Hilo Medical Center: Changing community culture with an EHR

Implementing an EHR solution at the Hilo Medical Center in Hilo, Hawaii, was much more than major change for hospital and clinic staff—though that's daunting enough.

Because HMC is a singular healthcare facility in its community, the EHR program represented more than process changes for physicians. It was a culture change for an entire community—one that earned it a 2015 Davies award for implementing cutting-edge IT while achieving significant ROI.

“We really tried to grow the system into the culture that was in Hilo,” says Kris Wilson, regional director in HMC's Information Systems and Project Management Office. “We're the only hospital in a 50-mile radius, the only critical, acute hospital on that side of the island. So whatever we did to alter the patient care, it transitioned whole community. We had to make sure it was implemented with a lot of foresight and buy-in.”

HMC is a 276-bed facility with 137 acute beds, 20-bed behavioral health facility, and 119-bed, long-term care facility. Overall, 72 percent of HMC's patients have Medicare or Medicaid insurance. And before the EHR rollout, everything was on paper.

“When you take an organization from paper to electronic … it's just so radical for so many people,” Wilson says. “We're the largest employer on the island, we're civil service, quasi-state employees who have a strong union.”

That meant working up front with clinicians, staff, union leaders and the community to communicate the need for change, the timetable, and particularly the benefits, both to workers and, most importantly, patients.

The effort to find an EHR vendor launched in 2009, and Meditech was selected. The new EHR solution went live in May 2010, affecting pharmacy, imaging, emergency and nursing documentation. “Our approach was to stage things to make sure everyone was ready for what happened next,” she says.

In the following months, further rollouts occurred: Surgery suite, community-wide scheduling, bedside medical verification. They implemented eScription software soon after, which still allowed doctors to dictate prescriptions.

A year later came CPOE, with doctors directly entering orders into the system. Other software vendors include Access, whose e-forms provide HMC's electronic signature forms.

From that point, a number of important innovations were implemented, several of which were highlighted for the Davies Award:

• ROI: By better addressing revenue cycle management alone, HMC dramatically reduced open days in accounts receivable, resulting in hard ROI of $10 million for its hospitals, and $4 million in its clinics.
• HIE: A new health information exchange lets patients and clinicians share records with health care facilities on other islands, such as when patients go for specialized treatment, and improves doctor-patient communication.
• Emergency: IT implementations in the emergency department have decreased the length of stay by 39 percent and increased patient volumes by 13 percent. Key to this were Meditech software modules for assigning patients to open beds, and time savings through electronically placing lab or imaging orders.
• Governance: IT implementation improved governance in a number of ways. The physician report deficiency rate—unsigned or incomplete reports that held up the billing process—dropped from 84 percent to under 5 percent. Further, processes were instituted to smoothly elicit and implement suggested changes from clinicians and staff.

Next, Wilson says, HMC will pursue certification of Meaningful Use Stage 3, and continue to develop its EHR system.

“We're undergoing Meditech's latest upgrades to 6.15,” she says, “which will go live in October, and will complete rewrite a number of our modules.”