When Dave Garrett, senior vice president and CIO of Novant Health, a four-state integrated network of physician clinics, outpatient facilities, and medical centers, with headquarters in Winston-Salem, N.C., first began working on rolling out the health system’s electronic health record (EHR) across its ambulatory group, he estimated that it would be a five-year project.
Yet in only two years’ time, the organization was able to complete implementation of the Verona, Wis.-based Epic EHR system for its 350 physician clinics, accomplishing the goal significantly ahead of schedule and under budget, according to Garrett.
With hard work comes reward, and in October, Novant Health became one of only six systems in the country to attain the highest level of EHR use, receiving the Stage 7 Ambulatory Award from HIMSS Analytics, the research arm of the Chicago-based Healthcare Information and Management Systems Society (HIMSS).
Developed in 2011, the EMR Ambulatory Adoption Model provides a methodology for evaluating the progress and impact of EMR systems for ambulatory facilities owned by hospitals in the HIMSS Analytics Database. Stage 7 represents the highest level of EMR adoption and indicates a health system’s advanced electronic patient record environment.
Through the second fiscal quarter of 2013, only 1.16 percent of the more than 19,085 U.S. ambulatory clinics in the HIMSS Analytics database have received the Stage 7 Ambulatory Award. With 350 primary care and specialty physician clinics across three states, Novant Health more than doubled the number of Stage 7 ambulatory facilities in the country.
As a Stage 7 organization, Novant Health utilizes a variety of EHR features and tools to elevate the quality of care provided and increase affordability, says Garrett. One of these unique features, advanced decision support, achieves both by allowing providers to identify their patients who are in need of or who are overdue for care—ranging from routine tests associated with management of chronic conditions to annual screenings such as mammograms. Providers are then able to proactively reach out to patients to ensure care is given in order to prevent illnesses or conditions where acute care would be needed, which results in a more costly visit for the patient.
Healthcare Informatics Assistant Editor Rajiv Leventhal recently had a chance to speak with Garrett about the significance of being a Stage 7 health system, the difficulties in getting there, the necessary strategies it took, and how far the industry has come in terms of EHR progress. Below are excerpts from that interview.
How difficult was it for Novant Health to get to Stage 7?
We have come a long way in making life better for our patients. Adoption of an EHR in a way that Stage 7 outlines and defines it means that you’ve gone above and beyond what most people have done. You have to remember, it’s all about the patient and what makes it easiest for them.
For us, our ambulatory group consists of 1,400 providers in [approximately] 300 different locations, across three states. Logistically, that presents a big challenge. To roll this out over that many locations and providers was going to be tough, and we needed to be consistent in our delivery and create repeatable models. It was a five-year project initially, that we did in two years. We wanted to create a standard build, so we went with Epic’s model rollout. We built it once, and we pretty much have a very repeatable model in terms of how we roll it out across all of our specialties. We started small and then got confident and comfortable in how we rolled it out. Before you knew it, we had an implementation that [covered] more than 200 physicians in one go-live event. By doing that, we ate into the 1,400 providers in two years versus five years. That wasn’t the plan at first, but it started to make sense to do it larger and larger.
What technological strategies have you deployed to get to this level?
Internally, we branded the EHR system ‘Dimensions,’ because of our mission to deliver a remarkable patient experience in every dimension, every time. The six elements that make up what we call the ‘remarkable patient experience,’ are: Safety, Affordability, Quality, Easy for Me, Voice & Choice, and Authentic Personalized Relationships. When you have a very effective EHR and it is adopted by the clinicians and by the patients, you hit on all six of those vision elements. But it all starts around the EHR and its ability to make it easier to provide care. Just from a billing perspective, we had 90 different billing systems that we worked with across all of our providers. Now we have one.
We also utilize our patient portal, called MyChart, which connects you to your personal health information at home, on the road, or at work. Our growth in the use of it, whether on the PC or the mobile app, has been phenomenal. We started with zero users two years ago and have grown to more than 200,000 active users, a number that continues to grow. We see MyChart as a vital tool, one that gives you the ability to do online scheduling— you don’t even speak with someone at the front office anymore, since the appointment is all laid out. That saves a lot of time, energy, and money for people. We also now have e-visit capability with your provider, as well as video visits with our physicians. These types of technology have made it easier for patients to get care and do business with us, on their time.
Why do you think such few health systems have been able to reach Stage 7?
There are several variables, but the biggest one is, are you aligned around your patient? As an organization, we made sure we had to put the patient at the center of it all—and not just say it, but actually do it. When it comes to office managers, physicians, billing specialists, nurses, aligning everything around the patient might not be the way everyone wants to do it, but when you do, you start to put the other stuff aside, get to agreements quickly, and make it all work quickly. I think that’s the main crux of all of this. Of course you need funding, but centering the patient is the guiding principal that has allowed us to get to Stage 7.
Everyone falls into the leader category, the laggard category, or somewhere in between. With some of the government incentives and legislation out there, the environment is right for healthcare organizations to get out there and be aggressive in rolling out EHRs and everything that comes with it. The meaningful use incentives make it easier and more appropriate for folks to rally around this effort, but that doesn’t mean that everyone will. Some can’t afford it no matter what happens. We didn’t go after meaningful use for the dollars, just like I tell people I didn’t have children for the tax deduction. I wanted to have children, so I did. And we wanted to implement an EHR for the patients, so we did. If someone wants to pay us for it, so be it.
Can you talk about your ability to share medical records across health systems?
Through programs such as Care Everywhere and Community Connect, our providers have electronically exchanged medical information with clinics from New York to Oregon. The ability to share information is a benefit to patients who might be away from home when care is needed or to those who just began seeing a provider by ensuring the care team has the patient’s most up-to-date medical information.
We are also in the process of setting up the connection with the eHealth exchange, which is really the national level of a health information exchange (HIE). From a strategy perspective, we don’t want to work with hundreds of HIEs. Adding that cost becomes a problem for our patients, and we need to be efficient and effective with our dollars.