Tiny Texas Hospital Grabs EHR Bull by the Horns

John Commins, for HealthLeaders Media, March 25, 2009

With the federal government offering about $36 billion over the next seven years to incentivize healthcare providers to install electronic medical records and other health IT, several strategies are emerging among hospitals grappling with how to undertake the daunting task.

Some hospitals are taking it very slow and waiting to see what guidelines and standards emerge from the federal bureaucracy, waiting to see other providers succeed or fail with EHR, and waiting to see if EHR actually works.

Don't count Parkview Hospital in Wheeler, TX, among the wait-and-see crowd. The 16-bed critical access hospital, located on the gas and oil fields 120 miles east of Amarillo, is in full installation mode for its EHR, an effort that started last year, before the federal reimbursement program for health IT was even on the table.

CEO Ann Fagan-Cook says Parkview was going to have to make the technological leap anyway, because of the much-anticipated government push and the reduction of Medicare/Medicaid reimbursements for providers who don't. So the feeling was they might as well do it now, avoid the rush, and exert more control over the process.

"I don't like to have somebody from the government come along and tell me I should have done these things three years ago and now it's going to cost me more money than ever," Fagan-Cook says. "I like to be on the edge and have it done when they come, they say 'great,' and they don't write any deficiencies, and they go away."

Software is being installed this month, so Parkview can begin to enter medication data on vulnerable patients from nearby nursing homes who frequent the hospital, many of whom take up to 20 medications a day. "If we can get them preloaded before we start using the record fully, that will save a lot of time," Fagan-Cook says.

The plan now is to go EHR live in late August or early September, and Fagan-Cook is already anticipating the benefits. "It will allow our staff more time to do direct patient care instead of shuffling papers or looking for papers from lab and X-ray," Fagan-Cook says. "We are going to start with nursing and integrate the business office first. Then we will go to the pharmacy and X-ray and lab will be last."

Like most hospital administrators, Fagan-Cook is reluctant to talk about the cost of her EHR system. "I'm not supposed to discuss it. I am what is called a project site. So, we give tours and help educate people who haven't made a decision yet about what this system will do," she says. "Part of the contract is that I probably got a better deal than other people."

Fagan-Cook didn't pick the vendor. She created a steering committee of physicians and from among the 80 staff to weed through the sales pitches before selecting an EMR system. Fagan-Cook says giving staff a decisive role in EHR is critical. "It helps when you have steering committees and groups that work on things so it's not just my idea. They have input. They can say yes or no. That changes the culture more than anything," she says.

It takes moxie for a small, remote hospital to aggressively pursue EHR, especially because of the complexity of the technology, the tough economic times, and the high stakes for both success and failure.

If EHR delivers on its promise, it will greatly enhance Parkview ability to delivery quality care and measure success. If it fails, lives may be at stake. God help the EHR vendor who doesn't have an answer when feisty and focused CEOs like Fagan-Cook want explanations for why what they bought hasn't delivered. "I'm in the middle of nowhere," she says. "I don't want to spend my money and be told in a year from now that what I bought isn't going to work."

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.
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