Rockingham Memorial Hospital Chooses MEDITECH, Becomes 5.6 Early Adopter

If you don't have integrated applications, the struggle to achieve crisp communication between clinical departments can leave any health care organization tangled in a web of disparate platforms, databases, and interfaces. Rockingham Memorial Hospital (Harrisonburg, VA) decided to embark in a new direction, with an eye toward implementing an integrated system with advanced clinical applications. After selecting MEDITECH as its new I.T. vendor, Rockingham (RMH) took it one step further, choosing to become an early adopter of MEDITECH's Client/Server (C/S) 5.6 Release.

Why did RMH choose this direction? "RMH has a history of being innovative; we always consider implementing new and emerging vendor products where there is a significant benefit and manageable risk for our participation," explains Mike Rozmus, vice president, information services, and CIO at RMH. "Moreover, we were excited about the great opportunity MEDITECH's C/S 5.6 Release could provide us, based on its proven and stable underlying core technology, intuitive user interfaces, and Advanced Clinical functionality, such as the Transfusion Administration Record and IV Spreadsheet."

Now, within months of implementing the MEDITECH system, RMH is already experiencing significant improvements in system optimization, clinical processes, and data sharing. We're pleased to take the opportunity to share the hospital's pathway to achieving a successful implementation.

Proper Planning and Preparation Lead to Success
To help set the stage for the many changes to come throughout the hospital, RMH established a new project charter. Its goals were ambitious, calling for integrated technology, patient safety, and patient-centric care processes. The project charter encompassed a strategic I.T. plan as well as the design principles for a new hospital facility scheduled to open in 2010.

Next, RMH worked on mobilizing key stakeholders at the hospital to ensure a successful MEDITECH software implementation. "We assembled a strong core team of 100 clinical staff members to lead the project," says Rozmus. "Our chief nurse executive hand-picked Gina Yost, RN, clinical analyst, to coordinate our clinical build since she had recently been involved in a very successful perioperative system implementation. Furthermore, several other staff and management members had been involved in system implementations in the past and brought their experience to the team as well."

Training over 2,500 doctors, nurses, other caregivers, and administrative support staff was a challenge for the hospital, but RMH introduced numerous initiatives which enhanced the process for all. For example, medical staff members received an introduction CD to MEDITECH's Enterprise Medical Record (EMR) and a tutorial on Electronic Signature. Additionally, nurse training modules were created to help reinforce critical skills, such as the use of electronic Medication Administration Record (eMAR) and the Transfusion Administration Record.

Throughout the implementation process, RMH highly valued the support received from MEDITECH service coordinators, as well as from the consulting firm Navin, Haffty & Associates. "We engaged Navin, Haffty & Associates as both a supplement to our internal project management office and for subject matter expertise specific to the various MEDITECH applications," says Rozmus. "Additionally, our HCIS coordinator from MEDITECH, Chris DelGrande, was a key resource for providing suggestions and examples of successful training materials used in other customer implementations. We shared these with the core team, which used many of the ideas to develop training materials for their applications."

Revamping Workflow is Worth the Effort
Eager to implement Advanced Clinicals as soon as possible, and thereby close the loop on the medication process, RMH chose to do a "big bang" style phase one implementation. This included implementing eMAR during the first phase, with an eye toward implementing Bedside Verification during phase two. Naturally, the aggressive approach led to some necessary workflow changes. However, the clinicians have displayed an impressive ability to adapt and an appreciation for the long-term advantages of the software.

According to Rozmus, the nursing staff transitioned to MEDITECH's Patient Care clinical documentation system almost immediately. "Even though the nursing staff went from using a variety of customized paper medication administration records to the eMAR, they have adapted very well considering the workflow changes associated with the new clinical systems environment," he says. "MEDITECH's Patient Care System functionality has overcome many of the limitations of our prior documentation system, which was used for about 10 years."

He describes several workflow changes which occurred across departmental lines, most notably, the medication administration and documentation processes. "Before going LIVE, the nurses owned the paper medication administration records and a greater part of the administration process, whereas now the Pharmacy department plays a larger role with eMAR," says Rozmus. "However, the new medication administration workflow has been successful due to the high level of teamwork and communication between both pharmacists and nurses."

How can other hospitals prepare for similar workflow changes? "If you truly want to achieve clinical transformation, you need to prepare all levels of the organization for the impact," says Rozmus. "When your core team is in heads-down implementation mode, you can't underestimate the amount of communication that needs to occur outside the team." He also recommends engaging a full-time marketing and communications resource to follow the project, communicate progress on multiple levels, and build up momentum for the project starting a year before go-LIVE.

Availability of Clinical Data Ensures Quality Care in all Departments
With the proper processes and technology framework from MEDITECH in place, RMH is reaching new heights in storing and accessing data. Caregivers can view a patient's entire clinical record, use the data to make better medical decisions, and share information across the continuum of care.

In contrast, before MEDITECH's EMR solution was installed, RMH's "official" record was a paper record. Its clinical data repository, which was primarily used as a short-term clinical view of current data, was very limited. For instance, some of the data contained in the nursing clinical documentation and flowsheets was purged from the system shortly after the patient was discharged.

"We changed a lot of the way we do business by implementing the EMR," says Rozmus. "In the last seven months, we have admitted over 9,600 inpatients and registered over 175,000 outpatient visits. All of the data from each of these patient encounters is still available in the EMR. That's a significant improvement over our past clinical data availability."

One of the departments which benefited initially from the EMR was the inpatient physician group, as it manages more than 70% of the inpatient admissions. Carrying heavy patient loads, hospitalists are often called upon to make clinical decisions without being on the unit with the patient. "The EMR allows them to view up-to-date patient information—such as the patient's condition, I&O, vitals, assessments, and diagnostic test results—from wherever they are in the facility," explains Rozmus. "With EMR, the hospitalists no longer need to rely on the paper chart's availability to compile critical data for clinical decision-making."

Integration Trumps Previous Interfaced Solution
RMH has an abundance of good things to say about the newly integrated software environment. RMH is particularly excited about how the system's reliability is helping to improve patient care quality.

"Our singular, integrated HCIS is helping us fill in the gaps we previously had in our clinical data integration," says Rozmus. "For instance, we are able now to successfully perform medication reconciliation, which was previously a significant challenge for us. We fully expect to see more clinical and patient safety advantages like this as we move forward."

Having a more reliable and consolidated core clinical and operational computing environment also means RMH can focus on further optimizing I.T., for business continuity and disaster recovery endeavors. Rozmus explains, "Our prior systems, while somewhat reliable, had many more single points of failure due to our inability to provide redundancies across a diverse set of platforms. Now, we can feel confident that we're providing a highly available and reliable core systems environment to serve the needs of many departments and users, and ultimately our patients."

RMH Looks Forward to Additional Clinical and Organizational Changes
In the year ahead, RMH has a few challenges to meet prior to opening its new facility, including completing the second implementation phase of the Physician Desktop, beginning the first phase of Emergency Department Management, and implementing Bedside Verification. RMH also looks forward to outfitting its new facility with MEDITECH's Advanced Clinical System, including CPOE and the clinical decision support products.

Though challenges lie ahead, Rozmus expects the organization's teamwork, drive, and partnership with MEDITECH will continue to serve them well in the months ahead. He concludes, "As each day passes, we continue to make improvements. Our hospital's communication and workflow continually get better. I like to tell hospital personnel, 'take a deep breath and plan for the unexpected.' It's a journey, not a race, and requires the commitment of the entire hospital team for success."


About Rockingham Memorial Hospital
Rockingham Memorial Hospital, located in Harrisonburg, VA, is an independent community hospital that has been providing health care services since 1912. Serving a seven-county area with a population of close to 200,000, the 270-bed hospital admits more than 15,500 inpatients annually and delivers close to 1,750 babies per year. RMH averages more than 18,000 surgical procedures annually, and the RMH Regional Cancer Center provides more than 16,000 cancer treatments per year. The RMH Emergency Department treats more than 70,000 patients per year. RMH chose to be MEDITECH's Client/Server 5.6 early adopter site to ensure clinical excellence and full integration in its facility.

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