provide quality care and maximize their efficiency.
CASE 17: WATSON’S AMBULATORY EHR TRANSITION
Major theme: System acquisition
Primary care physicians play a key role in the U.S. healthcare delivery system. These providers integrate internal and external information with their clinical knowledge
to determine the patient’s treatment options. An effective ambulatory electronic health record (EHR) is critical to supply physicians with the information they need to
provide quality care and maximize their efficiency. This case involves the decision-making process to replace an inadequate EHR system in a primary care network
owned by a community hospital. The IT challenge reviewed in this case will be the decision-making process that optimizes provider support for the new EHR while
addressing the strategic plan requirements of data integration, clinical application, and practice management functionality.
Watson Community Association is a private, not-for-profit corporation that operates Watson Community Hospital (WCH), a 200-bed acute care facility located in Arizona.
WCH has pursued a strategy of employing primary care physicians in their primary service area to provide convenient points of access for patients and to secure a
primary care base for the specialists who utilize the hospital. WCH employs thirty-six physicians and seven mid-level providers in eight clinics, specializing in internal
medicine, family practice, infectious disease, and gynecology.
In 2011, the WCH board of directors adopted a plan to implement a systemwide EHR to, among other things, improve patient safety, integrate information from ancillary
systems, and provide access to patient information for all WCH caregivers. In addition, the plan calls for an evaluation of the effectiveness of the WCH physician clinic
The WCH clinics currently use the XYZ Data Systems Integrated EHR and Practice Management System. This system has been operational for four years. The XYZ
system was chosen because of its compatibility with the hospital’s Meditech platform. Physician needs and application functionality were secondary considerations. As a
result, physician system adoption and support has been poor. Under prior leadership, the hospital information technology (IT) department provided limited support for the
XYZ EHR. The clinic organization was left to develop its own internal IT capabilities to manage the XYZ system and, as a result, the system has not been routinely
The hospital has decided to stay with the Meditech platform to address the IT strategic plan for an integrated EHR. The clinic organization must now evaluate whether it
is in their best interest to stay with the XYZ system, with strong Meditech compatibility, or move to a different EHR platform. The path of least resistance from the IT
perspective would be to upgrade the XYZ system. This option offers the greatest integration and could be implemented much sooner. A new platform would require an
evaluation and selection process and a significant conversion. With either scenario, physician support will be critical to a successful transition.
EHR PROJECT PLAN
Next is a description of the planning process developed by the leadership team to transition to a replacement EHR. Read and critique the plan by answering the
questions that follow it.
The organizational phase of the project will involve establishing a project steering committee and identifying the leadership members who will ensure the project’s
success. WCH operates eight separate clinics, each with their unique teams and EHR experience. By necessity, the steering committee will need representation from
each of these clinics. The project steering committee will likely have twenty to twenty-five members. In addition to provider representatives, the steering committee will
also include nurses, medical assistants, and office managers from each clinic. IT representation is critical to the success of the project, and since the department
provided poor IT support in the past, the chief information officer (CIO) will play an active role on the steering committee. A representative from finance should also
participate on the committee, given the importance of billing and collections and other practice management issues.
The leadership of the steering committee will ensure the committee addresses key steps in the process and does so in a timely fashion. Ideally, the committee would be
chaired by a provider who is respected within the group, is objective, and is a supporter of EHR technology. Although the clinic organization does not have a provider who
meets all of these criteria, a physician with strong peer support and credibility will be selected to cochair the steering committee. To complement the clinical leadership,
the CIO will serve as a cochair for the committee, providing technical expertise. This individual has implemented other EHR systems and will bring a structured process
to the committee to ensure a thorough evaluation process.
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