Citizens Memorial Healthcare (CMH)

Bolivar, Missouri

• Annual revenues of $100 million
• Staff of 1,550
• 125 affiliated physicians, including 60 physicians employed by CMH in 10 rural health clinics and 15 specialty clinics.
• CMH provides services across the continuum of care, including acute care, emergency services, home care, hospice, long term care, assisted living, ambulatory surgery, cancer care, rural health clinics and specialty physician practices.

Challenge: During organizational strategic planning in 1999, CMH recognized that the system had grown to include a variety of services across a broad continuum of care for the community including the hospital, home care, long term care and physician practices - from cradle to grave.

Additionally, the organization wanted to promote seamless care across the continuum to the community. Unfortunately, the care wasn’t seamless. Patients were asked for demographic and billing information repeatedly and the more important clinical information needed for care delivery was recorded on paper records located in 33 different locations. From that analysis and a strategic planning effort, CMH committed to this vision for health information technology:

• Enable a patient to enter anywhere into the continuum of care and have a personal identity that is maintained across that continuum.
• Physicians and other caregivers will have access to all of that patient’s medical information within the healthcare continuum.
• Providers will be able to document efficiently within the software system, which will free them to have more time to spend with patients.
• The investment of time, talent and money will enable CMH to be a technologically advanced healthcare organization poised to grow and offer new services to our patients and the community at large.

The system is known as Project Infocare.

Implementation Solutions: CMH began implementing the Project Infocare EMR in 2002 and had eliminated the paper medical record in the hospital by December 2003. Paper records were eliminated throughout the system, including long term care, home care and physician clinics by 2007. CPOE is utilized in all locations. Since that time, CMH has added emergency services, barcoding for medication administration, in-home telemanagement, ePrescribing, additional physician practices and a patient portal to the EMR system.

EMR Solution: Meditech

Recognizing the ROI of EMR Implementation

Continuity of care: More than 95% of patients presenting for care in the CMH system already have a record in the system. Their demographics, medications, history and allergies only need to be updated. The medication, patient history and allergy lists are common across the EMR system. Any update from any location is immediately reflected for all users accessing a record.

Patient safety & quality: Medication safety/closed medication loop. Computerized provider order entry, pharmacy, nursing and barcoding all have contributed to a 70% reduction in reported medication errors in the hospital. Clinical quality measures show marked improvement. Across the CMH system, there are over 30 publicly reported quality measures from acute care, long term care and home health. CMH has made a tremendous improvement in those measures since implementing the EMR through the use of clinical decision support.

Financial ROI: CMH has reduced clerical and transcription costs and kept total employee costs down – all while increasing revenue significantly since the EMR implementation. In-home tele-management is integrated into the CMH EMR. For example, blood pressure measures that a patient takes at home this morning will be in the EMR...well, this morning. This information availability has enabled CMH to reduce costs while simultaneously improving care and outcomes. Patients with in-home tele-management require two fewer home care visits, but also have a lower rate of re-admission to the hospital. Overall, CMH has been able to reduce the re-admission rate for home care patients by 35%.

Lessons Learned
Communicate expansively to get everyone on board.

• Talk, talk, talk. To everyone involved and use every means available. Give updates on the implementation at meetings, during discussion forums, in newsletters, on posters, by email and with system sign-on messages.
• Listen, listen, listen. To everyone involved. Provide paper forms for those who want to write it out. Provide forums for those who want to be heard. Talk one-on-one with anyone you haven’t heard from. Follow up on every issue – and close the communication loop.
• Give feedback on results. The EMR will improve quality of care and outcomes if done right. Let everyone know when it happens and celebrate.

Cater to the caregivers.

• Physician leadership is important. Especially in a rural setting. There is not likely to be a budget for a CMIO, so physician champions are the representatives of the physicians. They bridge the technical and clinical perspectives and provide important communication between the physicians, the implementation team and other users.
• Go paperless. Remove the temptation to write an order or scribble a progress note.
• Recognize that change is hard. Be prepared for providers to go through some stages, like denial, anger, bargaining, depression and acceptance. Have support lined up and be ready to adapt but still keep moving forward toward the goal of the project.

Don’t forget the human aspects of using an EMR.
Use of an EMR to document care during a patient encounter is awkward at first. Build in training and practice early on to help users gain skills and confidence. Encourage them to share the screen with patients and document real time. Do it before bad habits form (like writing on a scrap of paper and entering documentation later).

If you are a healthcare provider and would like more information on how to obtain your hospital’s EMR score, e-mail us or call us at 866-546-2900.