tThe idea of a fully electronic health
system isn’t exactly revolutionary. Yet
even in today’s Web 2.0 world, the
prognosis for going paperless has
been less than promising. Texas
Health Resources (THR), a 14-hospital
network based in Arlington, Texas,
USA, knew it was in for some resistance, but it also knew the payoff
would be worth the effort.
“The underlying motivation is that
we needed better ways of capturing
and communicating information on
our patients,” says Patricia Johnston,
vice president of Care Connect,
THR’s information services department responsible for the project. “But
we faced a combination of technology
challenges and cultural issues. Getting to
electronic health records meant pulling
caregivers, including physicians, into the
electronic era.”
The team did it by figuring out where
the knowledge of healthcare experts
would yield the greatest return in project
work, building smart strategies to get user
buy-in and bringing training—often an
afterthought in similar projects—to the
forefront.
PHYSICIAN
leaders are not nec-
essarily cheerleaders
but we need them
on board. They will
ask the tough ques-
tions that we need.
Now implemented in five of THR’s
hospitals, the system affects 75 percent
to 80 percent of employees at each site.
And the changes extend all the way
from patient intake to bedside care.
–NANDA LAHOUD, PMP
“Instead of having a folder or file
where caregivers document things like
vital signs, they use a laptop on a cart,”
says Sallie Moore, PMP, THR’s former
senior project manager and training
manager on the project and now director of information services strategy and
business services. “That way, anyone
treating the patient has immediate
access to patient information. Rather
than having doctors writing an order on
paper and faxing it to the pharmacy,
they can enter it on the computer and
send it directly. It reduces the time lapse
between order and delivery.”
Designing and building a system
capable of serving the needs of more than
18,000 employees, including more than
3,600 mostly independent physicians, is
certainly a big job. And getting those
caregivers to adopt the system was another
project altogether.
A TOUGH AUDIENCE
One of the first things the project team
did after choosing an IT vendor was to
set up a governance framework that
addressed issues such as conflict resolution and communication processes.
“We had to have the right governance structure,” says Ms. Johnston.
“We couldn’t have implemented these
changes without executive, medical and
leadership support.”
To give the project added credibility
within the medical community, the team
formed a physicians’ steering committee
for each hospital.
And it picked those committee members carefully.
“We included some fierce opponents
on the steering teams,” says Nanda
Lahoud, PMP, THR’s former director
of project management and business
operations for the project and currently administrative director of value
realization. “Physician leaders are not
necessarily cheerleaders but we need
them on board. They will ask the
tough questions that we need.”
Next, a multidisciplinary committee
loaded with healthcare professionals did
a high-level workflow overview, setting
down a number of foundational process
decisions designed to serve as system
guidelines.
“We tried to agree on as many guiding
principles ahead of time as possible,” says
Ms. Johnston. “For instance, we decided
that we would document information at
the point of care. This is a huge cultural
change, because in the paper world, a
nurse would go into the room, take vital
signs, write them down on a piece of
paper and then take them back to the
nurse’s station for input.”
The potential for cultural repercussions played a huge role in how the system
was created. The comprehensive project
was designed as a broad umbrella to take
