When St. James Parish Hospital, a 25-bed, public, nonprofit, critical access hospital in Lutcher, La., embarked on its transformation journey, little did the hospital’s leaders know they would be “changing the wheels while the car was in motion” amid a global COVID-19 pandemic.
The hospital completed its transition to CommunityWorks — a cloud-based version of its EHR. tailored to the unique needs of community and critical access hospitals — and went live in August 2021, during the fourth wave of COVID-19. Along the way, the hospital’s leadership team crystallized insights, learned lessons and celebrated wins that reveal what other providers considering an EHR switch can expect.
Becker’s Hospital Review recently spoke with St. James Parish Hospital’s Mary Ellen Pratt, chief executive officer, Jeremy Martin, chief operating officer, and Derin Donaldson, director of information systems, about the planning and execution of this EHR transition. Their observations attest that reinforcing EHR infrastructure is one of the most transformative decisions healthcare leaders can make today.
Unconnected EHRs grind down decision-making and operations
Before St. James initiated the transition to Oracle Health CommunityWorks, its emergency department, rehabilitation center, ambulatory clinics, and hospital departments worked within disparate EHR systems both on premise and in the cloud. There was no consistency between those systems, which were developed at different times by different vendors and were not natively integrated with each other.
From a patient safety perspective, not having an integrated EHR system impaired clinicians’ ability to look up patient information across the continuum of care — for example, when a patient was admitted to the acute care unit from the emergency department— and to make optimal decisions about their care. That in turn elevated clinicians’ workload, frustration and the time spent looking for information.
“I knew we needed to evaluated a new EMR solution when it started to impact the clinical processes to the point where my clinicians were not leveraged to do the right thing at the right time for the patient,” Ms. Pratt said. “We would figure out workarounds, so it wasn’t that we allowed harm to occur to patients, but our workarounds were so labor intensive and cumbersome that it didn’t seem to be the right thing.”
With the onset of the COVID-19 pandemic and the ensuing staff shortages, transforming EHR infrastructure became an even greater priority. “When you’re short-staffed in a critical access hospital, you can’t have your people looking around for what they need to do — it needs to be integrated into their workflows,” Ms. Pratt noted.
The IT department suffered, too. “From an IT standpoint, you have to do everything as many times as you have systems: reporting, troubleshooting, getting data out, maintaining databases, maintaining usernames and passwords, managing interfaces, having backup and disaster recovery plans . . . that took up most of our department’s time and took us away from other things we could have been doing to grow the organization,” Mr. Donaldson said.
When choosing an EHR partner, watch for strategic fit and product portfolio
Community and critical access hospitals typically operate on thin margins, which may make investing in a new EHR seem unaffordable. But the cost of inefficiencies caused by maintaining multiple disjointed EHRs may be higher if it prevents organizations from leveraging resources to their full potential.
“We have a leadership philosophy that we’re not going to wait until we have a burning platform to make a strategic decision,” Mr. Martin said, emphasizing that the St. James leadership team began laying the groundwork for the EHR transformation before the pandemic. To evaluate potential vendors, the team followed several guiding principles:
- Put the patient at the center of the technology (“one patient, one record”).
- Use advanced technology to improve patient experience and reduce healthcare friction.
- Aggregate data to identify patient population risks.
- Ensure an intuitive design and interoperability.
- Partner with a vendor with a track record of adapting solutions to the organization’s needs.
Those principles were also critical once a partner was chosen and the new EHR system implemented, as they helped hospital leaders gauge internal decision-making. When there were differences of opinion, Ms. Pratt said those guidelines served as a North star: “If you don’t have that in advance, it’s hard for you to know what’s the right thing because you’re going to be getting pulled from different sides.”
St. James further evaluated partners on various components, chief among which were product portfolio and strategic fit. Mr. Martin explained the latter’s importance: “When we dove into strategic fit, we needed to see their vision, their culture, was there chemistry among the leadership teams. This was not a transaction but a part of our strategy.”
Driving EHR transformation is a change-management process
Beyond the pain points, technical challenges and desire for improvement, switching EHRs is a change-management process that requires aligning leadership, physicians and staff behind an overarching objective. St. James accomplished this change by ensuring that physicians were on the selection team that evaluated EHR vendors and chose the winning solution, which made them realize they were an integral part of the process and helped them understand its value. It also empowered its communications team to create excitement around the shift, drive momentum and celebrate the wins.
But change management also involves overcoming resistance — and resistance to changing something as fundamental to physicians’ work lives as an EHR — is inevitable. At St. James, much of the resistance manifested itself during implementation. “We would hear, ‘If it’s not broken, don’t fix it,’” Mr. Martin recalled. Such objections came mostly from departments with disparate but otherwise best-in-breed EHR systems who had long-established workflows that the new system would disrupt.
To ease their concerns, leaders worked to bring out the positives that the new integrated EHR would provide. Nevertheless, tough decisions still had to be made. When resistance was excessive, high-level leadership made itself heard. “We were not going to allow physicians to dictate operative reports for transcription rather we are committed to leverage our new technology for documentation,” Ms. Pratt acknowledged. “You have to step up to the plate, but it´s the way you communicate and prepare people for it, and we gave them resources to help them through that.”
Immediate wins of EHR integration: information simplicity and patient experience
The impact of switching to an integrated, cloud-based EHR platform accessible from any department and location within the St. James hospital system was immediate.
On the clinical side, when ER doctors admitted a patient, intake information flowed straight through the inpatient care department and ambulatory physicians were able to access their patients’ ER visits in an instant.
On the patient side, the Oracle Health Patient Portal gave consumers a one-stop shop to schedule appointments, view lab results and manage other aspects of their care without having to log into several portals.
And on the administrative side, the integrated system alleviated workflows related to distributing results, releasing patient records, physician messaging and issuing prescription refills.
The EHR also allowed St. James to leverage Oracle Health’s portfolio of virtual care offerings. “Oracle Health brought a really good all-in-one multifaceted tool,” Mr. Donaldson said.
Price should not be the main factor when flipping EHRs, even when price sensitivity is
Price and affordability are certainly a concern for critical access hospitals with limited budgets, so they are inevitably a factor when it comes to deciding on a new EHR platform. However, as long as the cost of acquiring a new solution does not exceed (or only marginally exceeds) the costs of running a less efficient EHR system, it should not be the determining factor. It helps to view the question of pricing from the prism of total cost of ownership, whereby organizations map out five- and 10-year projections to account for depreciation.
“We didn’t mind shelling out some upfront capital; we looked at capital as an investment into our future and we looked at our long-term operating costs,” Mr. Martin said. He added that under the old model, St. James Parish Hospital’s four EHR vendors each had a different financial model and different hidden costs — one was a capital asset with low operating costs, while another was subscription based — and when his team modeled those out against the new vendor’s, it balanced out.
What was harder to quantify were the inefficiencies under the current model. “It’s hard to quantify the labor expense [under either scenario] but I do think that anybody analyzing this needs to go out 10 years. The upfront costs hit in the shorter time period, but for you to really see the value of a more capital-intense thing, you need to see it over the long term,” Ms. Pratt said.
Conclusion
Change management in healthcare — an industry with many stakeholders with competing priorities, incentives and mindsets — is never easy and this holds true for EHR transformation as well. The experience of St. James Parish Hospital shows that in choosing an optimal solution, it is important to delineate guiding principles that empower leaders, physicians and staff to make the best decision and to look for strategic fit and a shared vision between partner and provider.
Ms. Pratt summarized the journey: “We liked the way that Oracle Health saw where the future of healthcare was going, how they were going to be creating new solutions for that future with a vision to improve population health.”