DeWitt Hospital is a critical access hospital in DeWitt, Arkansas. It provides emergency and outpatient services for rural Southeastern Arkansas. The hospital is equipped with a radiology department, a laboratory department, a respiratory department and an emergency room. It also operates a nursing home attached to the hospital, the Ferguson Rural Health Clinic, and the local ambulance and paramedic services.

THE PROBLEM

When Brian Miller joined DeWitt Hospital as CEO in January 2019, the hospital’s existing EHR from CPSI was sunsetting and the facility had nine months to find a replacement. Miller and staff knew they needed a system that was light on maintenance, updates and support; was able to adjust to different workflows and care levels; and was supported by a team willing to be a partner to the hospital, rather than just another vendor.

“It also was really important for us that our new EHR would be interoperable and could connect to the statewide SHARE health information exchange,” Miller explained. “We often transfer patients to other hospitals, and their medical data needs to transfer with them. On top of that, a lot of our patients have chronic conditions and receive health services from multiple providers, and their data is fragmented across each provider they receive treatment from.”

It is absolutely essential to continuity of care that clinicians have easy access to their patients’ medical records, no matter where the patient is coming from or where they have been treated in the past. By connecting to the SHARE HIE, DeWitt staff could access a unified longitudinal patient record, allowing clinicians and others in the state to make more informed decisions and improve the quality of care, Miller said.

PROPOSAL

For an EHR, DeWitt decided on vendor Azalea Health. Azalea came in with a cloud-based system that minimized IT spend and lift, reduced the need for training and expensive consulting services, and offered an interoperable approach that enabled DeWitt to connect to the SHARE HIE, while also connecting its facilities, so it could easily share patient data across its own network, Miller explained.

“The idea was simple: Azalea would deliver a system that limited the amount of upfront and long-term spend, empowered our hospital staff to customize the solution based on their clinical workflow, and unlocked our data so that we could have a unified view of the patient regardless of the care setting,” he said.

The move to a cloud-based EHR platform required a big shift in mindset for DeWitt.

"We made the right decision to go with a cloud-based EHR that helped us pivot to meet new demands for testing and tracking."

Brian Miller, DeWitt Hospital

“We were coming from an on-premise system that demanded time and dollars to maintain,” Miller said. “The interface was old and workflows were static. The idea of a cloud-based solution that we could quickly integrate into our existing technology ecosystem with very little lift was something totally new for the organization. And it was an approach we very much needed.”

MARKETPLACE

There are many vendors with electronic health records systems on the health IT market today, including Allscripts, athenahealth, Cerner, eClinicalWorks, Epic, Greenway Health, HCS, Meditech and NextGen Healthcare.

MEETING THE CHALLENGE

Right as DeWitt was moving from the integration stage of the EHR implementation into the support stages, COVID-19 hit.

“We were forced to finish the implementation remotely,” Miller said. “But it’s gone smoothly. Azalea simplified the process and worked to ensure integration into our existing radiology and lab solutions. They worked across our groups, including nursing, registration and IT, to make sure everyone was aligned, informed and prepared on Day One. Azalea has been a very supportive and attentive partner, and we still meet with them twice a week.”

The EHR vendor also played a big role in connecting DeWitt to the SHARE HIE. DeWitt is part of the Arkansas Rural Health Partnership (ARHP), a network of 14 rural hospitals that pools resources to better meet the unique needs of patients in their rural communities. When the pandemic started, Arkansas Blue Cross Blue Shield came to ARHP and provided the funding to connect all the rural hospitals in the partnership to the SHARE program.

For DeWitt, Azalea was instrumental in facilitating its connection to the SHARE HIE. With the vendor’s help, DeWitt became one of the first providers in Southern Arkansas to be connected to the SHARE program.

“The SHARE program has led to more informed care transitions between DeWitt and other local community clinic providers,” Miller explained. “We use the exchange to share episodic admission/discharge/transfer data, discharge summaries, radiology reports, image narratives, laboratory results, prescribed medications and clinical procedures. Our clinic gets 24-hour daily reports on all our patients, and we get notified in real time when any patient has an ED or inpatient discharge or if they test positive for COVID-19.”

RESULTS

Azalea also has supported DeWitt in testing the community for COVID-19. As one of the only places in the area to get tested, DeWitt had a lot of people coming to the clinic to get tested. One day the hospital had more than 100 tests, and that went on for about two weeks.

“What draws a lot of people is that they can get their test results in 15 minutes at our clinic instead of waiting a week,” Miller said. “This appeals a lot to local businesses. When the business is open and one employee tests positive, they need to test everybody. They don’t want to have to shut down for a long time, so rapid results are ideal.”

Testing kits were reallocated by HHS in late July. DeWitt still is testing people who come into the hospital. But the removal of these tests means that DeWitt does not have the resources to help local businesses test their employees. It’s an added strain to an already stressful situation.

“At its peak, the number of people coming in to get tested was more than double our normal patient volume,” Miller said. “With so many new people coming into our hospital, Azalea’s EHR has been a valuable tool for keeping track of new patients. Having this broader pool of patients in our records will be helpful for our recovery once we can ramp up elective procedures again.”

ADVICE FOR OTHERS

“The landscape has changed to the point where it’s difficult for smaller hospitals to stand alone and survive,” Miller remarked. “Larger hospitals have more access to funding and get better deals when purchasing equipment, but everything costs more for critical access hospitals. We’ve been fortunate enough to leverage our connection with Jefferson Regional Medical Center in Pine Bluff to use their buying power and save a lot of money on supplies.”

DeWitt is working to get the ARHP to a similar place, where the hospital can share resources between the 14 hospitals to secure grants, centralize staffing and acquire supplies at lower rates. Rural hospitals are in a tough place right now, and solidarity between hospitals might be the only way forward, Miller said.

It’s also important to understand the different kinds of solutions that are out there, the benefits and risks to each, and scalability to future demands, he added.

“We never would have anticipated COVID-19 and the resulting impact that it had on our hospital operations and data,” he concluded. “We made the right decision to go with a cloud-based EHR that helped us pivot to meet new demands for testing and tracking. And we have been fortunate to be part of the SHARE program, which is helping draw insights into the impact of COVID-19 on our community and the broader hospital network that serves Southeastern Arkansas.”

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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