Bridging the gap between IT and clinicians to enhance care at Chilton Memorial Hospital
Location:Northwestern New Jersey
- Resistance to moving from paper to electronic records
- Implementing EHR without forcing care providers to log in and out of multiple applications dozens of times a day
- Balancing security requirements to protect data with the convenience of fast and easy access
- Improved care provider work flow
- Created a balance between security and convenience
- Care provider satisfaction with IT, and technology in general, is much higher today than in 2011
The aging population and skyrocketing cost of care are driving healthcare organizations around the world to rethink their business and delivery models, and to develop more efficient ways to keep their populations healthy. In the United States, Meaningful Use objectives defined by the Department of Health & Human Services (HHS) under the Health Information Technology for Economic and Clinical Health (HITECH) Act have propelled hospitals to lead the way in the adoption of electronic health records (EHR) in order to optimize care delivery and improve patient outcomes.
At Chilton Hospital, an award-winning, non-profit hospital in Northwestern New Jersey, the benefits of digitization were clear, and the IT department was committed to making the shift to EHR, regardless of Meaningful Use and its incentives. Yet they anticipated resistance from their care providers, who were accustomed to finding all the patient information they needed in one paper chart. When Mark Lederman, Chilton CIO, joined the hospital in 2011, he knew that his team was going to have to find a way to implement the EHR system without forcing clinicians to log in and out of multiple applications dozens of times a day.
The first phase of roll-out of new MEDITECH clinical applications had begun, and the physicians and nurses were already frustrated with the workflow disruptions that passwords were causing. “Physicians and nurses want to do the right thing when it comes to security - as long as it doesn’t come between them and treating their patients,” said Lederman. “We needed to find a way to balance the security requirements to protect data with the convenience of fast and easy access for our care providers. And the key to striking that balance lay in our ability to collaborate with the medical staff. We needed their input, buy-in and support to be successful.”
The starting point:
Implementing an EHR system is one of the largest and most costly undertakings at any hospital, and Meraz Nasir, Chilton's Director of Technology Services, knew that in order for the clinicians to adopt the new technology, it would have to be conducive to their workflows, and not slow patient care. Step one for Lederman and Nasir was to seek the advice of the medical staff. “It’s really impossible to anticipate the needs at the bedside if you aren’t a care provider who has been in that situation,” commented Nasir. “On the other hand, most clinicians don’t want to understand the technology. They just want to focus on their patients.”
Dr. Richard Weinberg, CMO at Chilton, had implemented Single Sign-on (SSO) at another hospital and had been impressed with the way it improved productivity. He considered it a “clinician satisfier”, and a way to speed EHR adoption. An advocate for innovation, Dr. Weinberg believes most clinicians are eager to embrace technology, as long as it helps them care for their patients and doesn’t slow them down. “There is a growing sense among clinicians that living with one foot in the paper world and one foot in the electronic world poses a greater risk to their patients, and they want to make the move,” commented Dr. Weinberg. “We just need to make the shift easier.”
After considering the clinical and technical requirements, and evaluating the solutions available, Chilton decided to implement Imprivata OneSign in conjunction with the rest of their MEDITECH modules. “We were looking for an IT security solution that would meet our criteria today, and down the road for newer initiatives, like desktop virtualization,” according to Nasir. “Imprivata had the vision, the track record, and the reputation as the leader in healthcare IT security, so we felt comfortable with them.”
The road to implementation:
The team, which consisted of a mix of IT and clinical expertise, took a methodical approach to the implementation. They began by educating themselves on the functionality of the solution, determining which features would add the most value to their medical and IT staff. They brought an Imprivata engineer on-site for one week to train the team on how to profile their key applications and to share best practices for deploying SSO and Authentication Management to the users.
Knowing that the first impression could make or break the project’s success with the medical staff, the team took a cautious approach by deploying first in IT. When they were comfortable that the system was rock solid, a Big Bang roll out began in the clinical areas. The deployment was led by Tania Cutone, a Nurse Manager for Clinical Informatics who is an RN on the IT team. She maintained the “shoulder-to-shoulder” relationship with the Clinical Informatics User Group, enrolling them first and then relying on many of them to act as “super users” within their units. IT staff were also on the floors enrolling users and troubleshooting as needed.
While in the beginning clinicians saw SSO as yet one more technology that was going to take time away from treating patients, once the first users were enabled, the others quickly realized that it would actually improve their workflows, and allow them to spend more time with their patients. “Users who were not yet set up began calling to be enrolled,” said Cutone, “Once they started using the application, they saw the benefit and time savings." In less than a year 1400 physicians, nurses and other employees were using SSO and Authentication Management to access 84 applications.
“It is difficult to measure the impact that SSO and Authentication Management have had on clinical productivity, but I don’t think that you are likely to overestimate the gain,” commented Dr. Weinberg. “Allowing the staff to quickly access applications, without having to deal with onerous, strong passwords, speeds workflows and improves the care delivery process.” Chilton averages 70,000 MEDITECH log-ons each week. Factoring in a conservative 2 second saved on each log-on, that adds up to 39-hour every week that can be spent treating patients. This is not only critical to improving outcomes, but also to attracting and retaining top medical talent. "Imprivata OneSign has proven to be a phenomenal efficiency tool,” said Lederman. “From the operational perspective it has streamlined workflows for users moving from system to system as they treat patients, and in IT it has significantly reduced the amount of support calls related to passwords."
By collaborating and communicating from the start, IT and medical staff have seen the transformation from paper-based to electronic records in a short timeframe at Chilton. They have struck that balance between security and convenience in the new digital world. Clinician satisfaction with IT, and technology in general, is much higher today than it was in 2011. In fact, the medical leadership, on their own, recently mandated a deadline for CPOE for all active physicians. “To me, that says something about their appreciation of electronic records and their eagerness for adoption,” said Nasir.