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From 0 to 6: Making EMR Adoption Work

February 27, 2014
by Gabriel Perna
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Just do it. 
It's not only the famous slogan of Nike, it's the attitude of leadership at a mid-sized 387-bed full service hospital in Elyria, Ohio when it comes to implementing electronic medical records (EMRs). University Hospitals Elyria Medical Center, which is part of the large University Hospitals (UH) health system out of Cleveland, is a HIMSS Analytics Stage 6 EMRAM (EMR Adoption Model) hospital that has used technology to drive population health management.
Even before it merged into UH, back when it was independent, UH Elyria was on the path to wide-scale adoption of health information technology. Like many smaller hospitals, it has faced its fair share of resource issues, says Charlotte Wray, R.N., chief clinical and information officer, vice president clinical operations and information systems at UH Elyria. First, it's a matter of finding the funding to design, build, and implement costly systems across the enterprise. Then it's bringing on talent to manage those systems.
"We struggled a bit with that. We had to develop our own internal talent. They had IT experience, but not clinical IT experience," said Wray to Healthcare Informatics exclusively at the 2014 HIMSS Conference in Orlando. 
UH Elyria dealt with a problem that many hospitals and healthcare provider organizations have faced, regardless of size or type. They had to figure out how to implement the EMR into the practitioner's workflow in a way that would keep them happy. "You don't often hear them say, 'That's easy. That's fun,'" Wray quipped. 
Furthermore, UH Elyria is in a blue-collar community that has been hit hard by the decline of the auto manufacturing industry. Wray said its patient population often doesn't have adequate or any healthcare coverage. Many, she said, use the ED for their first point of care and suffer with chronic illnesses such as diabetes and heart disease. 
An Optimized EMR 
With this backdrop, it's all the more impressive that UH Elyria is a Stage 6 hospital, which is only one spot away from the top EMRAM honor that a hospital can get. Wray almost makes it sound like it was effortless. "We went from paper to just get it done," she said to HCI
The hospital uses Siemens Sorian on the inpatient side and Allscripts Enterprise on the outpatient side. To climb up the ladder of EMRAM, UH Elyria followed along the meaningful use guidelines and adopted a decision support engine that addresses variability to support clinical-decision support. As an example, Wray said using this engine ensured vaccines were distributed for influenza and pneumonia and drove out variability in that workflow.
"We were at 75 percent compliant, which is abysmal. Now we're at 99 percent," Wray said. "For (us), that's over 2,000 patients that would have slipped through the cracks before that wouldn't have gotten a vaccine before." 
For medication reconciliation, the hospital uses a barcoding scanner technology into the EMR. It uses visual cues, Wray said, to help clinicians verify if a patient's medication is correct. If it's not, there is a red X, which she said the nurses love. Discovering this, she said, was an "a-ha moment" for them as they understood the power and effectiveness of health IT. 
Equally important to the technology is leadership and culture surrounding it. For one, physician and nurse champions to partner with helped UH Elyria drive adoption on the ground level. Also, the hospital's board understood the importance of EMRs from both a clinical and business point-of-view, which Wray and others were able to deliver in their message. Having this support from the top is vital, she said. 
"You have to have relationships with your CMO, CNO. Our chief nurse has been phenomenal. She has a significant workforce, she has several hundred registered nurses. We had to make sure we were on the same page. We had a shared plan and were supportive. That's critical. If you have good clinical executives, they will make it happen," Wray said.