Knoxville Hospital and Clinics (KHC) is preparing to “go live” with its new electronic health records management system Sunday night, Oct. 13, a feat that caps years of planning and preparation.
Included in the February 2009 American Reinvestment and Recovery Act, the “stimulus” bill, was a mandate that required all hospitals to have electronic records by January 2015. This includes enrollment in the federal health information exchange. Hospitals faced penalties in the form of reduced Medicare and Medicaid reimbursements if they failed comply by this deadline.
For KHC, that could be costly, as 75 percent of the hospital’s inpatients are on Medicare. The percentage for outpatients on Medicare is lower, but overall, between 60-65 percent of KHC’s patients are on Medicare or Medicaid.
Hospitals have been directed to invest in electronic records management systems. If their system meets federal criteria, some of this investment may be eligible for reimbursement.
Maggie Hamilton-Beyer, Chief Financial Officer for KHC, said the hospital began working on this project in 2010. Since then, KHC has invested $2.8 million in the project, which includes hardware and software throughout the hospital. To meet the demands for the new management system, the hospital’s information technology (IT) infrastructure required updates. Nearly every computer and server in the hospital has been replaced.
The improvements have included those to computers which serve business purposes at the hospital. Reimbursement from the government will be received for technology upgrades which specifically relate to patient care and records. Of the $2.8 million invested by KHC, Hamilton-Beyer estimates that maybe $2 million is eligible for reimbursement. No money will be received in reimbursement until the system has been in place and operational for a period of time, to demonstrate that it will work. Funds may not be received by the hospital until this time next year.
KHC’s process to meet the federal government’s demands began to accelerate in March 2012 when Thom Richards was hired as IT Director. Richards has helped navigate the 700 pages of requirements, tied to the electronic records expansion. The Ottumwa native was brought in to Knoxville from Alaska, where he assisted three other Critical Access hospitals (a designation shared by KHC), 20 clinics and a larger hospital go through the same process.
Prior to Richards’ hire, KHC contracted for IT services and network assistance. Employee structure was changed to bring him on staff.
Richards believes the transition should be transparent to patients. It should not affect care or the process doctors follow.
There are hospitals in the country that are working to make the transfer to an electronic records system, directly from a system based entirely on hard, paper copies. KHC already has some electronic records management, and since this process has begun, paper records have been scanned in electronically to make the transfer.
Benefits to the transition to an electronic records management system include quick access to one’s entire medical history. The interconnectivity with other health care facilities that will come with the new system will allow doctors to quickly access a patient’s records regardless of where one needs medical attention. The risk of error when entering patient information will be decreased, Richards added. Files will be backed up. All entries into the system will be audited, to observe who made the entry, to avoid any unauthorized access or changes to one’s medical records.
For its electronic records management, KHC has turned to Cerner, based in Kansas City. According to Richards, this is the number two company in the nation to provide this system, and the top one available to hospitals the size of KHC. The top company exclusively services large hospitals. KHC is too small to be accepted as a customer.
Cerner will have several representatives on site in the early days of the system’s implementation at KHC. On Sunday, Richards expects to have 30 representatives from Cerner at KHC.
In addition, each department at KHC has one designated expert who has received extensive training on the system, to allow him or her to properly train the rest of the department. A former laundry room at KHC was transformed into a training center, complete with several computers, for employees to learn the system. Cerner will be based out of that room while on site.
Tests of the system have been performed. After each one, Richards has sought input from users regarding what they liked and disliked. The full system has been tested at least three times. Even with all of these tests, Richards knows there will be unforeseen challenges.
“You can plan all you want,” Richards said. “You won’t know until the moment it happens.”
He is not expecting many mistakes made by staff in the first few days. Staff will be nervous and pay extra attention to detail to properly work with the system. As time goes by, and things become more relaxed, IT issues may arise.
When seeing patients, doctors will use HP Revolve 810s, which serve as laptops and tablets. These laptops can easily be held, like a paper chart, to read a patient’s records during an appointment. The device is also easy to connect to larger desktop screens when a provider is in an office. Richards said the devices, as well as the new system, will save doctors and patients time.
Patients are also assured that when providers are looking at their records on a computer screen, they are looking at a file from a server. In the future, when patients can view records from home, the same holds true. The files will not be downloaded to a specific device to protect the confidentiality of medical records.
Hamilton-Beyer said KHC doctors are not attached to paper and are already used to electronic filing. For example, the system, including the laptops over charts, is preferred by the hospital’s longest-serving provider, Dr. Earl McKeever. Each provider has a login and password to the system.
In the future, though this will not be available when the system is launched at the hospital, patients will be able to access their records online at home. There will be a secure portal, also with a login and password, on the hospital’s website for this. Appointments can be made, and if one sees a mistake on their records, there will be a system in place for rectifying those issues.
Hamilton-Beyer and Richards said a great deal of work has already gone into this transition, but really, the work has only begun. They feel fortunate to be involved in this revolution of the health care industry in Marion County, but they are not the only ones.
Richards was complimentary of the hospital’s leadership, including its board of directors, CEO Kevin Kincaid, and everyone on down. The leadership has shown a willingness to do what it takes to accommodate the success of the transition, including expenditures. Richards said not every hospital facing these changes will have this attitude coming from the top.
Cerner will be joined in the training center by KHC employees taking calls with concerns or issues with the system. Richards said everyone, including doctors, administrative staff and janitors, have expressed interest in taking a shift on the phones during this time. All of them are eager to see success in the transition and the future of KHC.
Richards said hospital employees view the health of patients as their passion. Keeping people healthy is personal to them, which has made them more engaged in this process. It’s not just one or two people this is true for; it is the entire hospital.