Abstract
Background: Implementation of health information technology (HIT) has encountered many difficulties and produced mixed outcomes. Yet Trinity Health, a major integrated delivery system, successfully leveraged implementation of a systemwide electronic health record (EHR) to promote process redesign and continuous quality improvement. Implementing a Systemwide EHR: After several years of planning, two waves of EHR implementation were launched, in 2001 and 2003. One system HIT team collaborated with each hospital team for 18 months before its 24-hour transition to the EHR. During EHR planning, the system HIT team used five principles of redesign of care processes: (1) identify and address safety problems, (2) promote evidence-based practices, (3) reduce practice variations and standardize terminologies and care processes, (4) improve communication and relationships among clinician roles, and (5) augment multiple uses of data in HIT-sup-ported care processes. Patient-centered work flows were developed to design improved patient care processes for different types of patients, such as medical inpatients and emergency outpatients. These admission-to-discharge work flows addressed gaps in quality, safety, and efficiency and helped ensure that the EHR and decision supports reflected crucial interactions among clinicians and with the patient. By the end of 2008, 13 of Trinity Health's 17 major health care organizations (" ministries") made the transformation to using EHRs. Discussion: EHR-supported care redesign requires development of substantial system capacities in clinical informatics, customization and standardization of vendor's products, collaboration and coordination between system and hospital implementation teams, quality training for clinicians and change agents, and significant clinician participation in local preparations.
| Original language | English |
|---|---|
| Pages (from-to) | 82-92 |
| Number of pages | 11 |
| Journal | Joint Commission Journal on Quality and Patient Safety |
| Volume | 35 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2009 |
| Externally published | Yes |
Bibliographical note
Funding Information:The TH experience suggests that redesign of clinical care can provide a solid foundation for introducing advanced HIT within a large health care delivery system. This approach requires development of substantial internal capacities in clinical informatics, customization and standardization of content within vendors’ products, and careful coordination between system and hospital implementation teams. The initiative also requires significant participation in planning by clinicians and local change agents. The project described in this article was supported by the Agency for Healthcare Research and Quality —THQIT Implementation Research Project “Rural Iowa Redesign of Care Delivery with EHR Functions” # HS015196 . The authors also acknowledge the grant partners from the University of Iowa and Trinity Health, as well as the executives and clinical informatics managers within the Mercy Health Network. The authors also thank Dr. Donald Crandall, the principal investigator; Cheryl Haggerty; and Rita Miles. The views expressed in this article are the authors’ and do not reflect those of the United States Government, the institutions that funded their research, or those with which they are affiliated.
Funding
The TH experience suggests that redesign of clinical care can provide a solid foundation for introducing advanced HIT within a large health care delivery system. This approach requires development of substantial internal capacities in clinical informatics, customization and standardization of content within vendors’ products, and careful coordination between system and hospital implementation teams. The initiative also requires significant participation in planning by clinicians and local change agents. The project described in this article was supported by the Agency for Healthcare Research and Quality —THQIT Implementation Research Project “Rural Iowa Redesign of Care Delivery with EHR Functions” # HS015196 . The authors also acknowledge the grant partners from the University of Iowa and Trinity Health, as well as the executives and clinical informatics managers within the Mercy Health Network. The authors also thank Dr. Donald Crandall, the principal investigator; Cheryl Haggerty; and Rita Miles. The views expressed in this article are the authors’ and do not reflect those of the United States Government, the institutions that funded their research, or those with which they are affiliated.
| Funders | Funder number |
|---|---|
| Mercy Health Network | |
| THQIT | HS015196 |
| University of Iowa and Trinity Health | |
| National Institutes of Health | UC1HS015196 |
| Agency for Healthcare Research and Quality |