Creating a Safer Health Care Environment with the "3 Ts" of EHR Implementation

Michael Archuleta: You really have to try to get as much data into the system electronically, because the thing is is you really don't want paper records, you don't want digital records, and you're not trying to basically match those up. So it is extremely, extremely critical to do that.

Host: That's Michael Archuleta, chief information officer and director of information technology services at Mt. San Rafael Hospital. He tells us about how he implemented an enterprise EHR system to establish a safer, more efficient environment for handling patient records.

Michael: If we can connect the dots between the technology that meets their needs and provide them the tools to improve their overall lives, we can earn their trust and loyalty.

Host: This is Health IT on the Record, presented by MEDHOST. A show that dives into how health information technology innovations impact every aspect of the health system, from multi-hospital networks down to individual patients.

In today's episode, Archuleta shares his three Ts for successful EHR implementations for hospitals, and outlines how he partnered with Champion leaders at Mt. San Rafael to transform a paper-only workflow into an advanced, tech-based data system. And finally, along the way, we'll also hear his advice for protecting information in one of the most frequently attacked industries in the world. Enjoy the conversation.

Michael: Hello, my name is Michael Archuleta. I'm the chief information officer with Mt. San Rafael Hospital here in Southern Colorado.

Host: All right, Michael. Welcome back. I really enjoy our conversations. We've been getting a ton of good value, just real implementation, real perspectives into your experiences of taking a really undesirable nightmare of a situation, totally having a full digital transformation, and being an award-winning hospital now with the way you're managing all of your data. All of the above.

So today's topic: enterprise EHR solutions. And it's really about the journey that you've taken. And hopefully, your experience can help future people go through a smooth experience as well, and they can learn from you and also maybe – It's kind of like if you could go back and give yourself advice when you were implementing an EHR at that organization for the first time, what goes well, what to expect. So let's just start off of when did you first begin implementing an EHR at Mt. San Rafael?

Michael: We started our implementation journey in 2015. Very, very new process. And what I always look at is – when I look at the journey ahead, I always tell individuals that I like to focus on the three Ts of successful EHR implementation. People are like, "Well, what's the three Ts?" That's team, tactics, and technology.

When I look at the overall team objective, really as an organization, try to identify one or more EHR champions or don't implement, period. It is extremely critical, as I stated, to really incorporate and bring in the right individuals to make those decisions, to improve those clinical decision rules that you're putting out, those implementations that you're putting out. Including the physicians, including the clinicians, having them understand why we are doing this. And really make sure your organization's senior executive fully support the EHR, which is extremely, extremely critical. As I always say, it starts from top down.

And looking at it is – once you have your team in place, really look at having a very experienced, skilled project manager that's going to basically manage the project from bottom to top, all the way to the basic end which is extremely critical. Because I've seen many EHR companies too, they assign you a project manager; a week later, you have another project manager. And it was kind of funny because with our EHR implementation, I had three project managers because the last two kind of dipped out.

So it's always critical to really have that experienced, skilled project – and really utilize sound change management principles, which is extremely, extremely critical.

Michael: And I always say too, when we focus on some of the team aspects is, as a team we must have clear, measurable goals. That is extremely critical.

When I came into this organization, basically, when I had cable hanging from the roof and you had an actual speaker just basically hanging from a bob wire from top – I mean, honestly, man, this place was a completely different place. And as I stated, you're going to have those pictures to see the before and afters. But really coming together, I think, as a team, we really need to have those – honestly, those measurable goals that are going to be extremely critical.

And also, when you look at measurable goals, you also have to incorporate making sure your users share your goals as well too. Because if your users don't share your goals or don't understand the reason why we're basically doing this implementation, you will not be successful moving forward.

As I always tell everyone, we must share the story. We must have them understand why we are doing this. We are not doing this to ruin your life. We are not doing this to impact your workflow traumatically. The reasons why we're doing this is to improve the overall care of our patients, but make them understand those specific processes there.

And then when I go over into a tactic standpoint, I always tell everyone, "Plan, plan, plan and plan." That's extremely critical. Looking at some of the tactics that we basically brought into this organization, and kind of did an overall analysis. We really had to redesign the workflow here in this group. Because it was going from a paper system to a fully digital system. So workflow design was a complete change-up, so it was extremely critical to really focus on those plans and making sure you're executing those, and that you have the proper support to move forward with your overall project.

And I always say too, "Don't automate processes just because you can. Make sure the automation improves something." We always look at different things when it comes to, "Well, I'm going to automate everything here in this organization." Well, it is a benefit, but really make sure, at the end, that your automation process is going to make a point and basically improve the overall flow moving forward.

Michael: And looking at really designing a balanced scanning strategy, which is extremely critical too. And I always say, get data into the EHR electronically when possible. I mean, I'm hoping a lot of organizations have moved over to an EHR.

But of course, when you're starting and you're starting this journey – which I hope, if you're listening, I hope you already have an EHR – wink, wink – because this would be a disaster if you didn't. I'm just kidding. But moving forward, you really have to try to get as much data into the system electronically, because the thing is is you really don't want a high braid system. You don't want paper records. You don't want digital records, and you're not trying to basically match those up. So it is extremely, extremely critical to do that.

When we started on our EHR journey, we basically had a whole medical records room. Well, health information management room, that was filled with medical records. Paper records. So we started doing an electronic scanning process, scanning in records into the EHR, making it more efficient, making it better for easier access, making it where the physicians can access the information that they need from an archive chart, etc.

And then of course, with your tactics, you have to train, train, and train. Training is such a critical thing. Having them understand the overall aspects of your reasoning on why you're doing this, and having them understand the system is going to be critical to the success that you basically do with this implementation. If you get into visuals and you struggle or if you get into visuals and have never touched a computer before, you will have problems. But it is critical to always improve the training. Try to have that one-on-one training if possible with them. Really give them the knowledge and the good feeling that you are available for them and you are here to help them and that they are not alone moving forward.

And this is what I always say too: Don't ever go live on Mondays. I'm just hoping everyone hears this. Don't ever go live on Mondays. Mondays is always a chaotic day, but I always like adding that into my tactics. We never have gone live Mondays.

And really, at the end of the focus towards what we're trying to do is really lighten your workload when you go live, which I think is extremely critical. And for a short period afterwards, really don't underestimate how much time and work is involved in becoming an expert within EHR. And really, when selecting the vendor, really pick a vendor with an excellent reputation for support. And as I stated, that's really why we went to MEDHOST, because MEDHOST, as I said – I am looking for a business partner, not a vendor. And MEDHOST was definitely an actual business partner that our success was their success and their success was our success.

And their reputation for support was right there. When we had our go-lives, we had support from them. We had on-site staff. We had individuals from days and night shifts available to basically help. And it's always critical to really utilize your power users at each site, which I think is extremely, extremely important.

And then my passion, moving over onto the three Ts, is technology. Don't skimp on your IT infrastructure. Do not be cheap on your IT infrastructure, period. The thing is is it really upsets me because individuals have to have that built in cultural understanding of what technology basically brings to an organization. Without technology, especially without technology in this new age of digital healthcare, you will not be successful moving forward. So really focus on trying to create the most efficient, the most advanced process. Because you figure, your IT infrastructure is the backbone of any organization. That either makes you or breaks you, period.

So really focus on those specific items. And if you're a small practice, really maybe consider an application service provider model. Like maybe an ASP. Really look at that. And make sure that your IT personnel has the proper training and does the adequate testing of the specific applications that are being implemented into your environment.

And it's always critical to really utilize the expert IT advice when it comes to servers and networks. This is what we do. This is basically – I know we are in healthcare, but you figure health IT is really a backbone of any organization. Really utilize those experts' understanding of what it takes to move the organization into the new age of digital healthcare. And really looking at making sure your servers and interfaces are maintained on a daily basis, which is extremely critical, ladies and gentlemen.

When I see healthcare and when I see cybersecurity attacks and healthcare being the most attacked sector out there, I always go back and look at servers, interfaces, infrastructures that are basically put in place, because there's a lot of organizations that deprive technology, that deprive patch management, that deprive verification of interfaces. And that is why these hackers are gaining access into your system.

And another thing is, too, is really try to improve and change that culture concept of having individuals understand what cybersecurity is. As I stated, there was a poll that went out that stated 43% of individuals didn't even know what ransomware was. So you come into rural America, that percentage gets a little higher. So really focusing on those specific culture changes is going to be extremely critical for you because the technology that you have is basically providing and improving the care towards your patients, and your patients all deserve to have their information as private and as secure as possible.

And going over onto those aspects too, I look at backup your database on a daily basis. Backup, backup, backup. That is extremely critical. Reason why I said that is: I knew a group out of New Jersey that lost 10 years worth of data. 10 years, because poor backup systems. Because poor investments in technology. Because lack of cultural improvements on what cybersecurity basically is. Those are specific issues that will hurt your organization.

Then you get hackers coming in. Personal health information is so valuable. It's basically 10 times more valuable than a credit card and a social security number. So then, my number one thing would be like, "Okay, hey, let's grab these smaller organizations that really don't focus on technology, that really have poor backup systems, and that the culture really doesn't understand what cybersecurity is." And why would someone come and get us because we live in such a small community? Those aspects really need to change.

And really critical, moving forward, is having disaster recovery plan and testing it to the fullest is extremely critical. Because the journey ahead of you is absolutely going to be either a good journey or a bad journey, but that's really going to depend on yourself moving forward. And that is why I always look at the three Ts of successful EHR implementation, and that's team, tactics, and technology.

Host: Health IT on the record is brought to you by MEDHOST. With over 30 years of experience, partnering with providers nationwide, MEDHOST is helping evolve better solutions for healthcare management through innovative workflows and technologies. For more information, visit www.medhost.com.

Host: That is a great overview of those three Ts. Now I've got a couple follow-up questions to those, and I've heard you talk before about the champions and how important it is to gain their buy-in, specifically as it relates to creating a story of collaboration to move forward. That's an aspect I've heard you return to. So I want to ask you: How are day-to-day staff activities affected by the implementation of an EHR? Can you think of a single example?

Michael: Well, you figure with EHR implementations, there's always disruption everywhere. I mean, you're going from a full documenting on paper, now going to documenting on a computer system. Really complete change. You have some of these older nurses that were basically used to just pulling an overall assessment from a jar. Start documenting from there. So now, everything is at your fingertips, so of course you have some disruption. But that is why you really try to incorporate as much training as possible to be successful moving forward with your EHR implementation.

And I always say too, really, to create a leadership team for successful EHR implementation, you really need to have those champions within your environment. And I think everyone listening knows the importance of really having those team leads that basically help make final decisions regarding the implementation plan is extremely, extremely critical.

Michael: Because when we look at, say, a physician champion – an EMR implementation should not begin with a physician champion. The role of a physician champion is to act as a liaison between the physicians in the group and the implementation sheet. And the physician champion acts as a point of reference for how things are done from a clinical perspective and how physicians need the EHR application to function which is extremely critical. And the physician champion is responsible for keeping the physicians up-to-date on the progress of your systems implementation, and really maintaining physician buy-in to the overall project, which is extremely critical.

And that's when I look at a nursing champion or a nursing lead. Really same focus. You need that specific aspect. And I've seen a lot of organizations out there too, is forget to add nurses in the mix of things. And you figure, nurses do, a lot, focus more towards the overall documentation, the verification of the patient. So documentation is a heavy hitter for those individuals. And if those individuals aren't included in your overall EHR implementation and the EHR implementation team, you will not be successful moving forward. So really incorporate those right individuals to have a successful project.

Host: Something else I've heard you talk about is making your patient your new CEO. And so following up on what you were just talking about as it relates to documentation, my final question for you is: what role does documentation play? But from the perspective of the patient. How the hospital's helping the patient make better decisions.

Michael: Yeah, absolutely. So I want to kind of read something that I created. And it was basically – it was comments on patient-driven care. So the shift from a provider-driven market to a patient-driven market is here. That's the bottom line. And I always say, "The patient is your new CEO, who will disrupt the way we provide healthcare as a whole." If we can connect the dots between the technology that meets their needs and provide them the tools to improve their overall lives, we can earn their trust and loyalty.

Technology is part of an answer by helping patients really manage their health, inside and outside of your organization. Healthcare is changing. That's the bottom line. We are in the new, digital age of healthcare and we need to provide opportunities and avenues that will allow our patients to access their information more efficiently. When we're doing documentation, when we're basically providing better continuity of care, transfer of care, which really helps, which would really minimize the time between leaving their provider's office to having their patient health information readily available at their fingertips. And I always say, this is vital to the overall success of any organization.

Because healthcare organizations need to get to know their patients while also providing them the necessary information to keep them – to become familiar and comfortable with their place of care. When a patient honestly feels fully informed, welcome, and in control of their healthcare decisions, they will become an engaged patient, leading to a trusting relationship between a provider and patient, which would mature into the patient seeking healthcare services at the organization on a long-term basis. Because the patient has to be at the center of our focus because patient care is number one. We need to continue to develop asynchronous tools focused towards patients that help them meet their needs and solve their problems to improve their quality of life. And that is extremely critical.

Host: I know. It all comes back to the patient experience for you, and it's always the bottom line, and I like how you're talking just now, how this is all changing. And that is the bottom line. So let's wrap it up right here. I think we have covered a great session with you today. And let's just go ahead and – any final things on your mind or heart that we've not uncovered?

Michael: I think we got them all.

Host: I agree. Well, good deal. Well, thank you so much. As always, I am looking forward to the next time we get to talk.

Michael: Hey, sounds good, Clark.

Host: Thanks for listening to Health IT on the Record, presented by MEDHOST. For more stories and content like this, be sure to visit medhost.com/resources. Thanks.