Nebraska hospital goes paperless by emphasizing workflow

A Nebraska critical access hospital found success in going paperless by focusing on its work processes, according to a case study from the College of Healthcare Information Management Executives (CHIME).

Chadron Community Hospital and Health Services, a 25-bed facility in rural western Nebraska, went live with its electronic health record system in 2011. It was also recently named a 2014 Most Wired winner for the second consecutive year.

The hospital has seen benefits beyond ready access to hospital records: providers also can access state immunization records, and images from the hospital's digital radiological system are accessible from the EHR, according to the study.

The organization first did an in-depth study of workflow in each area before vendor selection, which itself took a year.

"Early on, we came to the conclusion that our system had to be something that fit our processes, rather than something that we had to adjust our processes to," Anna Turman, the hospital's CIO and COO, said in the study.

The hospital did run into some challenges, though. It had its full-time employees helping with the efforts, so there was no one dedicating 100 percent of their time to the project. However, the hospital did ensure that there was a "super user" in each department, Turman said in the study.

"We asked ourselves how we were going to provide care at the bedside. Were we going to use computers on carts and have nurses wheel them to the bedside, or would we have fixed workstations in each room?" Turman said. "We wanted to figure how we could make the transition easier and be most conducive to our workflow and quality care. We took an in-depth looked at the processes, and the staff and training before we actually selected a vendor."

Once a vendor was selected, it had just six months for implementation and training.

Besides clinical records, the organization automated its pharmacy, emergency department, physical therapy, human resources and financial departments.

While it has achieved Meaningful Use Stage 1, Turman calls Stage 2 "a tough haul." Its efforts to meet multiple high priorities quickly has staff experiencing constant change.

"We are making progress but could use some breathing room to celebrate our successes," she said.

Chadron's not alone. Just 4 percent of hospitals and 1.3 percent of eligible professionals have met the Stage 2 requirements thus far.

One of HIMSS's three "Congressional Asks"--formal requests to Congress presented as part of National Health Information Technology Week--was for some relief for healthcare organizations simultaneously pursuing multiple initiatives.

To learn more:
- read the case study (.pdf)