Rural Iowa Redesign of Care Delivery with EHR Functions (Iowa)
The purpose of this project was to evaluate the impact of implementing electronic health record (EHR) functions on patient care and organizational culture in rural health care hospital inpatient units, ambulatory care, and two primary care clinics. The partners implemented a comprehensive integrated EHR using computerized provider order entry (CPOE), interdisciplinary documentation, medication administration scanning, and clinical decision support (CDS) tools in a planned one-day "big-bang" approach. A time-series design was used to evaluate effect on reported errors (medication errors); CMS/ Joint Commission quality measures; computerized ordering and decision support tools; emergency length of stay; and clinician/staff assessment of the implementation process and how the EHR has changed the quality and safety of patient care, communication among clinicians and patients; and daily work life. After thirty months the hospital and clinics had sustained a 70 percent CPOE rate with over 250 evidence-based order sets; 76 CDS rules; redesigned all patient-centered workflow processes to include quick registration, up-to-date medication lists, technical and content safety and error-prevention designs with required documentation. The partners improved timely antibiotic use and patient education CMS indicators while maintained others in the top quartile; maintained organizational engagement; and found no untoward consequences during the changes.