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Able to Adapt

September 1, 2006
by Frank Jossi
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Ray Gensinger Jr.'s work implementing an EMR solution took him from the build to the buy.

When Ray Gensinger Jr. M.D., moved from Illinois to take a job at Hennepin County Medical Center (HCMC) in Minneapolis in 1995, he had one assignment as deputy medical director, medical informaticist: Build an electronic medical record from scratch.

While Gensinger made some progress over the next six years in creating an EMR, for Minnesota's busiest public hospital, the medical information technology market had begun developing sophisticated EMR applications. Where once there were few vendors of EMRs there were many by 2001. Gensinger and HCMC decided to change direction and find an application that would serve the organization's needs.

Eighteen months later, the hospital selected an EMR developed by Epic Systems Corporation (Verona, Wis.), which has also been the application of choice for several major healthcare providers in the Twin Cities. A staged roll-out began this year at HCMC, with a read-only version of Epic's EMR being made available in May. In February 2007, the hospital will "go live" with a final version that will be used by more than 260 staff physicians and hundreds of medical personnel, interns and residents.

"For a safety net hospital to find energy and enthusiasm to fund an end-to-end EMR is a pretty tough task and to continue to motivate staff is a difficult task in tight financial times," explains Gensinger. "We've got physicians, pharmacists, residents and nurses to buy into something like this — and that's the exciting trip we're on now."

Still, much work needs to be done. Gensinger notes more than 750 physicians practice intermittently at HCMC and most of them will have to be trained on the Epic software. If they have had some experience with Epic, the hospital will allow them to take an online test, and if they pass they can avoid training.

A crucial challenge in the implementation has been recruiting and managing people who participated in the project. "The biggest hurdle in doing this for an organization like the medical center is just being able to assemble a team to make this project work, from hiring a project manager to having enough staff," he explains. "It was the equivalent of adding 120 people to our staff."

Around half of that number came from HCMC's ranks, the other half had to be hired externally. At any one time during the process another 30 to 40 Epic consultants were on hand to help. Deloitte & Touche USA (New York, N.Y.) handled the project management duties, he says.

Gensinger's involvement in the information technology healthcare arena extends far beyond his work at HCMC. He helped create a recent Twin Cities' conference for Epic users which drew more than 350 participants. In addition, Gensinger serves on the HIMSS board of directors and on Minnesota's e-Health initiative, a state-wide version of a regional health information organization (RHIO).

"We're doing great," he says of Minnesota's efforts. "There are a lot of different RHIOs around the country, and we're at a mid to advanced stage. We have a steering committee that is addressing technology issues such as privacy and security, and we have a solid infrastructure and integration plan."

What Minnesota is doing in terms of a RHIO is what HCMC has done internally. Despite a long timeline that did not always go "smoothly" and a lack of an online training tool, Gensinger takes great pride in HCMC's achievement in accomplishing an EMR. He credit's the public teaching hospital's physicians, more than any other group, with staying the course.

"We pulled together physician champions as we moved it forward, and as we approached (the May) 'go live' date I heard many physicians say, 'We get it, we trust you and we trust your team, and this is the right thing to do,’” he says. "They trusted the team to pull this off."

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Frank Jossi is a contributing writer based in St. Paul, Minn.