- Finding success during an EHR selection process depends on how well hospital leadership understands the priorities of its clinical and non-clinical staff.
Executives at Meritus Health in northwestern Maryland spent nearly two years evaluating the EHR market for a system capable of meeting all the needs of its patients and providers as part of an EHR selection process involving a thousand hospital employees.
Ultimately, Meritus chose Epic Systems to provide a single, integrated EHR for its health system and have already launched an implementation and modernization project expected to take five years.
Meeting the unique needs of diverse providers, settings
According to the Chief Transformation Officer Carrie Adams, end-user satisfaction was top of mind. “It’s about the usability for end users,” she told EHRIntelligence.com.
“The biggest guiding principal in the selection process was that it was patient-centric and focused,” she explained. “How easy is it for a patient to view their information, and how easy is it for our providers to care for our patients while using the system?”
Beyond usability, Meritus officials also sought an EHR system that would support transitions of care and care coordination. Patient EHRs needed to provide comprehensive, longitudinal health histories. Additionally, these digital records needed to exist on a single system to enable efficient information sharing.
“We wanted a single integrated system,” said Meritus Medical Center EHR Project Director Joan Hall. “So regardless of whether the patient was seen in the hospital or one of our practices, they would all be one record.”
Adams also emphasized the need to improve efficiency in transitions of care. In addition to its hospital, Meritus operates ambulatory and community practices. Its leaders wanted to consider the varying needs of its ambulatory and community physicians as well as the needs of its hospital staff.
“Another big driving force was a system that allowed our ambulatory physicians and community providers to access a patient’s hospital stay and the ability to track a patient’s progress along with follow-up notes and recommendations quickly,” said Adams.
Meritus officials carefully weighed each of their options, ultimately choosing Epic from a pool of six potential health IT companies. The Maryland health system signed the $100-million contract with Epic for a five-year EHR implementation and hospital modernization project after a year and a half of deliberation.
"The biggest guiding principal in the selection process was that it was patient-centric and focused.”
Site visits, live demos, and provider feedback
With such an expensive, long-term end goal in mind, Meritus officials didn’t take any shortcuts.
“When we started this process, we looked at the hospital only and then expanded to include our ambulatory and home health facilities,” said Hall. “Once we did that — by virtue of trying to find one system to cover the entire continuum of care — it narrowed the vendors down for us. We ended up with three vendors that we felt had systems that could potentially meet our needs.”
The three remaining vendors were MEDITECH, Cerner, and Epic.
With the number of potential candidates cut in half, officials began a series of site visits and in-person EHR system demos after which physicians and hospital staff submitted thorough feedback regarding the ability of each system to meet their specific needs and expectations.
“We had each of those three vendors come in and spend a week doing detailed demos for our team here at Meritus,” said Hall. “We had very detailed scoring sheets at every demo that we’ve had everybody fill out. We then scored each of the vendors and compared them to each other.”
Following the week of vendor demonstrations, staff came to a consensus regarding which two health IT companies were likely the best fit for the environment. “We narrowed it down to two vendors—Epic and Cerner,” said Hall.
“From there, we went to site visits for multiple hospitals for both Epic and Cerner,” she continued. “Then we went to the headquarters for both Epic and Cerner. We came back, we scored those visits, we did a total cost of ownership, and we ranked both vendors.”
With two remaining candidates, Meritus focused on specificity.
The health system outlined its specific needs and moved onto site visits at facilities mirroring their own — 250 to 300 beds and other affiliated practices in the community.
Meritus officials ultimately decided Epic met the hospital’s needs from an organizational standpoint.
“We did some very focused site visits at a number of hospitals to see specific functionality around the Epic Beaker system and the Stork system,” said Hall. “Those two modules were just clarifying — the real factor that drove our decision was that our clinicians overwhelmingly liked the Epic system and the flow of functionality within it.”
This involved EHR selection process mirrors the advice of Epic Vice President of Interoperability Peter DeVault who at the most recent Value-Based Care Summit urged hospitals to avoid relying on health IT certifications and instead see the technology in action through site visits and live demos.
With health IT certifications recently under suspicion following the $155 million eClinicalWorks settlement earlier this summer, gauging the capabilities and effectiveness of EHR systems requires the kind of thorough, collaborative effort seen at Meritus.
Usability for provider and patient satisfaction
The decision to choose Epic largely came down to the wide range of functionalities the health IT company provides as well as the high level of provider satisfaction Meritus Medical Center staff reported during the lengthy scoring and feedback process.
“From a provider standpoint, they looked at what the workflow looked like within the actual computer system and software,” said Adams. “How many times do they have to go in and out of pages to find notes or lab data or look at medication lists? Flipping through all those screens decreases efficiency and adds redundant work to finding and documenting information. They also looked at the availability of information following patient discharge, the ability to look at labs and progress notes, and the ability to follow up easily and quickly.”
Prioritizing usability and efficiency is key considering the level of physician burnout resulting from dissatisfaction with EHR technology.
According to several healthcare CEOs across the industry, spikes in reported physician burnout are directly attributable to increased performance measurement, complexity of medical care, and the implementation of EHRs.
Meritus also focused on the level of clinical decision support embedded within Epic technology.
“For example, if a patient comes in with pneumonia, what pertinent lab should be ordered or what antibiotics are the best selection for patients?” offered Adams. “The system will drive that clinical decision pathway, which is best practice guidelines. Epic had a lot of that available. It views nicely for providers, and the system is highly usable, so they don’t have to go searching for information.”
For further guidance on the level of patient satisfaction Epic would likely provide, Meritus requested information from Epic specifically addressing observed patient satisfaction outcomes at similar hospitals using the EHR system.
“We wanted to be sure that whatever product we were getting was proven within our industry,” said Adams. “We wanted something using best practices and evidence-based guidelines. So we made sure whatever system we were looking at was already proven in a like-organization.”
Improving the patient-provider relationship
The advent of the EHR system has also given rise to criticism from both patients and providers due to perceptions of the technology as a barrier to the patient-provider relationship.
With a new streamlined Epic system designed to optimize usability and patient-centered care, Meritus intends to restore the relationship between patients and clinicians by cutting the amount of time the latter spend at their computers.
“We wanted to be sure that whatever product we were getting was proven within our industry.”
“The goal is to allow our nurses and physicians to document less in the computer, and spend more time at the patient’s bedside or with the patient in their office for that one-on-one interaction,” Hall noted.
Adams and Hall hope the Epic implementation will improve efficiency so that providers can bring a personal touch back to patient care.
“We expect our patients to be more satisfied with their personal attention with providers and nurses,” said Hall. “We want to make sure they understand the care they are receiving and their goals of their care plans, ensuring we give them the resources they need to maintain their health.”
The EHR implementation process at Meritus has already begun. The Meritus team is currently at Epic’s headquarters in Wisconsin getting certified in EHR implementation.
Meritus has also partnered with a technology services company to assist in the implementation process.
Presently, a discovery and direction-setting procedure is underway to lay out the overall timeline for the project.
“We hope to have that completed by the middle of September,” said Hall.