Artesia General Hospital is in the validation process for Stage 6 of the seven-stage HIMSS Analytics Electronic Medical Record Adoption Model, or EMRAM. Director of IT Eric Jimenez and his team faced and overcame various challenges along the way and have lessons to share.

"The journey this hospital and department has been on for the past four years has been amazing," said Jimenez. "The department started with three people and now has 17. In 2015, we implemented an EHR in 90 days, replaced our PACS system, and installed a new medication system at the same time. As the environment was changing around us, the hospital grew from 250 to 420 employees."

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There was a turning point to this story: Jimenez almost was let go 18 months ago. Team morale was low, the physicians weren't happy with the EHR, the list goes on. Luckily for Jimenez, and ultimately the hospital, he got a new boss.

"This was the catalyst that helped me," he said. "We started changing the mindset around the hospital, and now we are making great things happen, like EMRAM Stage 6. I am truly excited about the future at the hospital."

Challenges to getting to EMRAM Stage 6 included: difficulty reaching an agreement with physicians on what constitutes complete clinical documentation; physicians not seeing the value of EHR templates; and implementing clinical protocols.

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"That is a difficult procedural and political issue for a small hospital," he said. "At the end of the day, all of these challenges affect physician workflow, and that is the biggest issue."

To overcome these challenges, Jimenez and his team developed a clear IT strategy for the hospital that helped with communicating priorities. That strategy contained EMRAM elements. The IT team presented its plan to senior management and the board, and they agreed to the strategic direction.

"We built a partnership with our EHR vendor, Evident," he explained. "In order to get the most function out of the system, our clinical analyst would spend hours working with Evident to gain full understanding of the system."

The next step was to create an education program to train end users. When new providers would onboard, the analyst would focus on how to use the system, often tailoring education to a  provider's skill set; sometimes training would take weeks or even months. The major topic was CPOE.

And the IT team continued work on building and refining templates to ensure best practices.

"In order to help the providers change their minds about templates, we needed new technologies," he explained. "We implemented Dragon Medical One to help them use the templates. In addition, we worked with our EHR vendor to use built-in micros so they could easily type or say phrases that would fill in templates with ease. We created a monthly meeting to keep providers informed about changes."

Jimenez said the process of getting to EMRAM Stage 6 was difficult.

"At Artesia, we attempted to reach Stage 6 two years ago, but failed to meet the measure due to the then-newly completed implementation of an EHR, the brand new PACS system, and the brand new medication system," he said. "As we worked toward Stage 6 this year, the full support and backing of our administration, the partnerships built between departments, the solid IT plan, and making the project organization-wide helped us achieve the stage."

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com