Paula Hansen, R.N., MHA, FACHE, and David Bernard, M.D., Ph.D., may be strong independently, but together they are a force to be reckoned with. In 18 months, the pair transformed healthcare at The Methodist Hospital System in Houston by establishing a single EMR — providing anywhere, anytime clinician access to complete patient information. And as if this weren't enough to be dubbed innovators, the duo pulled this off on time and under-budget and changed the culture at Methodist in a most unusual way.
Hansen, vice president, clinical informatics, has been at Methodist for nearly two decades. She joined forces with Bernard, medical director of clinical pathology in 2004 who has been at the Houston hospital himself for 10 years, in order to establish an EMR at the system's flagship. However, soon after planning the new system, the project morphed, as Hansen calls it, to span all four of Methodist's hospitals (a fifth is currently being built). Hansen and Bernard co-led the project, and after casting a wide net that took a year-and-a-half to reel in, chose the Sunrise Clinical Manager Extended Architecture from Atlanta-based Eclipsys.
Prior to the implementation, the 900-bed not-for-profit hospital subscribed to a best-of-breed approach, which meant relying on several systems including an Eclipsys legacy system. Hansen had actually been involved in selecting the product 15 years earlier, and says she remembers thinking that it had reached its limit. “We had pushed it to the point of where it contained all of our acute care and critical care nursing documentation,” she says. As an early version of an EMR, it had some bedside monitoring interfacing, but wasn't able to interface with the pharmacy. Physicians used it to check vital signs, but not to document.
Executives knew they needed a robust EMR, and had begun to feel the pressures of bar coding solutions, order entry and medication reconciliation, Hansen says.
Another impetus for change was Tropical Storm Allison. Allison flooded Methodist's medical records department in 2001, which left employees freeze-drying records. It was at that point that Hansen says that hospital leadership said, ‘Never again.’ The consensus was, she says, “We may use paper but it will be imaged, and it will be put in an electronic format so we don't lose this information ever again.”
Coming from the clinical side, Bernard says neither he nor Hansen knew the nuts and bolts of computer systems. Once they moved into their project leadership positions and started speaking to people on both sides, it became clear that neither understood the other. The technical folks thought that doctors saw patients in a linear fashion, from diagnosis to hypothesis to treatment to discharge, which he points out is untrue. “It's all done at the same time,” he says.
Conversely, Bernard says the clinical people felt system design was easy, thinking, “You just tell the computer to do this, and the computer does it.”
Hansen says the understanding went something like this: “If I push a button, it'll tell everybody and get the answers.”
In order for the project to have legs, it needed to have ears and Hansen and Bernard spent the first nine months in translation. Bernard says they spent time changing mind sets and trying to create a culture of listening. People needed to understand why coming together was so important, the duo found. “We're all here for the patient,” he says. “We all do these individual things, but it all contributes to the whole.”
Bernard credits Jerry Vuchak, the health system's then vice president of information technology, with mixing things up by bringing IT out from behind their computers.
“We took people who were mainframe people and were in the bowels of IT, and every single member of the IT division was trained on the clinical application and had a role when we went live,” Bernard says. “You had people who had never been out on the floor, out talking with nurses and doctors and respiratory therapists and whatnot. I think that that did a tremendous amount for everyone. You'd start to see individuals who you never thought would be good interacting with a nurse, all of a sudden bloom into a star.”
As for advice, Hansen says a good leader must understand how best to use everyone on staff. “Not any one individual is going to have it all, but you need to recognize each individual's strengths and weaknesses on your team.”
When asked about his advice, Bernard laughs and says, “You've just got to persevere. You've just got to work through it. There are going to be ups and downs, and it's trite and everyone says it, but there are going to be good days and bad days. There are going to be things that you mess up, there are going to be things that are messed up for you, and there are going to be times when your car doesn't start and you still have got to get up and get it going.”