While smaller critical access hospitals often struggle to successfully and affordably implement electronic health records, a recent case study conducted by the College of Healthcare Information Management Executives (CHIME) found that Henry County Health Center in central Iowa is well on its way to success.

According to the case study, the 25-bed critical access hospital in Mount Pleasant, Iowa overcame many of the key obstacles facing smaller healthcare providers who are now facing challenges in implementing electronic health record (EHR) systems. 

Henry County anticipated the challenges it would face as a small organization working on a project as large as implementing a new EHR system, the study shows. From the beginning, it sought input from staff and their assistance in reviewing potential products.

One of those helping to review information systems was Robb Gardner, current chief executive officer of the facility.

"From a clinical standpoint, we had a voice in the decision," said Gardner, who became Henry County’s CEO in November 2009. During the selection process, he was the organization's rehabilitation services director and helped review various brands of information systems. After the staff-assisted selection process, the facility chose to implement a system from Mobile, Ala.-based Computer Programs and Systems Inc.

Henry County CIO Stephen Stewart said the new records system engendered greater trust among staff that patient information would be available and also improved the ability to access information throughout a patient’s treatment.

Physician adoption has been facilitated by executive efforts to provide consistent, direct and honest communication, various efforts to assist them in training and ongoing use. Study findings suggest that small size worked to Henry County’s advantage. "When you have a small medical staff, you get to know them as individuals," Gardner added. "They know your values and work ethic, and they’re willing to work with you. In a larger facility, you may not get the opportunity to know someone personally. Here, we have the opportunity to have a more compassionate approach."

Case study findings also show that Henry County provided crucial training and ongoing assistance for nurses and staff, and it has made significant investments in the people needed to support the shift to use of the new system.

Henry County had two "super users" from the nursing staff, said Marcia Jamison, who also has a clinical IT coordinator role. "We helped with version upgrades, testing and training," she said. "Having clinical IT positions is beneficial for the facility and the nursing staff; this way, you always have a ‘go-to’ person if you have questions."

In gaining staff support, small size again can be an advantage, said Maureen Ewinger, director of inpatient nursing and a floor nurse at the facility. "We have the advantage of being smaller; we need absolutely every person here to make this successful. There is a tremendous amount of transparency in this organization. To gain staff support, the way it’s presented to them will make or break the project."

At any size of organization, hospital leadership must fully back the initiative, Stewart said. "Does your leadership really support what you’re doing or are they just providing lip service? Do they really buy in and support it? This is not an IT journey or project. It is a clinical project enabled by IT. Leaders have to really embrace this and carry this message all the time."

Recognizing the unique challenges faced by small hospitals, this September the federal Office of the National Coordinator for Health Information Technology  issued a Call to Action to see 1,000 rural and critical access hospitals and small, rural hospitals meaningfully using certified EHR technology by the end of 2014.

The study, "Electronic Health Records Help Henry County Prepare for Change," is the second in a series by Ann Arbor, Mich.-based CHIME, developed to highlight benefits and best practices of successful implementations of information technology.