Officials overseeing the construction of a brand new psychiatric hospital in Vermont are planning to cut the ribbon without a comprehensive, modern EHR installed on premises. Despite calling the facility “state-of-the-art” and hoping it will meet an important need for mental health patients in the region, contract woes and selection delays will leave the hospital with a patchwork of hybrid systems and paper-bound processes for at least the first year of operation.
According to the Burlington Free Press, the new Berlin hospital, as yet unnamed, will use the same combination of paper and electronic records currently in use at another area facility instead of starting off with a fully certified and integrated EHR suite. While the hospital hoped to update an build upon the limited technology currently in use at the Vermont State Hospital in Waterbury and the temporary psychiatric facility in Morrisville, negotiations with the EHR vendor who supplies those systems fell through last summer.
“The idea was to build upon that,” explained state Mental Health Commissioner Paul Dupre to a state Senate committee. “They didn’t have a pharmacy piece and wouldn’t have a fully integrated system by our timelines.” While Dupre then turned to Fleter Allen Health Care to see if their well-traveled EHR could suit, the projected $3 million cost of startup and $600,000 in ongoing implementation costs were prohibitive.
So the hospital is currently starting over by requesting proposals from EHR vendors, and Dupre hopes the RFP will bear fruit by the late summer of 2014. However, implementation may still take six months to a year, leaving the new hospital teetering along on an amalgamation of paper and electronic documentation.
The situation is not unusual in some established facilities that have cobbled together their health IT infrastructure in bits and pieces as time and budget allowed, but with the industry fully in the grips of meaningful use, with a high bar set for patient safety and clinical documentation, opening a new facility without having the technology piece in place may be a disaster waiting to happen.
The dangers of hybrid workflows are well known even for providers who have been working together for years. A report from the Pennsylvania Patient Safety Authority last year outlined the risks of combining pencil and keyboard, noting that important information can be easily lost or inadvertently ignored if a provider is looking for it in the EHR and not the accompanying paper chart. At the Memphis VA, handwritten notes bypassing EHR alerts caused three deaths in the fall of 2013. Requiring new staff to settle in to a new location while juggling hand-written notes and a patchwork of IT systems seems to be asking for trouble.
With the hospital unable to make its first attestation to meaningful use before the penalty phase of the program begins, it will be missing out on the last of the incentive payments and potentially setting itself up for a big financial hit before it even gets its act together. Dupre, who only took his current position in July, seems resigned to this fate. “I have to take it from today and make it work,” he said. Source
