Even as most hospitals have become members of multi-hospital integrated health systems, and the vast majority of hospital-based organizations use electronic health record systems from one of a handful of industry dominant EHR vendors, the leaders of a small number of hospital-based organizations are bucking those trends
One organization whose leaders have chosen to go their own way, both organizationally and EHR-wise, is Holy Name Medical Center, an independent 361-bed, 3,330-staff hospital located in Teaneck, New Jersey, just across the Hudson River from New York City. Not only have the leaders of Holy Name remained proudly independent as an organization; they’ve also developed their own EHR, with the support of the Chantilly, Va.-based Medicomp Systems, to provide a clinical database to facilitate intelligent charting and help physicians quickly find relevant clinical details within provider workflows. With a keen focus on improving patient outcomes and lessening the administrative burden on clinicians at the point of care, the new EHR’s design relies heavily on the input of the nursing staff. Since its go-live nearly three years ago, the technology has freed clinicians to focus on patient care and has helped advance performance improvement documentation. In fact, the new EHR has helped slash ED nurse documentation time by 50 percent.
Holy Name’s CIO, Saikrishnan (Sai) Kandamangalan, “was the brains behind all of this,” says Dawn Mattera, R.N., administrative director of critical care and the emergency department. Mattera credits Kandamangalan with strong leadership, and importantly, a total approach of partnership with the hospital’s clinician leaders. Mattera spoke recently with Healthcare Innovation Editor-in-Chief Mark Hagland about the development of the hospital’s EHR, and the lessons learned on the journey so far. Below are excerpts from that interview.
Tell me about the background to the self-development of your organization’s EHR?
Yes, we have our home-grown system. We have our own IT department—programmers are heavily embedded and collaborate with nursing, etc. We’re able to listen to staff’s needs. We have a physician network system that’s an extension of the hospital. And all the physician practices are using our electronic health record in the practice, as well.
How was the decision reached to self-develop?
Our CEO has always had a vision of having our own systems. We did have something in the past. But our newest one, is our IT system, Harmony. Before that, our EHR vendor had been Web-HIS. We had a lot of paper documentation, order entry. We’ve changed everything over to computerized order entry now. We had been missing the nursing documentation; and Medicomp assisted us in that. In the past year, it’s unbelievable the things we’re able to pull from the record now, including through our data science department. Throughput, work efficiency. It’s wonderful. Every day, we’re thinking of something new to add on.
Why did you decide to self-develop?
Our organization felt they wanted to create something that was user-friendly, and have nurses really have input who are on the frontline, etc. Fortunately, our informatics nurses had been on the front lines. An ED nurse, a critical-care nurse. They know what it was like to be on the other end.
Tell me about the mechanics of the process?
They started working on this two years ago, and got nursing involved; they kept holding monthly meetings with leadership. They started in the ED, and I wasn’t in charge of the ED at the time. So, 2-3 years doing the backbone. And then we went into the inpatient area, we spent about a year getting the inpatient portion completed. We started in critical care, then ICU, then step-down and telemetry, and then a month or two, the entire inpatient. So it was entirely rolled out across the inpatient area within six months.
Were there any challenges involved?
The IT department staffers were onsite, and we decided to go live later in the afternoon, we figured less activity. And they stayed overnight with us a few nights in a row. And They did training. And provided a written-out handbook. And that keeps changing, because we keep adding things. And we forgot one element when we went live in ICU, but they were able to add it immediately. And they had a chat function for input from us. We’d send these chats and lists of things, and they were constantly updating them for us. We have a large IT department: programmers, developers, informatics nurses.
Why did you do this, instead of simply purchasing commercially developed system?
Because we’re able to constantly give input to IT and have changes made on a quick turnaround. And the IT department is right here, and we’re able to meet and implement the change. We have upgrades every so often. We meet with them every two weeks to create a new process map. And every day, we’re looking at new things to get new data and new reports. Pulling reports, being able to see things in real time, having dashboards—it’s great. I asked for a clinical dashboard for the ED. I wanted to see how many patients overall, who’s discharged, who’s waiting to be discharged, who the high-risk patients are? They’ve created that for us; we started that about six months ago. They did it within six months.
What have been the biggest lessons learned in this process?
To continually listen to your frontline workers; to make sure we have collaboration on all levels; and to make sure that things go smoothly. We realized early on that we had to bring the frontline staff in; we did that before we went live. But you need to bring them in from the beginning, we realized. They’re at the bedside every day.
How does the way you’ve done this speak to the culture of your organization?
We have a truly collaborative culture; we’re interdisciplinary; we work together as a time. We consider ourselves a family. And no matter your level in the hierarchy, everyone has a voice. And we always find a way to come to a compromise, and make it all successful.
What should senior leaders, including CIOs, CMIOs, and CTOs, in peer patient care organizations across the country, take from this narrative?
Always listen to your nurses who are providing care on the frontline. And yes, it’s important for billing and coding and regulatory issues; but also, you need to think about workflow and listen to the clinicians on the front lines.
I would imagine that you’ve experienced a nursing shortage, as have most of the hospital-based organizations nationwide?
Yes, and that’s why efficiency is so important. The IT people developed a dashboard for nursing, but we asked for changes, such as things like changes to colors, number counters. And they listened and made changes, and that made it more efficient and improved patient safety.
