Physician alignment, end-user support vital for EHR success, CMIO says

Physician alignment, end-user support and solid leadership are critical navigation tools on the journey to Meaningful Use, according to Dr. Richard Ferrans, vice president and chief medical information officer at Memorial Hospital at Gulfport in Mississippi. 

"You can't get around the support issue," Ferrans said. "You've got to give just a ton of end-user support. It's required for success."

FierceEMR recently chatted with Ferrans about the challenges associated with implementing electronic health records, as well as some of the surprises he's encountered.

FierceEMR: What are some of the challenges you've faced with Meaningful Use? 

Ferrans: The challenges can be divided into several areas. The first one is the challenge of rapidly introducing new technology and putting in a large amount of change into a short period of time. 

It was a very aggressive schedule for the vendors, and it turned into a very aggressive schedule for us because we had to do many go-lives in a confined period of time. We were updating, in our case, all of our inpatient systems, which was not a single upgrade, but a whole series of upgrades because of the interconnectedness of things. We were installing EHR technology in our 40 owned physician clinics, while also preparing for an upgrade to a Meaningful Use version of that technology, and we were going live in the emergency department with EHR technology. 

Between those things, it was a big challenge to do that many projects simultaneously, bring that much change to our medical staff and our nursing staff, and do it with either new products or new versions of products. 

FEMR: What were some of the key requirements from leadership during this process?  

Ferrans: [When] upgrading inpatient and outpatient systems and putting in an emergency department system, several things are required. First of all, there has to be buy-in and support from the CEO, the board, and our senior leadership. It's very important that we have a strong foundation, a good relationship and a lot of dialogue and interaction with our medical staff. No matter what you're doing, going through all of these upgrades and introducing this amount of change creates a lot of stress. 

The most important thing above everything else, though, is to have a tremendous amount of end user support. Often that involves outsourcing, either to the vendors or to third parties, to augment our existing support. Many times doing these things, you find yourself having to do 24/7 on site support with really clinical people who understand the applications, not just your sort of traditional PC support people. That's a challenge, too, to staff up for support.

This process taxes anyone's project management skills. It is a challenging thing to do, it's a great challenge to have, but it requires a certain amount of intestinal fortitude, I'll put it to you that way. 

FEMR: Has anything been easier than you thought it might be with Meaningful Use?

Ferrans: I found much less resistance from our medical staff. I found that they generally wanted to help the hospital achieve its goals, and I thought that was a very admirable thing. That was a very pleasant surprise to the degree which we had physician cooperation. I think that points more to a much broader alignment strategy with the medical staff that's paying off. 

Our ER system go-live went much better than expected, too. I was always told that ED go-lives, by definition, are nightmares. Ours was really, really wonderful. 

FEMR: Can you elaborate on each? 

Ferrans: We have a very principled and excellent staff leadership that understands the value of IT, while at the same time they are very focused and really push us to make our systems as reliable and fast as possible. There's this notion that physicians are going to fight hospitals and not participate, but I've found that a lot of physicians are willing to do the right thing and work with the hospitals, and the only thing that they ask is that the systems don't slow them down. We do our best to try to make that happen. Knowing that, by nature, sometimes these systems do slow them down, I think that engagement really helps. 

With the ED, while we managed the project very well and had very engaged department management and physicians, the most important thing was that we took the recommended level of support and we tripled it. That made the difference, I think. 

FEMR: How did that impact your budget? 

Ferrans: It was built in knowing that traditionally, ER systems tend to produce better charge-capture of procedures and better coding, because most ER physicians under-document the care that they provide. Given that and Meaningful Use, we made the decision to spend what we thought was right because we really wanted to do it right. 

FEMR: What challenges do you foresee on the horizon for your organization? 

Ferrans: In Stage 2 [of Meaningful Use], there is a lot of emphasis that the Office of the National Coordinator for Health IT (ONC) has put on personal health record technology. Whereas I applaud the notion of communicating information to the patients and empowering them, that technology is very immature. We're going to be required to achieve Meaningful Use with basically first generation technology that's going to be rushed. I think that's going to provide a significant amount of challenges. 

I think also what the ONC is planning with respect to privacy tagging is going to be extremely complicated to implement from a process and technology standpoint. They want privacy preferences to follow patients around, and again, I think it's a great idea. I just think when you look at the timelines and the current maturation of the technology, it will prose significant challenges for people to meet whatever threshold. 

We need pilots demonstrating that the technology is effective, but we need to think very carefully about the unintentional consequences. There can be unintentional consequences when patients, for whatever reason, want to withhold electronic transmittal of information; that information can theoretically be important in detecting drug-drug interactions, for example. 

I would say that we need to proceed, but we need to proceed with caution and a lot of flexibility. Let's not rush this just so that we can put this into a particular stage, or where we want to feed the market with this. We want to make sure the technology's robust. 

FEMR: If you had your way, how would you change the Meaningful Use process? 

Ferrans: There is a balance to be struck between making progress and making the requirements so onerous that it's very difficult. The bar must be set low enough where if a provider demonstrates that they are adopting and using the technology at some minimal threshold, or that they have installed it and are piloting it, then that should be sufficient. We want to get everyone on those roads, but we want to get the technology to catch up. 

What I would say is, I want as much change as possible without impeding patient care and without significantly reducing productivity. When the technology is early stage, a lot of times it does reduce productivity, and in those cases either physicians see their incomes diminished, or hospitals see expenses rising or declining revenues, and that puts even more strain on the system. 

With healthcare reform, there's a lot of cost pressure already in this era, so we don't need to make that problem any worse. It's already there. 

FEMR: Given that bigger practices and practices connected to hospitals and health systems have, so far, been quicker to adopt EHR technology, what do you think is the best way to get smaller systems more involved?

Ferrans: I don't think that size necessarily matters. IT management and leadership and physician alignment really matter. Here's what I can tell you: Our hospital vendor worked very, very hard with us and they brought a lot of resources to the table. And we brought a lot of resources to the table. I can tell you it wasn't easy. It was a challenge for us. 

So for a smaller hospital that has an average IT department that's used to a few sort of view-only clinical applications, this is a big stretch. They probably need guidance in terms of getting to Meaningful Use. They need guidance from their vendors, but I also think they need guidance in how to bring leadership on board, how to bring the physicians and the nursing staff on board.