WHATEVER IT TAKES

Success Story

Implementing a New EMR at Port Huron Hospital – in Only 12 Months!

Building the New … While Still Supporting the Old

Port Huron Hospital (PHH), in Port Huron, Michigan, is a 186-bed

medical complex with four community health centers that provide a full

spectrum of inpatient and outpatient healthcare services to residents of

the Port Huron and the surrounding area. As a result of the timeframes

mandated through the American Recovery and Re-investment Act for

achieving Meaningful Use of electronic health records, PHH was faced

with a difficult choice.

Having met the initial requirements, PHH could either continue to fulfill

the mandate by extending the use of its original legacy system, or they

could select, implement, and begin using a new system within 12 months

– all while keeping their legacy application fully functional until the cutoff

date. Industry research had revealed that the usual timeframe for a full

conversion to a new EMR of this size typically takes 18 to 24 months.

Through a robust system-selection process that engaged the entire

organization, the decision made by staff and supported by management

was to move forward with MEDITECH as their new EMR vendor.

Consultants from CareTech Solutions and MEDITECH suggested that

the likelihood of success would be greatly increased by adhering to a

number of best practice principles:

1. Utilize the MEDITECH READY build process that provides a partially

built and configured application

2. Engage an overall project manager to coordinate the various schedules,

resources, and activities of vendors, consultants, and staff

3. Limit the number of customizations and add-ons to the build

4. Obtain a commitment from PHH management to ensure the proper

resources were available when needed.

In addition to pursuing the READY methodology, a full-time project

manager from CareTech was engaged to bring structure and to regularly

manage and monitor project progress. A project management core

team, consisting of PHH staff, physician representatives, CareTech, and

the vendor provided the authority to manage all aspects of the project.

CASE STUDY

Why the Time Crunch?

In addition to Meaningful Use implications, PHH had encountered

instability with their previous vendor’s technical environment. With no

full backups and data redundant only within the server, the hospital

feared that critical data could be lost, potentially devastating hospital

operations. Maintenance could not be performed on failing equipment,

due to the age of the hardware.

With considerable work already done toward Meaningful Use attestation,

the decision was nevertheless made to transition to MEDITECH. In

order to reduce the risk of lost data during the transition period, PHH

chose to implement Caretech’s iDoc™ Archive legacy decommissioning

system to extract and normalize the data from the obsolete server for

future migration to MEDITECH. This far-reaching decision would prove

invaluable when the server eventually failed, since iDoc provided a

means to preserve and access this valuable information. The system’s

functionality and ease of use enabled the first users to be trained within

an hour.

Challenges and Barriers Faced

In order to increase the potential for project success, a number of key

risks, assumptions, and constraints were identified, with risk mitigation

plans then developed to address each. These risks were regularly

monitored and addressed.

• While the initial Meaningful Use year-one functionality needed to

continue to work, the new year-two Meaningful Use requirements had

to be built and implemented within the 12-month time constraint.

• There could be no interruption during the transition from the old system

to MEDITECH.

• Physician engagement was minimal at the beginning of implementation.

Physicians were resistant to using the system, and did not attend any of

the four demo meetings. Since they weren’t employed by PHH, there

was no way to compel their compliance.

• Staffing was a concern, in that the budget did not allow for hiring

additional hospital staff despite the extra workload laid upon the PHH

employees. Project success required a large time commitment from

end-user departments to configure and build the new system. It was

essential to monitor the staff’s workload and ensure that the increased

duty was do-able.

• The team recognized the need to plan for unforeseen circumstances,

evident in all large IT projects. PHH fully supported allocating a

contingency fund to quickly address unforeseen problems and issues.

CASE STUDY

Planning the Project: Requirements and Approaches

In order to ensure that their investment reaped the desired benefits, Port

Huron Hospital utilized the requirements for Stage 2 of Meaningful Use,

as well as the 2014 quality core measurement requirements, to establish

several measurable goals for the project, such as: CPOE adoption rates,

medication reconciliation thresholds, use of alerts and reminders, and

capturing and communicating critical patient information.

In addition to quality improvement measurements, Port Huron Hospital

set a number of goals for fulfilling its financial strategy, including

optimizing the use of resources based upon data, reducing operational

costs through automation, such as transcription costs, and the cost of

supplies.

With an understanding that system reliability and speed are critical to

caregiver adoption, Port Huron Hospital established metrics for end-

user response time as well as for system availability that would support

end users during the patient care process.

Five Key Planning and Process Steps

As the intensive project of transitioning to the new system got under way,

CareTech’s project management team instituted project management

best practices to lay the foundation for the project:

1. A complete project scope definition

2. Clear resource roles and assignments

3. A comprehensive – all-encompassing work plan that was:

Segregated into specific easy-to-understand assignments for all

resources

Continually updated to track project progress

4. A comprehensive communication plan that included

Weekly status reports

Regular issues tracking

A shared document repository

Regular team meetings for all the project sub-groups

Monthly executive updates

Meetings with vendor management

5. Comprehensive testing, training, and go-live planning

CASE STUDY

The Project in Phases (2014)

Phase I (June – September) focused on complete data redundancy for

disaster recovery.

Phase II (September – May) involved daily incremental transfer of newly

created data in the still-active old system.

Phase III (May) included the live launch of the new EMR system and iDoc

Archive.

Key Activities that Were Done During Development of the System

Included:

1. Mapping the current workflow in every department of the hospital

2. Mapping workflow improvements to the future state of the system

3. Builder training: nearly 30 MEDITECH sessions explained and taught

the capabilities of the system

4. Building and configuring the system with a core team of roughly 100

people

5. Testing and refining, throughout development and system-wide

integration testing

6. End-user education (100 sessions) , with a “Monday Magazine” and

white-board updates

7. An extensive internal marketing plan to facilitate effective project

communication of key developments

Three Essential Elements to Personnel Engagement

Role of Marketing: Marketing cast a positive light on the whole process,

answering the questions of why the compressed implementation effort

was being done and why it was important. The communication initiative

put the focus on better patient care, quick and easy access to records and

to historical information – rather than mandated requirements. Executive

buy-in and staff engagement were helped by frequent informative

bulletins, training, and personal involvement. Hospital leadership was

fully supportive and engaged throughout the effort.

Physician Champion: Dr. Sara Liter-Kuester, PHH’s chief medical

information officer, coordinated all the physician issues and also hired

appropriate physician consultants throughout the implementation in

order to engage the physicians. The physician perspective was a key

factor in gaining acceptance from the physician users at PHH. A physician

who had in-depth knowledge of the new MEDITECH system helped to

gain the confidence and trust of the medical staff users. Incentive to

attend training included providing physicians with their choice of laptop

or iPad upon completion of their training courses.

CASE STUDY

Physician Incentive: The Dragon voice-recognition application, used

for automating physician documentation of medical procedures, had

been previously implemented in the Emergency Department. The

scope of installing the MEDITECH application included expanding voice

recognition throughout the entire hospital. This feature helped gain

goodwill and support of the physicians by saving them significant time.

It was instrumental in their adoption of the new MEDITECH system.

A Last-Minute Complication

An additional risk was encountered when in the middle of the

implementation, the hospital was sold to a larger organization. As a result,

a couple of key resources who had been instrumental in developing

the system left the organization. The difficulties were somewhat

alleviated because of the contingency money that had been set aside

for “unforeseen circumstances.” By setting up a contingency fund, PHH

was able to bring in specialists from a MEDITECH consulting firm who

worked with designated staff in these areas to learn, design, build and

test the areas of the system for which they were responsible.

Outcomes Achieved: When reviewing the benchmarks that PHH had set

as project objectives the following benefits were realized:

• The hospital went from 30%+ usage of CPOE to 88% as soon as the

system went live.

• The amount of re-orders went down to almost nothing.

• Dragon voice-recognition system was successfully expanded from the

Emergency Department to the entire hospital.

• Implementation was accomplished by existing staff without any new

hires.

• The number of calls to the help desk during the first week after go-live

went to half of normal: 380 the first day, then half of that the next day.

During that weekend they continued to go down.

• The nature of the help desk calls went from problems that were

fixed quickly, to just questions on how to use the new system, due to

unfamiliarity.

• The goal of reducing paper reports to a minimum by utilizing real time

and on-line queries resulted in the elimination of over 2,000 paper

reports.

• Transcription costs went down to zero. Former transcriptionists were

redeployed as support people and coders.

CASE STUDY

“

PROJECT STATISTICS

8 YEARS OF HISTORICAL DATA STORED

4 TERABYTES OF DATA

76 MILLION DOCUMENTS

2.3 MILLION RECORDS

$500,000 IN SYSTEM SUPPORT ELIMINATED

INITIAL USERS TRAINED IN LESS THAN 1 HOUR

SOLUTION TIME-TESTED THROUGH13 YEARS OF USE

STORAGE IN THE ONLY TIER 3 AHA-ENDORSED DATA CENTER

QUOTES:“Communication was key, and project management was a team

effort. From MEDITECH project managers to Navin Haffty consultants,

everyone was willing to collaborate on a methodology that would work

best for Port Huron.”

Jim Deren, IT Planning Director

CareTech & McLaren Port Huron EHR Project Manager

“Our order entry numbers are at 97 percent with MEDITECH—higher than

any other system we’ve ever used—because of the intuitive interface

and big-bang rollout.

Dr. Sara Liter-Kuester, CMIO

McLaren Port Huron

“Our READY implementation included a strong partnership with

Port Huron’s executive team. Monthly meetings between our joint

organizations ensured that areas of concern were recognized early and

quickly remediated. Without this dedication by the leadership at Port

Huron, the level of success would not have been achieved.”

Cathy Turner, Associate Vice President and Executive Sponsor

MEDITECH

CASE STUDY