As hospitals adopt advanced clinical strategies to help them connect caregivers, departments, and facilities throughout the continuum, there are a diverse number of challenges that may stand between them and true interoperability. Furthermore, these problems and their corresponding solutions can be different for each organization—depending on their size, location, and the specific needs of the patients they treat. But, while there is no one universal way to build effective care communities, several MEDITECH customers have forged their own paths, by having the right technology and leadership to help them achieve their individual goals.

Watertown Memorial Works Closely with Physicians to Ensure Success
For Watertown Area Health Services (Watertown, WI)—an organization consisting of a 95-bed hospital, as well as three hospital-owned clinics and three privately-owned clinics—expanding their Client/Server HCIS and LSS Ambulatory Record to include a community-wide EHR was their ultimate goal. Achieving that goal meant that physicians had to be on board with learning and using new technologies. And, according to Jennifer Laughlin, vice president and CIO, the key to long-lasting physician buy-in was taking things slow at the onset.

"Our physicians are fiercely independent, so they wouldn't have taken to us changing their entire process in one fell swoop," she says. "We took more of a 'soft sell' approach, showing them what the latest I.T. tools were, and all the cool things they could do with them. First we gave them e-mail to try, and then we moved into Electronic Signature. We even used a few peer pressure tactics, publicizing that our older physicians were adopting the new technologies faster than the younger ones, so we cultivated a bit of competition there."

Laughlin notes that they were sure to secure support for each step on the road to becoming paperless, by consulting the Medical Records Committee for recommendations and the Medical Executive Committee for approval, and also attending the Medical Staff Meeting to spread the word. They also enlisted the aid of physician champions to work through the complexity of issues and give immediate help to those who needed it.

"Giving physicians plenty of forums to give feedback was so important," Laughlin says. "We also made lots of one-on-one training available. The classroom setting did not work well for our physicians; they needed a setting where they could feel comfortable and ask questions without getting embarrassed."

Acknowledging physicians' perspectives and keeping their interests in mind can also go a long way in helping to secure their support, she says. "Leaders need to be diplomatic, to understand the variety of personalities and priorities on staff," Laughlin adds. "We were prepared for a wide range of responses to the technologies, because different physicians may need information presented in different ways. Recognize which physicians are receptive to change, but also keep naysayers near too, because Devil's Advocates help us all to be realistic about our resources and priorities."

To keep the momentum going once training began, leaders at Watertown were sure to focus on quality and the importance of being errorless, instead of extolling the virtues of going paperless. "We really sold I.T. to our physicians by explaining that it was the right thing to do for patient care," says Laughlin. The approach seems to be working so far: Watertown has already established integration between its hospital and clinics through LSS, as well as remote access capabilities via Natilla. Over the next year, they plan to tackle physician documentation, PACS and CPOE.

"People who complain that technologies don't make care faster, they're absolutely right," says Laughlin. "But, they do make care better, and that's what we're trying to achieve."

Participation in Statewide Interoperability Initiative Brings Rewards to Northern Berkshire
The growing prominence of health care I.T. has inspired Northern Berkshire Healthcare (North Adams, MA) to take its own leap towards an interoperable future. Last year, the organization became a participant in the Mass eHealth Collaborative—an inter-community project focused on exchanging health information with other facilities in Massachusetts.

"We're seeing a realignment of priorities now, as the industry shifts from volume-based health care toward more quality-based health care," says CIO David Delano. "We're part of a fundamental change movement that's placing safety, security, and interoperability at the forefront."

Fully funded by the eHealth Collaborative, Northern Berkshire has been able to build a single electronic medical record serving North Adams Regional Hospital, Sweetbrook Transitional Care and Living Centers, Sweetwood Continuing Care Retirement Community, and the Visiting Nurse Association & Hospice of Northern Berkshire. They have also connected 14 physician practices to the system via eClinicalWorks.

"We're breaking down all care barriers, so that no matter where the patient is receiving services, their information will follow them to where it's needed," says Delano. "We already have bedside nursing assessments, medication reconciliation, process interventions, allergies, and vitals on-line. And, we just recently went LIVE with a community-wide eHealth Summary, which provides a current snapshot of each patient's history and relevant results, wherever they go throughout the enterprise." He adds that in the future, Northern Berkshire's capabilities will also include automated health reminders, integrated digital imaging, and a patient portal for personal health record-keeping.

"We've had to confront a lot of challenges, including time constraints, varying technical aptitudes amongst our staff, and achieving consensus on what technologies would suit us best," adds Delano. "But, through this program, we've been able to push our overall vision of sustainable, paperless health care forward, faster than we ever could have otherwise."

Effective Governance Strategies Keep Sauk Prairie on the Road to Positive Change
Sauk Prairie Memorial Hospital (Prairie Du Sac, WI) found sustaining a momentum of change to be critical to their success, as they replaced their old, best-of-breed system with MEDITECH's integrated HCIS. The 36-bed rural facility faced the challenge of quickly implementing their new system, despite having limited resources on hand. And, according to CIO Mike Bartman, effective governance strategies were the key to undertaking this project.

"The key is to keep your organization constantly in 'change' mode, so there's no stopping once you start. For us, it all started with creating a vision and educating all the stakeholders on where we stood in the present and where we wanted to go in the future," he says. "We analyzed all of the risks and opportunities before creating an 'organization-centric' I.T. model, where integration is king. From there, the biggest task is sharing your vision with others, so that everyone is on the same page."

Keeping the stakeholders up-to-date on all plans and progress, while communicating a consistent message to all users were key elements of Sauk Prairie's strategy. "Technology adoption is a cultural process that doesn't happen overnight," says Bartman. "By repeating our goals, objectives, and philosophies often, we made sure that everyone was always fully aware of what was happening and why."

The hospital undertook a Big Bang approach with core areas already using technology, and collaborated with their four affiliated physician practices to connect their disparate systems with the hospital's MEDITECH system. "We installed reliable wireless throughout the facility, while computers were installed in every room," says Bartman. "We also conducted on-site training for our users, which proved to be very important in getting them used to using the system in their own environment."

To further raise awareness of information technologies and increase computer literacy amongst the hospital staff, Sauk Prairie gave users e-mail, WiFi, and Internet access, as well as created a Learning Center for technical training. Forming a partnership with the I.T. department as well as with MEDITECH helped them to smoothly work through issues with users.

"The I.T. Department consults with and facilitates technology implementations for stakeholders, but they cannot drive or own the initiative," says Bartman. "We counted on them to maintain a stable, reliable infrastructure, so our cross-functional teams could take ownership of the project. They also worked with our contacts at MEDITECH to work through issues quickly and with minimal disruption to the staff."

While Sauk Prairie still has several major I.T. plans in the works (including completing automation of the clinical areas and adopting CPOE), Bartman believes that solid planning and strong leadership have brought the facility great results so far.

"Hospitals are never 'finished' when it comes to implementing I.T.; it's a continual process that evolves as technologies evolve," he says. "But if you're willing to make the commitment, the reward—a safer, healthier community—is well worth it."