity to the demands on physicians’ available time led us to remove most of them from the actual transition process, preserving involvement to a select few clinical staff members as physician representatives. While physicians remained involved to provide input to the new standardized workflows required by the new system, most of them had minimal exposure to the new system prior to clinical training.
The scheduled training sessions involved the clinical staff who were part of the change-management team performing training duty: nurse practitioners training other nurse practitioners and physicians training other physicians. We had anticipated this to be one of the easier tasks of implementation, and hadn’t fully accounted for the learning needs of clinical staff.
Although our physician leadership group requested they be the trainers, it soon became apparent that many healthcare professionals are simply uncomfortable voicing the need for additional help, especially to their peers. We also learned that having select clinical staff involved in the overall process didn’t necessarily translate directly to building teaching skills; the ability to understand complex technology and to teach its use are quite different. We decided to revisit training with the assistance of our own KMS – knowledge management systems – education team.
Getting clinical training back on track
Together with the KMS education team and led by four top instructors, we created a new, three-day program that integrated training for physicians, nurses and physician assistants.
Working in small groups, clinical staff participated in the training program, which was rolled out across facilities in series. Feedback gathered at the end of each training session helped to improve each subsequent session. Satisfaction increased quickly and steadily, and ARcare has continued to provide training updates on a regular basis to ensure continued optimal performance.
Well worth the effort
Five months after going live with our new system, ARcare became the first ambulatory practice that was not part of a hospital to achieve Stage 6 on the HIMSS Analytics EMR Adoption Model. One year later, we became the first FQHC to achieve the highest level of EHR usage, Stage 7.
The overall experience helped the organization recognize and develop an appreciation for the fact that change can and should be a positive experience. ARcare has developed a level of confidence across the organization where employees are less reluctant or fearful of change, and where learning from failure produced valuable outcome – not just in successful training, but in the successful adoption of a new Greenway Health EHR that brought with it substantial benefits, including:
- Improved patient management with better information access for providers and clinical event management that drives events and orders, computerized provider order entry and closed-loop medication administration, and other advanced functions that improve patient care
- The ability to exchange data directly with the state health department
- Streamlined access to patient records across the network of primary care clinics, dental clinics, pharmacies and wellness centers
During the transition to the new system, ARcare successfully converted more than 17.2 million records, including clinical notes, images and test results. Now, when ARcare identifies and secures a new clinic site, the new site can be completely operational from an IT perspective in 30 days or less thanks to advanced system capabilities for scalability and extremely fast implementations. As of today, the system provides paperless charting and order entry for 37 ARcare clinics.
In all, it’s been a very satisfying transition in which the gains were well worth the pain – pain that can be avoided by following the lessons learned in ARcare’s approach and re-working of clinical training. In short: It’s all about identifying an effective training team.