Electronic Health Records

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EHR replacement: Benefits of a single, streamlined system

By Kyle Murphy, PhD

- Not all decisions to replace an EHR system are based on dissatisfaction. Sometimes, choosing a new EHR vendor and solution is motivated by a healthcare organization’s mission to improve the delivery of care across the entire continuum and scale its operations toward managing the health of entire patient populations.

According to Tripp Jennings, MD, System Vice President and Medical Informatics Officer for Palmetto Health, the health system in Columbia, S. C., based its decision to replace its array of EHR and health IT systems with one system (in this case, one provided by Cerner) in order to streamline its operations and the exchange of health information between its own providers as well as other hospitals and care settings. In this Q&A for “EHR Replacement Month,” Dr. Jennings explains the benefits of a single, streamlined system over a best-of-breed approach.

What motivated your organization’s decision to replace your previous EHR system?

We recognized with all the change that was going on in healthcare and with the fundamental shift to population health that we really needed to do as much as possible to get our systems simple and aligned so that we could have flow of information to meet our needs. We had a mixture of multiple vendors on the outpatient side ranging pretty much the entire spectrum. We had some that were Allscripts, Centricity, Greenway, or multiple other vendors [and some paper-based] that we felt the need to align with our acute care services into one continuum of care system.

How did you go about determining what system you would use to align your organization?

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We weighed the multitude of complexities of switching the acute care side to another vendor and aligning with that or having a natural approach to aligning those across a continuum. We certainly did evaluate it, but the fundamental point that we kept coming back to was: Did it make sense to switch all of our acute care side from a system we were happy with and having success with to something else while looking at what we were going to do with our ambulatory network?

It was like a crash course in change management. It’s very difficult but much more difficult from a human standpoint than it is from a technical standpoint. Technical challenges can be and have been resolved. It’s really the process of changing everybody’s workflows and taking a practice from a paper system to an electronic system. You have to stop and evaluate all of the clinical and workflow processes. You can’t just take a paper system and plug it into an EMR, no matter what the vendor. The real challenges are doing that while still keeping a practice performing at an acceptable level.

Why were you using so many different systems? Was it the result of a best-of-breed approach?

It was a mixture of best-of-breed approach as well as the reality of a growing health system, meaning as we were growing our ambulatory network. We were starting new practices as well as acquiring new practices like most health systems across the nation. Many of those that we were acquiring were on paper or different system. At this point, we’ve leveled off and are coming back to making sure we’re aligning our practices in the new era of healthcare.

As a result of going with one vendor, what will the system be able to achieve using a streamlined EHR system?

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First is optimizing information flow across the continuum. Now we have systems that talk, but we need to optimize those so that they talk effectively. We went from having no information now to having so much information we have to it organize effectively for the providers. The second piece of that would be designing care pathways that support population health. The third would be reaching out and connecting our goal of an organized system to other organized systems in our region. We have a health information exchange and are looking at connecting it to other health information exchanges as well as a multitude of other small and large systems in our region.

If you had to do it all over again, would you have gone with a single system or a best-of-breed approach?

If we were building a brand-new health system from the ground up, I don’t think there would be anybody in the nation who would go with a system that was a collection of disparate systems. There has been a definite change: While feature functions are important, intercommunication and caring for the patient across all care venues are critical.

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