Issue link: https://beckershealthcare.uberflip.com/i/1471341
14 EXECUTIVE BRIEFING 3 EXECUTIVE BRIEFING strategic fit, we needed to see their vision, their culture, was there chemistry among the leadership teams. This was not a transaction but a part of our strategy." Driving EHR transformation is a change- management process Beyond the pain points, technical challenges and desire for improvement, switching EHRs is a change-management process that requires aligning leadership, physicians and staff behind an overarching objective. St. James accomplished this change by ensuring that physicians were on the selection team that evaluated EHR vendors and chose the winning solution, which made them realize they were an integral part of the process and helped them understand its value. It also empowered its communications team to create excitement around the shift, drive momentum and celebrate the wins. But change management also involves overcoming resistance — and resistance to changing something as fundamental to physicians' work lives as an EHR — is inevitable. At St. James, much of the resistance manifested itself during implementation. "We would hear, 'If it's not broken, don't fix it,'" Mr. Martin recalled. Such objections came mostly from departments with disparate but otherwise best-in-breed EHR systems who had long-established workflows that the new system would disrupt. To ease their concerns, leaders worked to bring out the positives that the new integrated EHR would provide. Nevertheless, tough decisions still had to be made. When resistance was excessive, high-level leadership made itself heard. "We were not going to allow physicians to dictate operative reports for transcription rather we are committed to leverage our new technology for documentation," Ms. Pratt acknowledged. "You have to step up to the plate, but it´s the way you communicate and prepare people for it, and we gave them resources to help them through that." Immediate wins of EHR integration: information simplicity and patient experience The impact of switching to an integrated, cloud-based EHR platform accessible from any department and location within the St. James hospital system was immediate. On the clinical side, when ER doctors admitted a patient, intake information flowed straight through the inpatient care department and ambulatory physicians were able to access their patients' ER visits in an instant. On the patient side, the patient portal of Cerner's EHR gave consumers a one-stop shop to schedule appointments, view lab results and manage other aspects of their care without having to log into several portals. And on the administrative side, the integrated system alleviated workflows related to distributing results, releasing patient records, physician messaging and issuing prescription refills. The EHR also allowed St. James to leverage Cerner's telehealth platform through the patient portal. "Cerner brought a really good all-in-one multifaceted tool," Mr. Donaldson said. Price should not be the main factor when flipping EHRs, even when price sensitivity is Price and affordability are certainly a concern for critical access hospitals with limited budgets, so they are inevitably a factor when it comes to deciding on a new EHR platform. However, as long as the cost of acquiring a new solution does not exceed (or only marginally exceeds) the costs of running a less efficient EHR system, it should not be the determining factor. It helps to view the question of pricing from the prism of total cost of ownership, whereby organizations map out five- and 10-year projections to account for depreciation. "We didn't mind shelling out some upfront capital; we looked at capital as an investment into our future and we looked at our long-term operating costs," Mr. Martin said. He added that under the old model, St. James Parish Hospital's four EHR vendors each had a different financial model and different hidden costs — one was a capital asset with low operating costs, while another was subscription based — and when his team modeled those out against the new vendor's, it balanced out. What was harder to quantify were the inefficiencies under the current model. "It's hard to quantify the labor expense [under either scenario] but I do think that anybody analyzing this needs to go out 10 years. The upfront costs hit in the shorter time period, but for you to really see the value of a more capital-intense thing, you need to see it over the long term," Ms. Pratt said. Conclusion Change management in healthcare — an industry with many stakeholders with competing priorities, incentives and mindsets — is never easy and this holds true for EHR transformation as well. The experience of St. James Parish Hospital shows that in choosing an optimal solution, it is important to delineate guiding principles that empower leaders, physicians and staff to make the best decision and to look for strategic fit and a shared vision between partner and provider. Ms. Pratt summarized the journey: "We liked the way that Cerner saw where the future of healthcare was going, how they were going to be creating new solutions for that future with a vision to improve population health." n Cerner's health technologies connect people and information systems at thousands of contracted provider facilities worldwide dedicated to creating smarter and better care for individuals and communities. Recognized globally for innovation, Cerner assists clinicians in making care decisions and assists organizations in managing the health of their populations. The company also offers a connected clinical and financial ecosystem to help manage day-to-day revenue functions, as well as a wide range of services to support clinical, financial and operational needs, focused on people. For more information, visit Cerner.com, Cerner Perspectives, connect on Facebook, Instagram, LinkedIn, Twitter or join the discussion on Cerner's podcast Perspectives on Health & Tech. Nasdaq: CERN.