Successfully implementing an electronic medical record (EMR) system requires, among other things, starting from scratch with a clean system, without importing databases from older systems in a misguided attempt to save time.
That’s one of the lessons that Scott Soefje, PharmD, MBA, BCOP, the associate director of oncology pharmacy services at Smilow Cancer Hospital at Yale-New Haven Hospital (YNHH), in Connecticut, learned as YNHH went through the challenging process of implementing an EMR system that went live Feb. 1, 2013.
Dr. Soefje was one of the team leaders during the implementation and also helped guide a second EMR rollout that went live last June at a sister hospital, the Hospital of Saint Raphael. (The hospitals have since combined into one location.) He shared some insights gleaned from both rollouts with attendees of the Hematology/Oncology Pharmacy Association’s (HOPA) fall conference in Chicago.
To ensure successful implementation, he reiterated that the system has to be clean from the beginning (Table 1). “You can’t be importing databases from an old system and try to make it work,” he said. “We imported a database from another hospital and tried to modify it to save time, and when we launched in February, we found that we just didn’t get to everything we needed to [address]. There was a lot of disconnect between the systems.“So in June, with the second implementation, we started with a clean slate and went through each drug line-by-line to make sure everything was accurate, and that launch went perfectly,” as opposed to the first, which “definitely hit some road bumps,” Dr. Soefje said.
There were, he noted, “tens of thousands of lines that had to be edited. There were two people who spent the better part of two months doing it. But it was worth it. We are still cleaning up databases from our first launch. In contrast, the database from the June implementation is pretty much clean right now.”
Keep It Simple
Also critical is the need to standardize and simplify. “This is particularly important with chemotherapy treatment plans. You can’t have multiple treatment [regimens] individualized for each doctor. It makes your system messy and difficult to manage. It’s not worth it.”
For both implementations, the YNHH team sat down with doctors, grouped by their treatment specialties into teams, and worked together to agree “on what should and shouldn’t be in the standardized treatment plans,” Dr. Soefje said. “We got to the point where we realized that as we simplified, things got easier and easier to work with, and we believe it will ultimately save money.”
YNHH also discovered, he said, that the EMR system “will pull from the drug database into the treatment plan, but it only does it one time. So if the drug database changes, the treatment plan has to be relinked to the drug again to make the plan work.” A related lesson learned: YNHH had to test all its interface systems to ensure that each drug routed correctly to all its systems, including Pyxis, billing etc., Dr. Soefje added.
The first implementation showed that despite pre-study expectations to the contrary, workflow was significantly affected, in part because differences in how care is delivered in varying hospital areas were not fully appreciated. For example, “you have to make sure that the EMR system provider understands that inpatient and outpatient treatments are different. They function differently, the workflow is different and so you have to walk the EMR provider through the system so they understand that,” Dr. Soefje stressed.
Change management, he added, is also critical. “It requires leadership all the way from the top down through the department heads to drive the change. We kept reminding our people that these changes were being done to improve patient care. As we kept pushing that, even though change was hard, people more willingly began to accept it.”
Dr. Soefje added another point worth stressing: “This process never stops. There is continued implementation and a continuing need for change management even after the system is up and running successfully.”
Even at Start-up, Keep Maintenance Top-of-Mind
In another presentation, Joseph Bubalo, PharmD, BCPS, BCOP, an oncology clinical pharmacy specialist at the Oregon Health & Science University (OHSU), in Portland, described how OHSU included an ongoing maintenance program in the start-up building process for its EMR system, which went live in 2009 (Table 2). To ensure that maintenance would be successful, he said, OHSU employed two full-time equivalent (FTE) technicians to support the module in OHSU’s EMR system dedicated to oncology when it went live. Today, OHSU still has one FTE on staff for support. source
