Southern Maine Health Care (SMHC) is a leading non-for-profit organization that serves patients from Biddeford, Kennebunk, Saco, Old Orchard Beach, Waterboro and Sanford areas. The firm is currently the fifth largest health organization in Maine. The institution has more than 125 experienced and highly skilled physicians. Its primary health care services include breast care, wound and ostomy care, behavioral health, eldercare, sleep disorder therapies and several other rehabilitation centers. SMHC implemented the Epic electronic health care systems to enable it to deliver exceptional services to its clients. The technology allows the organization to conduct accurate diagnosis, save on operation costs and disseminate timely information to the relevant stakeholders. This was in line with SMHC’s mission that requires the hospital’s staff members always to improve the health of the communities that they serve.
However, a recent survey revealed that SMHC’s EPIC electronic health system is characterized by multiple challenges that affect the organization’s ability to achieve strategic goals. Transitioning from the old to the new health record system exposed the company to dysfunctions such as delays and high operation costs. The organization acquired Epic HER system in December 2013. Although SMHC spent over $ 160 million in installing the new technology, the efficiency of its communication systems decreased significantly. SMHC cites that the hospital incurred $ 13.4 million operating loss in the fiscal year ending 2014. The institution’s president and chief executive officer, Richard Petersen, attributed the decline in profitability to the declining patient volumes and the launch of the new HER system. He pointed that the Epic technology created several unintended financial consequences. The hospital recorded errors in billing that threatened its financial health.
About Epic Electronic Health System
Epic is one of the best electronic health record systems (EHR). It has high-tech features that enable institutions to run their essential operations such as clinical support decisions functions. According to Wager, Lee, and Glaser Epic has the best combination of usability and features. For example, the technology has easy-to-use interface and functionality that enables the entire health care community to exchange valuable information. Epic records clinical information, maintain critical functions such as patients’ registration, scheduling, and billing. In contrast, other electronic health record systems are often disintegrated, therefore, cumbersome to use. In fact, Epic has won several industry awards and ranks among the best information systems in the health sector. The world’s leading organizations such as Mayo Clinic, Olympic Medical Center, Cleveland Clinic and many others use Epic.
As such, SMHC installed Epic EHR to manage its critical activities efficiently. The system helps the institution to access and maintain vital information such as clients’ demographics, progress notes, medications, laboratory data, radiology reports, and medical history. Southern Maine Health Care believed that it would create a unified patient record system. It hoped to enjoy e-commerce services such as computerized provider order entry, online booking, and consultation. The new technology provided SMHC’s patients with a dashboard that allows them to interact and navigate the clinic’s electronic health record systems. For example, a diagnosis such as high blood pressure automatically triggers a series of information and recommendation to the patient. SMHC aimed to achieve the following benefits by installing Epic technology.
- Eliminate human and medical errors thereby improving the quality of its services.
- To improve the accuracy of medical records by reducing operational inefficiencies.
- To monitor patients past medical history and use the new data to predict and take precautionary measures against adverse treatment outcomes such as readmissions.
- To streamline the physician’s workflow and track the patients’ progress over time.
- To automate and promote information exchange between SMHC and other health entities.
- To engage the patients and their families in designing appropriate treatment plans.
- To provide support services to the quality management team, and finance department.
Challenges SMHC faces due to Epic Electronic Health Record System
Epic’s cutting-edge technologies features should have given SMHC competitive advantages over its rivals; increase its profitability; and ensure sustainable growth. The organization incorporated the new software to increase patient engagement and deliver high-quality health outcomes. Carberry et al., cite that the health institution wanted affordable and efficient methods of engaging the larger community and building and maintaining strong relationships with its stakeholders. However, the firm experienced other dysfunctions that threatened its strategic goals. The hospital has been recording significant losses and reduced employee morale. For example, SMHC did not include the charges for the caesarean services it provided for over six weeks after it implemented the new system. This was because the hospital did not train its staff adequately. According to Bernie SMHC’s employees complained that the vendor did not inform them to charge the patients for the services offered at each stage. The staff assumed that the system automatically updated the patients’ bill once they had included the services provided. On the other hand, Epic EHR requires the physicians to charge for the services. As a result, the company allocated over 55 million in launching training programs thereby bringing the total cost to $ 200 million.
Southern Maine Health Care resorted to desperate measures that may further compromise the quality of its services. For example, it implemented restrictive practices such as selective travel, hiring freezes, and reducing overtime. Nevertheless, the strategies are likely to reduce the employees’ morale. This is because the measures reduce some of the hospital staff remuneration packages. For example, the nurses no longer benefit from the overtime compensation. The challenges resulted because the management did not create a clear vision. That is, the implementation plan should have included well-defined goals as well as measurable targets and quality control procedures. In addition, the management did not create the right organization culture to motivate the employees to work hard towards achieving the project’s objectives. Azad et al., argue that appropriate culture often guides entities’ stakeholders to manage changes successfully. In contrast, Southern Maine Healthcare clinic experienced the crisis because it did not provide adequate resources in terms of manpower, education, and training. The institution’s managers should have conducted prior studies to identify potential risk factors that resulted in the adverse outcomes.
The organization also lacked clear decision-making structures. The top managers such as the departmental heads should have led the transformation processes by discussing with their team members about how the new system will change the routine functions. Instead, SMHC top physicians and nurses executives used the Epic technologies to design new workflows but did not involve all the affected stakeholders. The persistent problems in deriving accurate bills reveal that the employees lacked the necessary skills required to incorporate the changes into their routine functions. This means that the organization needs decision-support systems to guide the employees. SMHC also lacks adequate interactive online platforms to enable the members to share experiences with each other. Such conversations should have provided information to help the organization address the clients’ concerns. Fast responses to the patients’ inquiries would have reduced the reduction in clients’ volume.
SMHC struggled to implement Epic HER because it did not follow the correct procedure. However, the hospital can resolve the crisis by implementing new strategies that should include conducting adequate pilot testing while launching new projects, appointing a team comprising technology experts, customizing the system functions to meet the targeted clients’ needs and benchmarking its information systems with the world’s best health organizations.
a. Pilot Testing
Petersen admitted that the hospital underestimated the resources it required to ensure successful transition process. The health care provider should have started with a pilot project. Muller explain that there is cost friendly Epic system that allows health care providers to regain the resources it invested in the project through eliminating inefficiencies and extra staff time. On the other hand, SMHC did not conduct adequate feasibility studies before it installed the new system. The organization can access stand-alone components at affordable prices that Southern Maine Health Care could have used for trial purposes and slowly build an integrated system over time. Muller further argues that moving from one electronic health system to the next is always an overwhelming process that requires careful planning. Therefore, SMHC should have designed a comprehensive step by step implementation procedure. That is, begin with a sub-segment of the patients. For example, use Epic to record the data for a half of the new customers.
The pilot test would have helped SMHC to determine the problems at the appropriate time. The hospital would have also made necessary adjustments thereby preventing the dysfunctions from escalating to greater challenges. Wager, Lee, and Glaser advice that pilot testing is critical in revealing unforeseen problems that often arise in implementing changes. Therefore, SMHC plan should have included all the fundamental aspects such as logistics, staff training, operational and maintenance costs. Currently, the hospital should spend more resources on staff training and evaluate the program’s progress. The clinic can achieve the desired outcomes by working together to resolve the billing errors. The finance department officers should inspect the documents to ensure the relevant service delivery departments include all the charges for the tests, medications, consultations or the therapies provided to the clients. The information technology unit should also recruit accountants who are knowledgeable about the core components required to operate the system efficiently. The management should then assign the new staff to handle the billing problems.
At the same time, pilot testing would provide an opportunity for the clinic to access targeted customers’ feedback. Such information will provide SMHC’s management with the insight of both the positive and negative experiences the hospital staff will encounter while responding to the clients’ demands. Therefore, the clinic should always incorporate pilot testing in its future information and communication technology projects. This will ensure that the institutions’ employees are well prepared to address the issues arising from the full-scale implementation.
b. Establishing Project Committee
SMHC should also appoint a team consisting of business intelligence analysts, nursing executives and information technology experts to develop a comprehensive training program that prioritizes on meeting each stakeholder’s needs. The committee should first conduct a survey focused on identifying the implemented systems’ weaknesses. It must involve the affected stakeholders in decision-making processes. These should include evaluating and selecting the best vendors to provide the relevant software and hardware components, designing the workflow and templates to use for various services, and creating preference lists based on the most frequent orders and treatment plans. As a result, SMHC will customize its EHR systems to meet all the users’ specific needs thereby eradicating the current challenges.
The team should further organize regular training programs that should include classroom and practical lessons. Vuk recommends that health care centers should train their physicians about various electronic health record systems features for at least four hours. The lessons should emphasize on what the different EHR components looks like as well as how they work. This will enable SMHC’s staff to gain more knowledge about the systems aspects that they have been using. In this case, the training should prioritize on how to use Epic to create accurate bills, laboratory reports, and treatment plans. The training should also emphasize on Epic’s advantages over other EHR systems such as increased efficiency and speed at which the physicians deliver services to the clients. The support team should then appoint an experienced member to engage each unit in practical lessons and provide multiple opportunities to apply the newly acquired knowledge into practice.
Next, the hospital should establish detailed quality control standards to measure its progress at each level. Positive experiences such as increased efficiency, consistency in delivering accurate lab reports and bills, and cost savings in terms of reduced paperwork and exchange of information among the physicians will indicate that the system has achieved intended objectives. On the other hand, persistent medical and billing errors mean MSCH that the team should implement changes. The hospital can capitalize on platforms such as its websites, blogs and social networks to collect feedback from the stakeholders. The information will be critical not only in launching better EHR services but also address concerns such as declining patient volumes. The team can engage the patients in conversations, therefore, acquire valuable information that will enable SMHC to provide better services than its rivals. Moreover, the team should serve as the system administrators. Since the committee members are information specialists, they will always respond quickly to all the stakeholders’ concerns. The nurses and the physicians can contact the team in cases of problems. The management must also educate the staff on procedures to follow during a crisis such as system failures or loss of confidential data through cyber attacks.
c. Customizing the Systems Functions
Epic EHR has a standard screen that the health organization uses to collect and process patient information. SMHC customized its systems and created user-friendly interfaces. However, the negative experiences indicate that the firms’ management should make further adjustments to strengthen its relationships with the clients. SMHC’s CEO believes that the system failure contributes significantly to the reduction in the patients’ volume. However, Epic presents opportunities that allow organizations to gain competitive edges in their respective markets. For example, SMHC can configure the patients’ information with multiple choices for diagnoses, and develop efficient workflow procedures. As a result, the hospital will offer exemplary services that exceed the customers’ expectations. Many SMHC customers shifted to rival firms partly because of the frustrating experiences that resulted from the system failures. Therefore, the hospital can attract and maintain a large customer base by adding new features. These should include portals that provide useful information about the institution products and services as well as accessible support services to drive the quality improvement goals. Moreover, the management should reexamine the workflows and eliminate any potential threats that may affect the customers’ experiences.
SMHC should further benchmark its information technology with the top firms in the industry such as Cleveland Clinic that have been using Epic EHR for over ten years. This will allow the firm to incorporate the success factors into its ongoing operations. For example, Cleveland formed MyPractice Community team to provide all the relevant support services to the clinic’s members. The team also trained the hospital’s staff on all Epic EHR features that ensured the hospital successfully transitioned to a new information system. Carberry et al., cite that Cleveland has maintained MyPractice Community program since 2005. The team comprises 30 experienced and highly skilled personnel that are always ready to provide assistance to the organization’s internal and external members. SMHC can apply the same strategy to resolve the challenges it has been facing. The clinic’s information and technology department should liaise with quality control team, finance, customer service and other units to launch a similar program. The team will gain vast experience that it will share with the other staff members as well as the clients. Since EHR is subject to constant changes in the technological environment, SMHC must update its systems regularly to accommodate the fluctuations. However, with such a knowledgeable team, the organization will always select the best vendors to partner with and establish adequate proactive measures.
Electronic health record system is a prerequisite for coping with the ever evolving technology and increase in the demand for exceptional services by the patients. SMHC can deploy the Epic EHR to improve the quality of the services it delivers to the clients. However, the hospital has been suffering significant losses because of technology-related reasons. These dysfunctions have threatened the demand for SMHC’s services. On the other hand, the hospital can attract more clients and achieve sustainable financial growth by implementing comprehensive technology policies and practices. SMHC’s management identified several technical issues that contribute to the billing problems. It appointed a team of experts to resolve the inefficiencies in 2014, but the organization has not achieved the targeted positive outcomes.
It is evident that these logistical issues emerged because SMHC skipped an essential process while implementing the present EHR system. In other words, the health organization should have avoided the inefficiencies if it had conducted pilot testing. However, the hospital can successfully resolve the crisis by creating platforms where the affected staff can discuss the way forward regularly. It should establish a working group to encourage all the concerned stakeholders to provide timely input on the ongoing operations. The team will assess the staff training needs through the feedbacks, therefore, launch more appropriate intervention programs.