Sinek and his management team already had drunk the Kool-Aid by having Faith Regional's new bed tower designed in a way that made it hostile to paper charts by decentralizing nursing units and limiting printing capabilities. When the lights went on in that tower, the EHR simply had to be in place at the Norfolk, Neb.-based provider, which sits in a largely rural region in the Northeast corner of the state.
But Sinek had faith, pun intended, in both the project leaders and the management structure devised to execute the implementation and the subsequent changes in workflow and care processes.
The community hospital took calculated risks at every step of the project: implementing a complex EHR-Soarian Clinicals, from Siemens Healthcare, Malvern, Pa.-developed for large hospitals; focusing first on computerized physician order entry, politically and technologically the most fearsome of technologies; taking a multi-year implementation timeline and trimming it down to less than six months; and simultaneously doing a staff reorganization that initially spread fear through the nursing staff.
Sinek was taking Faith Regional across a landscape littered with broken dreams and financial heartbreak. Hospitals large and small have poured money into EHRs for years. But according to second quarter 2010 statistics from the HIMSS Analytics Adoption Model, less than 1 percent have a fully implemented EHR In place. The majority of hospitals are struggling to get to Stage 4 in the seven stage HIMSS adoption model (Stage 4 calls for use of CPOE and clinical decision support.)
Sinek and other leaders knew that the project's success-indeed, the success of any and all EHR projects in this era of meaningful use-is measured by how deeply and meaningfully CPOE is adopted by the physician staff. And he knew enough about CPOE to be scared. "I've heard first-hand from CEOs I know about the absolute horrors of CPOE. I've read about open revolt by medical staffs and millions of dollars wasted. Introducing it is not considered a great career move for CEOs."
But still he and other project leaders forged ahead. Ask why, and Sinek will tell you that the Health Information Technology for Economic and Clinical Health (HITECH) legislation-which established financial incentives for EHR adoption-was Faith Regional's tipping point. The hospital knew it had to catch up quickly in terms of automation if it was going to fulfill its mission to be a clinical leader for the 11 critical access hospitals in its area. HITECH galvanized them into action, for reasons both clinical and financial.
"ARRA and HITECH change the dialogue because they tell everyone in the industry that you simply don't have a choice anymore," Sinek says. "The story no longer can be that hospitals are deciding to implement EHRs and they're forcing physicians to use it. Whatever your political orientation is, you'd have to agree that the federal government has been clear on that message.
"From a clinical perspective, having the decision support and data collection and all the other benefits to clinical quality and patient safety were required to take us to the next level," he explains. "From a business perspective, it's quite simple for me. Based on our Medicare discharges we estimate we will be in line for more than $4 million in incentive payments. If we can get $4 million by hitting a target, we're going to get it. It's that simple."
Everyone on board
That was part of the equation Sinek brought to Faith Regional's board of directors when seeking the green light for EHR funding. Hospitals often struggle to justify the business case for EHRs because of a dearth of rock-solid research supporting the clinical and financial efficacy of the technology. But Sinek says the board did not need a lot of convincing.
"It was easy for our board to understand how paper can lead to medical errors, or the advantages of being able to send lab results and images electronically," he notes. "Most of our board members are from other industries, and they scratch their heads and wonder why it's taken this industry so long to automate."
Count board member Jeff Eisenmenger among the head scratchers. Eisenmenger's day job is vice president of the Norfolk marketplace for the Farm Credit Services of America, a cooperative lending institution that's part of the nationwide Farm Credit System. "It really does shock me how technologically far behind health care is at this stage," Eisenmenger says. "From the outside looking in, the benefits of an electronic environment are so obvious I'm not sure why anyone in health care would doubt them."
Suddenly, it's go-time
On June 20 the bed tower opened its door and the EHR went live. Once that happened, 100 percent of all orders were being entered electronically, with 69 percent of those orders entered directly by physicians. The EHR had been pre-loaded with visit histories, a master patient index, historical to current visit results and transcribed reports, allergies and order catalogues, among other information.
Within six months of the project's kick-off, the organization's effort, known internally as Electronic Data to Gain Excellence (EDGE), had transitioned Faith Regional from a paper environment to a digital one with electronically driven care processes. There was no hybrid paper/electronic way-station for Faith Regional: it decided to go electronic, and it did it.
The decision to skip that interim stage was a critical piece of the project "narrative," says Dean French, M.D., Faith Regional's vice president of medical affairs. While the medical staff was well aware of ARRA and HITECH, selling the project on the merits of federal legislation didn't really resonate with physicians. What did resonate were the benefits of an electronic environment-being able to access data from home, getting test and lab results immediately, etc.-as well as the dangers of operating in a hybrid environment.
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