Planning for and implementing an electronic health records system is a daunting task for any hospital or healthcare system. But when a network of seven critical access hospitals in northern Iowa launched its system in 2008 it became the country's first rural integrated EHR. Now the CIO is sharing details of how he and his team got the job done.
Trinity Health, based in Novi, MI, may not sound like a rural provider; it's the fourth largest Catholic health system in the country. But it operates 44 acute-care hospitals, as well as 379 outpatient facilities, 26 long-term care facilities, and numerous home health offices and hospice programs in seven core states.
Trinity's seven rural hospitals in northern Iowa, separated from each other by hundreds of miles are critical to the communities they serve. Connected electronically they are able to deliver higher quality patient care than they could before.
Even with financing facilitated by two grants from the Agency for Healthcare Research and Quality (AHRQ), the road to implementing an EHR must have looked impassable at times. To attain "comprehensive" EHR status, the hospitals would have to fulfill a long list of requirements. Their disparate information systems and applications would have to be standardized in what would become the foundation of the network.
In the end, the rural network would have computerized physician order entry, and clinical decision support tools, in addition to the EHR system. Trinity eventually also rolled out an integrated bar code medication administration tool. Now electronic verification of pharmacy orders can be done onsite, or from hundreds of miles away at another hospital in the network, because at the rural hospitals, all of Trinity's pharmacies are not staffed 24/7.
Other tools made possible by the creation of this rural network: evidence-based order sets and access to one of the hospital industry's largest digital medical record repositories containing more than seven million patient files.
Writes Browne: "I strongly encourage adopting a 'pay-now-or-pay-more-later' viewpoint." His method was to lead the implementation in phases at each hospital:
Phase one installs a central clinical data depository. In phase 2 legacy IT systems are converted over a single weekend, and a suite of clinical applications is launched. Other phases incorporate clinical workflow redesign, training , and change management for clinical staff.
As of May 31, 2010, Browne writes, the seven-hospital network has created EHRs for 82,606 patients. Upgrades that will improve care in obstetrics, nursing workflow, and surgery are planned.
See also:
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