Seamless integration with new clinical applications
smoothed the transition

"The learning curve was much shorter because we were working with new applications that were already integrated into the system."

Terry Brinkley
Vice President of Finance
Paris Community Hospital
Paris, Illinois
25-Bed Facility 

A vital integration

As the only hospital in a rural county of nearly 20,000, Paris Community Hospital is the healthcare system for those living on the eastern edge of central Illinois.With the next closest hospital 20 miles away in Indiana, Paris Community is a lifeline for the elderly residents who dominate the area's population. But, a few years ago, the 25-bed critical access hospital was mired in its own crisis: It was drowning in paper.

Clinicians couldn't keep up with the flood of paper charts. Patient files went missing or weren't updated often enough. Physicians either couldn't find records they needed or wasted time flipping through charts for the right information, a life-threatening delay for unconscious elderly patients often rushed to the hospital's emergency room.

With access to medical records inconsistent and the potential for handwritten errors likely, a safety disaster loomed.

"Our physicians were at the forefront saying that we needed to do something," says Terry Brinkley, vice president of finance. "They knew we couldn't continue operating this way."

Physicians expressed their concern at a retreat held annually to give hospital administrators, board members and key medical staff a forum for exchanging ideas. Out of those discussions came a strategic vision, set by the board, to replace paper charts with electronic health records.

The board formed a task force, consisting of physicians, department managers and two of its members, to explore the details of implementation. Board members determined from the outset that the hospital needed an integrated system, since it didn't have the resources to hire a large IT staff.

"We felt that trying to interface multiple vendors and systems would require more ongoing support - and that wasn't going to be cost-effective for us," says Brinkley,who headed the task force.

Choosing HMS

The hospital had already been using HMS financial solutions to organize its general ledger, accounting, billing, payroll and purchase and inventory systems, as well as HMS laboratory, radiology and pharmacy solutions to streamline paperwork for patient orders, lab results and medical images. HMS not only offered the full suite of clinical technologies that the hospital needed to become paperless, its solutions were already integrated with the clinical software that Paris Community had.

"We never thought of looking at anyone else but HMS," Brinkley says. "We knew that it would meet our needs and provide us with the integration that we wanted.

"Part of what we liked about the system was that we could operate it on our own and rely on HMS for troubleshooting or customization."

Though HMS seemed like the obvious choice, the task force still had to convince the board. The fact that two board members worked on the plan with the task force and participated in HMS' presentations to the hospital helped sway the rest of the board, Brinkley says.

"We knew that we needed their input; we needed them to be exposed to what our needs were. If we had gone back to the board with a plan that cost $750,000 [and not asked for their input], there would have been a lot more resistance, and more questions about why we were spending that kind of money.

"Overall, it was a pretty easy sell. We had a lot of support from the top down.The fact that we had five years experience with HMS and a relationship that already met our needs was a big factor."

The hospital decided to gradually add a range of new clinical technologies, including Clinical View, Patient Care Documentation, eMAR and Transcription.

Securing the finances

Finding the funds to upgrade and expand the information system at Paris Community Hospital wasn't as difficult as it usually is for rural hospitals its size.

"We are more fortunate than most in that our hospital has pretty significant reserves that come from investments developed from endowments, donations and community support through the years," Brinkley says. "We get this support because the community views us as an asset - one it wants to retain."

The hospital drew from its sizable reserve fund,which it mostly uses for capital expenditures, to cover the initial implementation costs. Because of its large elderly population, the critical access facility also receives Medicare reimbursements based on the actual cost of treating each patient, rather than fixed payments. Since these reimbursements increase with the cost of care, administrators knew that they could cover the ongoing cost of maintaining the new clinical applications.

Making the transition

HMS worked closely with the hospital during each implementation phase to design solutions for applications that needed tweaking, holding weekly conference calls with Paris administrators until the process was complete. The seamless integration between the new clinical applications and the previously implemented software smoothed the transition.

"The learning curve was much shorter because we were working with new applications that were already integrated into the system," Brinkley says.

Getting staff that had never used the technology to embrace it was trickier. Administrators eased the adjustment by turning a conference room into a computer lab so clinicians could train and practice anytime.

"Some of our clinical staff who weren't comfortable using computers went through a learning curve, but once they mastered that, they were fine," Brinkley says. "Most of them say now that they wouldn't want to go back to the days before the new system."

Being open with staff from the beginning about the reasons behind the change also helped pave their acceptance.

"We explained what our goals were - that this was about improving patient care, safety and access to information," Brinkley says. "No one was going to argue with that."

Reaping the benefits

It hasn't taken long to see the benefits.Being able to pull up records from anywhere in the hospital through Clinical View gives clinicians constant, immediate access to information they need to treat patients; they no longer have to frantically search for missing charts or wait for the right ones to be pulled in emergencies. Information is segmented into categories, another time saver.

"If they want to see lab results, for example, they don't have to page through a huge chart to find them," Brinkley says.

Having patients' medical history at their fingertips also provides doctors and nurses with tools to make quick treatment decisions, Brinkley says. Clinical View has even improved turnaround for processing patient claims. When an insurance company requests more information on a patient, the hospital's business office can access the file immediately, instead of waiting for it to be routed from medical records.

Doctors like being able to review their transcriptions online and sign off on those electronically "from the convenience of their office, in between seeing patients," Brinkley says.

The future payoff

Once paper is eliminated completely, the technology will save the hospital in paper and storage costs. Most of all, it will ensure the hospital's future survival,Brinkley believes.

"When you look at new physicians coming out of school now, they're all trained on electronic medical records. That is what they expect.

"Eventually, all of our older physicians will retire and newer ones will take their place. Soon,we will get to the point where physicians won't want to work in a hospital that doesn't have electronic medical records."