One Record, Many Lessons

Ironically, the demand for new technology became a hurdle to overcome, as well. During the implementation, one Allina hospital decided to deploy a bedside meal-ordering system. "At first blush, you would not think it would impact the EMR project, but it did," says Pedersen. That's because with a digital record, such transactions as meal ordering became a legitimate component of the patient chart. Allina had to build an interface to the application, adding to the cost and complexity of the EMR effort. "In the old world, the [meal-ordering application] would have been siloed. You would have printed out the record, and it would have wound up in the patient chart. But electronic records are integrated. That's where a lot of the scope problems came from."

Lesson 5: Prepare for ruffled feathers
Heichert and Pedersen freely concede that the transition to the EMR was difficult on the IT staff. Early on, Allina decided to manage the Excellian Project outside the IT department. The project was wrapped around new technology, true, but the real work involved revamping clinical workflows—an area beyond the expertise of the IT staff. Pedersen's clinician-heavy implementation team reported up to the chief medical officer, not the chief information officer (who declined to be interviewed for this article). "This was our biggest IT project, yet IT was not leading," Pedersen says. "That created problems. You want the best and brightest, and that is what we said we wanted. We made a big deal about the implementation group being the A team, but then everyone else felt like they were not the A team. It immediately created bad feelings. It wasn't as respectful as it could have been. We could have taken time to explain why we didn't use their people and processes."

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at gbaldwin@healthleadersmedia.com.

The Lowdown

Organization: Allina Hospital and Clinics
Location: Minneapolis
Description: 11-hospital health system with 70 clinics
2008 "Excellian Project" (EMR) operating budget: $17.4 million
2008 Excellian staff: 173
Excellian budget 2004-2007: $250 million, 300 staff
Honors: Winner, 2007 HIMSS Davies Organizational Award
Web site: www.allina.com
Key vendor partners: Epic, OnBase (document scanning), GE (lab system), and Emageon (picture archiving)

What's Next

Allina has come a long way with its EMR. But its list of pending projects, offered by Susan Heichert, vice president health information and systems, suggests the hard work may be just beginning.

1. Complete remaining three hospitals (an eye hospital, small community hospital, and a new facility).
2. Integrate a large, recently acquired group practice into the mix.
3. Begin to explore sharing information with medical groups not owned by Allina.
4. Evaluate role in statewide health information exchange.
5. Devise data warehouse strategy, to improve retrospective reporting.

Brokering a Deal

Not only did Allina implement new technology, it deployed computerized physician order entry, as well. By itself, CPOE is a tough nut to crack. And during its first two go-lives, Allina backed off the order entry application, permitting the medical staff to continue ordering on paper forms. That proved to be a mistake. As a result, the system turned to a "big bang" approach, bringing up all applications at once as hospitals converted to the digital record. The digital-paper hybrid was too confusing for the staff, says Kim Pedersen, former vice president of the project. "We had significant productivity issues and nurse morale issues," she says. "Physicians using the computer by and large did not look at paper. And physicians using paper by and large did not look at the computer. It left the nursing staff and pharmacy in the middle to figure out conflicting or duplicate orders."

Eventually, Allina turned to a medical staff-issued mandate to use CPOE. The mandate was not issued capriciously, however. Before the medical staff agreed to the mandate, Pedersen had to address certain performance issues. Allina CEO Dick Pettingill brokered a deal with the medical staff in which physicians would agree to use the order entry system in exchange for improved screen design and system performance. Allina standardized the way it scanned documents that would be imported into the medical record, deciding on naming and indexing conventions that made it much easier for physicians to find records, says Pedersen.

Patient Portal

As part of its EMR, Allina launched a patient portal. The online service enables patients to request appointments, pay their bills, and see portions of their own health record. According to Susan Heichert, Allina would like to expand its patient connectivity options. "We would like to connect to devices in the home. We are looking at congestive heart failure patients. They could take a blood pressure reading at home and upload it to our system."