Becker's Hospital Review

13 EXECUTIVE BRIEFING 2 EXECUTIVE BRIEFING SPONSORED BY How an EHR switch propelled this critical access hospital in Louisiana to excellence W hen St. James Parish Hospital, a 25-bed, public, nonprofit, critical access hospital in Lutcher, La., embarked on its transformation journey, little did the hospital's leaders know they would be "changing the wheels while the car was in motion" amid a global COVID-19 pandemic. The hospital completed its transition to CommunityWorks — Cerner's cloud-based version of its Millennium EHR tailored to the unique needs of community and critical access hospitals — and went live in August 2021, during the fourth wave of COVID-19. Along the way, the hospital's leadership team crystallized insights, learned lessons and celebrated wins that reveal what other providers considering an EHR switch can expect. Becker's Hospital Review recently spoke with St. James Parish Hospital's Mary Ellen Pratt, chief executive officer, Jeremy Martin, chief operating officer, and Derin Donaldson, director of information systems, about the planning and execution of this EHR transition. Their observations attest that reinforcing EHR infrastructure is one of the most transformative decisions healthcare leaders can make today. Unconnected EHRs grind down decision-making and operations Before St. James initiated the transition to Cerner's CommunityWorks EHR, its emergency department, rehabilitation center, ambulatory clinics, and hospital departments worked within disparate EHR systems both on premise and in the cloud. There was no consistency between those systems, which were developed at different times by different vendors and were not natively integrated with each other. From a patient safety perspective, not having an integrated EHR system impaired clinicians' ability to look up patient information across the continuum of care — for example, when a patient was admitted to the acute care unit from the emergency department— and to make optimal decisions about their care. That in turn elevated clinicians' workload, frustration and the time spent looking for information. "I knew we needed to evaluated a new EMR solution when it started to impact the clinical processes to the point where my clinicians were not leveraged to do the right thing at the right time for the patient," Ms. Pratt said. "We would figure out workarounds, so it wasn't that we allowed harm to occur to patients, but our workarounds were so labor intensive and cumbersome that it didn't seem to be the right thing." With the onset of the COVID-19 pandemic and the ensuing staff shortages, transforming EHR infrastructure became an even greater priority. "When you're short-staffed in a critical access hospital, you can't have your people looking around for what they need to do — it needs to be integrated into their workflows," Ms. Pratt noted. The IT department suffered, too. "From an IT standpoint, you have to do everything as many times as you have systems: reporting, troubleshooting, getting data out, maintaining databases, maintaining usernames and passwords, managing interfaces, having backup and disaster recovery plans . . . that took up most of our department's time and took us away from other things we could have been doing to grow the organization," Mr. Donaldson said. When choosing an EHRpartner, watch for strategic fit and product portfolio Community and critical access hospitals typically operate on thin margins, which may make investing in a new EHR seem unaffordable. But the cost of inefficiencies caused by maintaining multiple disjointed EHRs may be higher if it prevents organizations from leveraging resources to their full potential. "We have a leadership philosophy that we're not going to wait until we have a burning platform to make a strategic decision," Mr. Martin said, emphasizing that the St. James leadership team began laying the groundwork for the EHR transformation before the pandemic. To evaluate potential vendors, the team followed several guiding principles: – Put the patient at the center of the technology ("one patient, one record"). – Use advanced technology to improve patient experience and reduce healthcare friction. – Aggregate data to identify patient population risks. – Ensure an intuitive design and interoperability. – Partner with a vendor with a track record of adapting solutions to the organization's needs. Those principles were also critical once a partner was chosen and the new EHR system implemented, as they helped hospital leaders gauge internal decision-making. When there were differences of opinion, Ms. Pratt said those guidelines served as a North star: "If you don't have that in advance, it's hard for you to know what's the right thing because you're going to be getting pulled from different sides." St. James further evaluated partners on various components, chief among which were product portfolio and strategic fit. Mr. Martin explained the latter's importance: "When we dove into

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