- Ambulatory EHR replacement has played an important part in helping EvergreenHealth promote EHR adoption among its clinicians as well as put the health system in position to achieve two prestigious recognitions — Stage 6 on the HIMSS Analytics EMRAM and Most Improved on the Most Wired list.
Jamie Trigg, Director of IT at EvergreenHealth, has helped the health system on its EHR adoption journey as a Cerner shop in both its inpatient and ambulatory settings, with the latter requiring EHR replacement and initial resistance from clinicians. According to Trigg, the implementation of a Cerner EHR and other health IT brought it numerous opportunities and some challenges.
In this one-on-one with EHRIntelligence.com, Trigg reveals the numerous health IT activities that have enabled EvergreenHealth to delivery safe, high-quality care to its patient population while at the same time increasing provider EHR use and qualifying the organization for EHR incentives up through Stage 2 Meaningful Use.
EHRIntelligence.com: How does today's EvergreenHealth compare to when it first began its widespread implementation of health IT?
Jamie Trigg: All of it has to do with patients while they're in the hospital and better outcomes once they are discharged. When we first started out, Cerner was more of a clinical data repository. We would feed data in and you could retrospectively look back to see lab results, reports, and that type of stuff. But in the last five years, we have switched from that retrospective look-back to more of a proactive system that is really integral to the care of the patient.
We put in our close-loop medication administration five or six years ago. At that point, it was the first piece of functionality where we were depending on the system for patient safety. Shortly after that, barcoding went live, and within two years we went live with CPOE. As you can imagine, that changed things in a fairly dramatic way. That has allowed us to put in more real-time clinical decision support capabilities within the system, so now we can alert our providers if they are ordering too many or the wrong meds or if there are allergies. It has become a system that is integral to the real-time delivery of care.
EHRI.com: How has ambulatory EHR adoption fared at EvergreenHealth?
JT: We have 23 clinics, ranging from primary care all the way through various specialties live on the Cerner Ambulatory EHR. We opted to roll out the Cerner Ambulatory PowerChart, and we have been rolling that out to all of our employed clinicians and clinic groups for the past two and a half years now. It is really a wealth of information. The acute side likes to be able to see the clinic notes and the clinics like being able to see what happen to their patients who were in the hospital and do more proactive follow-ups with the patients, etc. It has been a real boon for us to have our clinics on the EHR.
It has been an interesting phenomenon to watch because initially with our first few clinic go-lives there was significant resistance by the clinics — nobody wanted to disrupt their existing workflows. They were using an older McKesson Practice Partner EHR that they had grown accustomed to and didn't want to change. With the first two to three clinics, we worked out all the bugs and workflow considerations. Then within a year when we have had eight to ten clinics live, we have people clamoring to get on to the ambulatory EHR. Now we have a list of clinics — 10 or 12 more to go — that are demanding that we get them on the EHR as soon as we can.
EHRI.com: How has participation in the EHR Incentive Programs bolstered EHR adoption?
JT: The nice part about it is that if you are using the EHR as it's intended to be used, you almost meet those objectives naturally. There are a few clicks here and there where it is awkward or doesn't fit into the workflow, but for the most part if you're using the EHR as it's intended to be used you meet those objectives.
The other piece of it, especially on the ambulatory side, is that you've got these competitive providers who see this dashboard each week and don't want to be the only ones in their clinics not meeting meaningful use. So we've set up this kind of competitive structure to help that long.
EHRI.com: How does the health system enable health information exchange and information sharing among providers?
JT: It's a couple of things. In the Cerner world, the acute EHR and the ambulatory EHR share the same database. They are in effect using the same system. So that's for our employed physicians.
We also have a network we call EvergreenHealth Partners and that network is not only made up of our employed physicians but also affiliated physicians in our community who are not employed and don't have the same EHR. We've got I don't know how many different flavors of EHRs that we send data to — probably 10 or 12. We're utilizing the Cerner HIE tool set, comprising the Cerner Health Hub — an interface engine in the sky more or less — and appliances called HealthDocks that we sent out to these affiliated clinics in our EHP networks for those who are on EHRs other than Cerner. That appliance acts as basically an HIE gateway. It has all of our master patient index information. We actually send a series of reports from our acute setting out to these clinics — admit notifications, discharge summaries, lab results. We were also one of the first CommonWell clients and we have at this time approximately three athenahealth clinics live on CommonWell that we're sharing data with as well.
EHRI.com: What's next in terms of health IT, especially in light of the Stage 6 designation from HIMSS Analytics?
JT: Some of our implementations are in various stages of adoption. For example, we have physician documentation rolled out in a few of our inpatient settings but not throughout the house. This year we're doing an inpatient documentation roll-out that will coverage a majority of the rest of the hospital. Some of these are Stage 7 requirements.
Another one is that we don't do meds administration scanning in our emergency department, so we'll be doing that. Our meds administration scanning throughout the hospital is in the low 90s when you measure it. We need to get that to 95 percent to qualify for Stage 7. We’re working on a data warehouse and our strategy for that. We have at best a data mart capability at this point. Stage 7 requires a full data warehouse, so we're looking into what that means.
We're going to try to incorporate some of these other Stage 7 requirements in some of our ongoing projects.