Kadlec Regional Medical Center: David Roach, Vice President of Information Services and CIO

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All healthcare facilities are interested in or moving toward electronic health records, both as a federal requirement and for improved efficiency and safety within organizations. Implementing these systems across a health system or even within one hospital is often a headache and requires many moving parts coming together.

Kadlec Regional Medical Center implemented the Epic suite of products a little over a year ago with much success. The hospital did a “big-bang” go-live, bringing up all service lines in the hospital simultaneously, and replaced more than 30 smaller applications with one large, integrated medical record.

As a 280-bed acute-care community hospital, Kadlec is one of the smaller clients with whom Epic has engaged. Kadlec’s services include open-heart surgery, interventional cardiology, a neonatal intensive-care unit, among many others, as well as physician practices and primary- and specialty-care clinics, for a total of about 15 sites.

Budgetary concerns for implementing an EMR

Vice President of Information Services and Chief Information Officer David Roach said budgetary concerns are often the biggest hurdle in receiving buy-in from the executive suite on a major system. Also, staff and physicians have a comfort level with the existing clinical applications and may be hesitant to learn something new.

When presenting the need for an integrated health record, Roach said he used a 10-year projection to demonstrate cost savings. He estimated the maintenance costs of Epic over 10 years compared with the maintenance and upgrade fees of the 30 existing applications that Epic would replace.

“One unified system will save you money in the long run,” Roach said. “It’s a large investment in the front end, but when we looked 10 years out, the back-end savings were huge. I knew the time horizon would need to be long to make the point clear to the CEO and finance committee.”

Once he received buy-in from the finance committee and CEO on the unified system, Roach found the need for many more budget items that may sometimes get overlooked or not included in the initial phase of planning. He suggests hiring legal counsel for contract negotiations, mainly because the investment is likely to be a 10 to 20-year partnership.

“When contracting for a product that would outlive me, I hired a couple of lawyers to assist with contract negotiations,” he said. “It is helpful to get some expertise on your side. Contracting is key to a successful partnership.”

Staffing was another large budget item. The hospital had a shortage of IT staff at the time, so Roach hired consultants to fill in the day-to-day work and maintain the existing clinical applications, while the full-time IT staff focused on learning the new applications, receiving certifications, meeting with physicians and medical staff to configure the system to meet their needs, and other training. Roach said the consultants were onsite for about 14 months, which was no small investment, but it was necessary.

At the go-live, Roach also had about 100 consultants onsite for two weeks providing floor support to clinical staff.

“The cost of consultants was not insignificant, but it was the right thing to do to support the clinical people making the conversion,” he said.

Getting the clinical staff on board with an EMR

Getting physicians, nurses, and other clinical staff on board with a new electronic system can be a major challenge. Roach said his team opted to go live with all hospital departments at once because it minimized the clinical risk. However, the off-site clinics came online a few months before the hospital.

Training and communication with medical staff are also key to a successful implementation. Roach decreed that no optimization changes would be made to the system within the first three months. The IT team’s focus would be on fixing things that didn’t work, but all other requests would be put on hold. IT worked closely with the clinical team to prioritize the fixes and then later, worked with them to prioritize the optimization changes.

“Once we had an ongoing dialogue with the clinical team, they were happy and on board with the process,” Roach said. “We had meetings to prioritize, then would report at the beginning of every meeting what we had completed from the last meeting. The clinical team realized that IT was trying to meet their needs.”

Next steps to mine data

Now that the system is in place, Roach said his next efforts are to focus on how to use the data coming from Epic. One area is to arm the hospital’s business staff with patient-care and quality data that they can bring to the table in negotiations with insurance companies.

Focusing on meeting Meaningful Use requirements is also a large part of Roach’s responsibility. He said the funds available add up to about $8 million over five years. So far, the hospital has received about $3.5 million.

“Someone has to oversee the use of the system and hold doctors accountable,” he said. “The government does pay you, but it’s not without a lot of effort.”

The next steps for Kadlec are to increase connectivity across the region by developing a community-connect model and selling the Epic system to local physicians and possibly some critical-access hospitals.

The data and connectivity provided by the system also place Kadlec in a good position to lead an accountable-care organization in the region should the market trend that way.

-by Patricia Chaney

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