CCMSD hopes record system switch will increase efficiency

No longer willing to struggle with an electronic medical records (EMR) system that Crook County Medical Services District (CCMSD) employees have precious little liking for, the district has undertaken an extensive vetting process to replace it.

It’s all in the name of patient safety and efficiency, according to Wesley Davis, DNP, who led the EMR selection steering committee.

Davis gave a presentation to the board of trustees last week after a ten-month process during which the committee was able to whittle its options down to a single finalist: Cerner.

It was a six-step process, he said.

“We identified our stakeholders – the key people involved within the organization [this affects],” he said.

At first, he noted, staff members would often believe the EMR didn’t really have an impact on them. But as the conversation got more involved, Davis said you eventually come realize that the system affects “everyone from the top down.”

Consequently, the committee wanted this to be a fully inclusive process, led by providers and staff.

“Everybody was included and invited to be an active participant in this process,” he said. The goal of the process was to identify “where we are and where we want to be”, culminating in a document of questions, issues and desires that came out at about 40 pages of priorities ranging from “nice to have” to “high priority because they were high-stake items, such as patient safety issues”.

After putting together a vendor list of all the available EMR vendors, “We narrowed it down to three top contenders,” Davis said. The committee then looked at specific challenges and reached out to the shortlisted companies to ask how their EMR would help to solve them.

Two of the three were then knocked off the list, one because it requires millions of dollars of infrastructure and the other because it doesn’t sell to critical access hospitals and wanted the district to partner with a larger organization such as Monument Health.

The third candidate impressed the most. The committee was able to develop a “very good relationship” with Cerner, said Davis, and met with them on multiple occasions.

“They’ve had a very good communication style,” he said, including direct access to a representative, quick responses to emails and in-person demos of the software.

Davis said that Cerner’s software appears to have the capacity to streamline CCMSD’s workflow, reduce the number of steps needed to perform a task and cut down the chance for error.

Other members of the committee spoke to their preference for Cerner, describing issues with the current system, such as the need to go through many, many screens during the patient check-in process, difficulty in tracking referrals and a lack of automation, such as the ability for a patient to check in via their phone ahead of time.

Medical Director Heath Waddell, MD, described the current system as a bottleneck for productivity.

“We just can’t get people through the door quick enough,” he said, stating his belief that Cerner would be more efficient, “even in the routine clinic day.”

The current system, he said, involves a lot of “useless clicking”.

“You guys pay me a lot of money every week to click through boxes,” he said. According to Waddell, CCMSD has recently been gaining quite a few patients from Spearfish due to doctor retirements; patients like that CCMSD providers give them plenty of time, he said, and he believes the district can capitalize on this without the bottleneck.

Waddell also stated that the current system causes a lot of “near misses” and miscommunications in patient care due to issues such as having to hand-write notes and inefficiencies with passing information to other providers.

Trustee Ed Ray asked about the implementation of a new system and whether it would require extra staff. Waddell said that a temporary team would be a good idea, because it’s a “monumental beast” and an investment at the front end would mean it was properly set up. Whether or not current customers of Cerner are happy with the system appears to be linked to how well they invested in the implementation, he said.

Acknowledging that this would likely be an added cost for the district, Waddell commented, “In the long run, you increase my productivity and I can make that back.”

For example, he said, “I have quite a lot of face time, [but] I need more patients through the door,” while the hospital would be able to accept more swing patients because the nurses would not be “bogged down by [the system] wanting to know what someone’s shoe size is.”

CEO Micki Lyons commented that the changeover would require a project manager. This would not necessarily be an IT professional, she said, but “one person that is gathering all that information” and is willing to dedicate their time going department to department and making sure the information Cerner needs is being completed in a timely manner.

Trustee Sandy Neiman questioned the decision to move across to the current system a couple of years ago. Was CPSI believed to be the right choice to meet all these needs for efficiency and patient safety?

Davis explained that he was not asked to participate in the process of choosing the current system, so he was not involved.