More than two years ago, Beebe Healthcare in southern Delaware made an important decision about their health IT infrastructure in deciding on EHR replacement technology to demonstrate meaningful use in the near term and prepare for a transformation in care delivery in the years to follow.
The health system's current Vice President and CIO Michael Maksymow, Jr., joined the organization as it approach the end of its EHR selection process, providing the final push that saw Beebe Healthcare opt to become a Cerner EHR shop.
With an aggressive nine-month implementation schedule set, the Delaware health system had little margin for error, keeping its Cerner implementation project scope purposefully narrow and laser-focused on delivering the EHR functionality necessary for achieving meaningful use while leaving room for later EHR optimization efforts.
As Maksymow told EHRIntelligence.com in an exclusive interview on the factors contributing to a successful EHR implementation, Beebe's EHR success story would not have been possible without key partnerships both internal with physicians and clinical staff and external with Cerner professionals. While two tenets drove the Cerner implementation at a high level, a fully engaged clinical staff prove the difference ultimately in the satisfaction EHR end-users now experience at the health system.
EHRIntelligence.com: What is Beebe's history with EHR adoption?
Michael Maksymow: Prior to my coming here — I came here in 2013 — we had already started the RFP selection process for a full-functioning, scalable EHR that would fit our organization and wherever we were going to go. Before I joined, It was narrowed down to two prospective vendor partners, including Cerner. I went to HIMSS that year prior to joining and actually interviewed both vendor partners in their own booth to learn about what they had and see it for myself, came back, and was able to provide a recommendation, which was Cerner. Gladly, the organization chose the same.
When we were going live, we were replacing a previous EHR. It was a legacy system that was being sunset, and it would no longer allow us to meet meaningful use fully. We were under a little bit of time crunch if we were going to try to meet meaningful use. Cerner had committed to us that we would indeed be able to implement theirs in time for meaningful use.
From kickoff to completion, we had a nine-month, extremely aggressive implementation, again with Cerner's assurance and commitment and our team's commitment to the project. I am happy to say that we absolutely implemented this on our go-live date as planned. The number of solutions we went in with in the range of 20 to 30 solutions. Something this large typically takes 18 to 24 months.
One thing I look for is partnership. It's about a relationship, not the vendor-client transaction. Don't treat me like a number — my site ID — but truly as a partner working together. We both want the same thing: a successful implementation. We want successes at the end of the day and to work together to transform how we deliver care to our community and our visitors. Cerner has absolutely been every bit of a partner that I had hoped for and I finally got them to say "partner" too and not vendor. I know I'm making progress with all my vendor partners.
In all seriousness, it's the value of that partnership that really helped us get to the finish line.
EHRIntelligence.com: How did that aggressive EHR implementation impact optimization post-go-live?
MM: Yes, you never know fully what you're getting into until you're in process. Even if we'd had 18 to 24 months, you're going to discover some things — whether it's enhanced functionality or a misinterpretation. But what you really strive to do is implement it as successfully as possible and with limited fallout, and then your optimization after that is making it feel like a tailored suit.
Some of that is around crystallizing an understanding of the scope, making sure it's the right size — what's in now, what's in later — because there are some decisions that you make to exclude something at some point. That wasn't in scope in the implementation but would be part of optimization afterwards.
Some of this, too, is about setting expectations with your vendor partner with contract negotiations and moving forward. And not just your vendor partner, but your internal stakeholders as well. These are usual intense in terms of capital resources, both monetarily and human resources, if you want it to be a successful implementation.
Again, it's about right sizing the scope, setting those expectations, carving out some things you'll be able to provide your attention to later, and making sure you have the capital and human resource funding to support this project.
EHRIntelligence.com: How significant a driving factor was EHR usability in the implementation?
MM: If you don't have users using the system or can't use the system, they'll do one of two things — shut down and not use it or find workarounds. We had two tenets when we went into this project. One was it's not an IT project. This requires a multidisciplinary, cross-functional collaborative team. We're going to build it together. This is a very complex toolbox, and these aren't necessarily my tools — I don't know how to use them — but IT is the steward of the system and we will help build this so that we are successful. The system is useable and provide quality, safe care.
The second part of that is it's not a project. A project has a defined start and stop date. Your EHR isn't a project but a program. A program doesn't have a defined stop date. EHR implementation isn't about implementing it and then you're done and walking away. It's a journey, so be prepared for that journey.
The second tenet was that our approach wasn't to implement this just for meaningful use. If we were that short-sighted and were going to squeeze this is in to meet meaningful use, the incentive dollars pale in comparison to the full investment in these systems. We would have likely made usability a limiting factor and may not have had the success and engagement of our team. Rather, we built it to be meaningful users of the tool, of the system. Things like meaningful use, HIMSS Analytics EMRAM — these are all validators that we are truly transforming healthcare. They shouldn't be our goal.
EHRIntelligence.com: What is the lasting impact of the Cerner implementation?
MM: One of our success factors, besides our tenets, is to get your physicians engaged. At Beebe, we're fortunate to have a chief medical officer who got that and worked with me as a partner internally to garner that interest and engagement. That governance team still meets today and talks about relevant issues in optimization, improvement, and driving our use and adoption of the EHR. That is key for any organization that wants a successful implementation. Your partner will get you so far. Your IT team will get you so far. Your other stakeholders will get you so far. But your physician engagement is critical to the use of that EHR.
Image Credits: Beebe Healthcare