June 18, 2014

How one health system botched its EHR rollout

Daily Briefing

    Lack of clinician input and training contributed to the troubled rollout of an electronic health record (EHR) system at Athens Regional Medical Center (ARMC) in Georgia, according to a top hospital official and two vice presidents of EHR vendor Cerner.

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    Background

    On May 4, ARMC went live with Cerner's EHR system in "most areas" of the health system.

    On May 15, more than 12 physicians affiliated with the health system sent a letter to ARMC President and CEO James Thaw and Senior Vice President and CIO Gretchen Tegethoff stating that the timeline to install the EHR system was too "aggressive" and that there was a general "lack of readiness" among its intended users.

    Some of the concerns raised by the physicians include:

    • ED patients leaving after lengthy wait times;
    • An admitted patient who had not been seen by a physician for five days;
    • Lost or overlooked orders; and
    • Medication errors.

    Shortly afterwards, the Athens Regional Health System's board of trustees announced Thaw's resignation as the hospital's CEO and president. The move came after hospital staff voted 270-0 that they had "no confidence" in the hospital's administration.

    Tegethoff resigned from her position a few days later.

    Hospital officials have not confirmed whether the resignations were directly related to the EHR implementation.

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    The EHR implementation problems

    James Moore—senior vice president and CMO at the medical center who has taken over as the administrative lead on the EHR project—says that a lack of provider input in the way the medical center implemented the EHR system and limited user training contributed to the communications and recordkeeping issues.

    Cerner Vice President Michael Robin, who has worked closely with the medical center on its EHR implementation, notes that although some clinicians were involved from the beginning in the planning and design process, the Cerner team noticed about halfway through implementation that the medical center's IT team was leading the project, which is "atypical" of Cerner customers.

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    Meanwhile, Cerner Vice President Ben Hilmes says that important decisions about EHR workflow and design should have been made by health care providers and hospital staff that will use the EHR system daily. He said, "If you look back at this effort, hindsight is 20/20 ... Successful projects—and this is true across the board—are clinically driven, not IT driven."

    Robin notes that since the issues were discovered, health care providers have taken on a bigger role in the EHR project. He adds that it feels like the project "is on the right path."

    What hospital board officials have to say

    In an Athens Banner-Herald opinion piece, Rob Hoyt—chair of the Athens Regional Medical Center Board of Trustees—and Marilyn Farmer—chair of the Athens Regional Healthcare System Board of Trustees—write, "While we anticipated there would be challenges, particularly given the complexity and magnitude of adopting an integrated medical record system on a compressed timeline, the implementation of the [EHR] system has not gone as well as we hoped."

    They note that since medical staff raised concerns about the new EHR system in a May 15 letter, "[w]e have been working diligently with them, with Cerner, with our nurses and our support staff to address those critical issues."

    They write, "As a board, we have learned some important lessons through this process," adding, "We understand more fully the importance of communication with both internal and external audiences" (Cochran, Athens Banner-Herald, 6/15; Hoyt/Farmer, Athens Banner-Herald , 6/13).

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