Electronic Health Record Implementation for Continuum of Care in Rural Iowa (Iowa)

Project Final Report (PDF, 333.71 KB) Disclaimer

Summary:

This project was a three-year electronic health record implementation and evaluation project led by Hancock County Memorial Hospital and eight additional small rural hospitals in north Iowa in partnership with Mercy Medical Center-North Iowa, Trinity Health, and the University of Iowa Department of Health Management and Policy. These partners combined clinical and technical expertise as well as financial resources to make it possible for these very small rural health care organizations and their 24 affiliated primary care clinics to successfully implement a highly sophisticated, comprehensive EHR system with computerized physician order entry, evidence-based care guidelines, decision support tools, and a full suite of revenue cycle products. These new interoperable EHR technologies are accessible to authorized providers whenever and wherever they care for patients.

The project had four major goals: 1) increase standard evidence-based care practices throughout the implementing partners, 2) enhance the abilities of providers to coordinate patient care across the network and beyond, 3) maximize use of clinical expertise and learning within and across their organizations, and 4) produce significant, measurable, and sustainable improvements in patient safety and quality of care, as well as increased organizational and financial efficiencies.

The major evaluation dimensions studied by the University of Iowa were: A) changes in patient care delivery, B) changes in quality, patient safety and access to specialty consultation, C) changes in staff and physician perceptions of quality and safety, and D) organizational learning. The specific dimensions studied within these areas were: i) the leadership strategies for hospital security levels used in the EHR/COE implementation; ii) how the common integrated role-based work flow processes, clinical decision support rules, and condition of service-specified evidence-based order sets change patient care processes; iii) changes in staff and physician perceptions of quality, safety, and specific indicators used to assess patient care quality and safety as a result of the implementation; iv) how access and relationships among the nine hospitals, MMC-NI, and visiting specialists are affected; v) how job satisfaction, work tasks, and adverse event and error reporting are affected, and vi) how an EHR/CPOE implementation influences organizational learning within individual hospitals and a multi-hospital network.

Electronic Health Record Implementation for Continuum of Care in Rural Iowa - 2008

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    RFA: HS05-013 - Limited Competition for AHRQ Transforming Healthcare Quality through Information Technology (THQIT)
  • Grant Number: 
    UC1 HS 016156
  • Project Period: 
    09/05 – 09/08, Including No-Cost Extension
  • AHRQ Funding Amount: 
    $1,474,178
  • PDF Version: 
    (PDF, 57.98 KB)


Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Implementation and Use

Summary: The purpose of the project was to implement and evaluate a comprehensive electronic health record (EHR) system to improve quality of care in rural Iowa. The various functionalities of this EHR system included: computerized physician order entry (CPOE), evidence-based care guidelines, and decision support tools. The project also included implementing a barcoded medication administration (BCMA) system that was integrated with the EHR and electronic medication administration record in order to prevent medication errors. The system connected seven rural critical access hospitals with the same system used by their rural referral hospital, which is part of the fourth largest Catholic health care system in the United States. The project was led by Hancock County Memorial Hospitaland six additional critical access hospitals in north Iowa in partnership with Mercy Medical Center-North Iowa; Trinity Health, based in Novi, Michigan; and the University of Iowa Department of Health Management and Policy. As additional funding has been secured to continue work, project researchers are conducting additional interviews and surveys, analyzing data on post-live perceptions, conducting evaluation of readiness activities, and refining post-live support.

Specific Aims

  • Complete go-live. (Achieved)
  • Conduct a post-go-live evaluation. (Ongoing *)
  • Define and provide post-live support. (Ongoing *)
  • Conduct end-user training. (Achieved)
  • Develop hardware and infrastructure readiness. (Achieved)
  • Increase use of standardized evidence-based care practices. (Ongoing *)
  • Enhance the abilities of providers to coordinate patient care across the North Iowa network and beyond. (Ongoing *)
  • Maximize use of clinical expertise and learning within and across network organizations. (Ongoing *)
  • Produce significant, measurable, and sustainable improvements in patient safety and quality of care, as well as increased organizational and financial efficiencies. (Ongoing *)

2008 Activities: While the grant period officially ended in September 2008, work continued toward meeting some unfinished specific aims. In February 2009, all seven sites were making progress in activating BCMA. Key informant interviews for post-go-live evaluation are being analyzed. Post-live support processes are also on track, which will allow essential communications between all sites. Hardware and infrastructure assessments, upgrades, and configurations have been completed.

Impact and Findings: Despite some project delays in 2008, as of Spring 2009, all sites are live with BCMA.

Selected Outputs

This project has no outputs to date.

Grantee’s Most Recent Self-Reported Quarterly Status (as of September 2008): This grant has officially ended, but work continued into 2009 to achieve original specific aims.

Milestones: Progress is mostly on track.

Budget: Somewhat underspent, approximately 5 to 20 percent.

*Several aims of the grant were not completed prior to the scheduled conclusion of the grant (August 2008), yet, as other sources of funding have been secured, these aims are still targeted for completion.

EHR Implementation for Continuum Care in Rural Iowa - Final Report

Citation:
O'Brien J. EHR Implementation for Continuum Care in Rural Iowa - Final Report. (Prepared by Hancock County Health Services under Grant No. UC1 HS016156). Rockville, MD: Agency for Healthcare Research and Quality, 2009. (PDF, 333.71 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Principal Investigator: 
Document Type: 
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