The Healthcare Information and Management Systems Society (HIMSS) recently recognized MultiCare Health System with the 2009 Organizational Davies Award. The award recognizes health care organizations that achieve excellence through the use of electronic health records (EHRs), but what, specifically, did Multicare do that sets it apart from other EHR implementers? Are there strategies Multicare used that would benefit others along their own path to a fully integrated EHR?

Background

Located in Tacoma Wash., MultiCare is an integrated health organization made up of four hospitals, numerous clinics, hospice, home health and many other services. MultiCare used EHR software from Epic in its ambulatory clinics for more than 10 years before developing an enterprise-wide EHR. 

Vision

In 2001 leadership and focus groups consisting of employees, physicians and patients developed MultiVision, a long-term, patient-centered strategy aimed at creating a seamless experience for patients no matter where they were seen in the Multicare system. Part of that vision and strategy included development of an enterprise-wide EHR.

Investment

MultiCare's vision to transform the way care is delivered led the executive team to realize that an investment in leading-edge technology was vital to offering the best care for patients. Fortunately, MultiCare's board members understood the benefits, and the organization invested more than $140 million in information technology, including the EHR.

Partnership with Memorial Care Hospital

Multicare established a partnership with Memorial Care Hospital in Southern California through Epic. Several members of the project leadership team (including the COO, CIO, hospital administrators, quality manager and communications lead) visited Memorial Care Hospital. After working with Memorial Care personnel firsthand and hearing their lessons learned, Multicare established a Project Steering Committee, engaged the Physician Advisory Board and created task forces to address various areas of the project. Within six weeks, leadership and staff received training in project management, and Multicare established a scope document, completed a workflow analysis, put a full educational plan in place, and tied workflows to policies and procedures. 

Project leadership

The Project Steering Committee (executive leadership) and Project Leadership Team (implementation leadership) guided the project's development. Their leadership was supplemented by the existing Physician Advisory Board, Project Management Office and the Clinical Oversight Advisory Committee (COAC).

Clinical directors; build and subject-matter expert team leads; project managers; and IS mid-level leaders established themselves as key players in the project as well. They participated in the Project Leadership Team, the Physician Advisory Board and through nursing leadership meetings such as the COAC. 

Workflow

Multicare did not just layer technology over existing processes but used the transition to the EHR as a catalyst to transform the way the organization delivered patient care. Every process underwent at least minor modification. Multicare applied the following quote from Bill Gates throughout its EHR design and build: "The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency."

Multicare also sought to standardize where possible. Objections to using a standardized process were evaluated by project team leads and the COAC. These groups considered each approach weighing the impact on patient safety, clinicians and the build timeline; the continuity of the EHR; and ongoing system maintenance.

The project team hosted events called Workflow Walkthoughs and Tunnel Tours. The Workflow Walkthoughs allowed employees to see how the new system worked in the day of the life of the patient. Members of the project team wrote and performed the "day in the life" experience, highlighting the patient's experience in the emergency department, as an inpatient and what happened after the patient was discharged. 

Tunnel Tours provided participants with an opportunity to visit an area of the hospital where workflows were printed out in Visio and shown end-to-end on the walls. Subject Matter Experts were available to show the workflows in greater detail on a laptop and to answer questions. These Tunnel Tours provided opportunities for the clinical staff to point out workflows that didn't match daily practice or to identify areas that could be improved to better conform to best-practice standards.