Banner Health Achievement Highlights EHR Struggles
Just 82 hospitals have completed the prestigious HIMSS Analytics EHR adoption program, and 17 of them belong to Banner. Is the bar for another EHR measurement--Meaningful Use--set too high?
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HIMSS Analytics, the research arm of the Health Information Management and Systems Society (HIMSS) IT trade group, has recognized 17 of Banner Health's 22 hospitals for having reached Stage 7, the final stage of its U.S. EMR Adoption Model (EMRAM). What this means is that Banner's hospitals have developed a comprehensive EHR that includes everything from computerized physician order entry and electronic documentation to a data warehouse, closed-loop medication administration, and health information exchange capability.
The health system's outstanding achievement only serves to highlight the struggles that less advanced providers have in meeting high EHR standards. The American Hospital Association (AHA) recently noted, for instance, that more than 80% of hospitals have not yet met the government's stage 1 Meaningful Use requirements for electronic health record incentives. With that in mind, AHA said, the government should be careful not to raise the bar too high in Meaningful Use Stage 2.
HIMSS Analytics' Stage 7 award is considered a great honor because so few hospitals have received it. Only 65 U.S. institutions--more than half of them Kaiser Permanente hospitals--had received the recognition before Banner increased the total to 82. Banner, which operates hospitals in Alaska, Arizona, California, Colorado, Nebraska, Nevada, and Wyoming, expects four more of its acute-care facilities to reach Stage 7 by the end of July.
Lee Lemelson, system VP of clinical applications for Banner, told InformationWeek Healthcare that the biggest barrier to more hospitals fully implementing in-patient EHRs is financial. "Most of us operate on a very narrow margin," he said, and the cost of all the hardware, software, and interfaces involved in a hospital EHR is formidable. For example, he said, closed-loop medication administration requires bar code scanners that cost $800 to $1000 apiece. Also, in a mission-critical environment such as a hospital, an EHR requires redundant computer systems that can be very expensive.
Another key ingredient that many healthcare systems lack is a strong leadership commitment to EHR development. Because of Banner Health's decision to build a comprehensive EHR, he said, "We didn't allow any hospital to opt out. And that included the nursing staff, the physicians, and the departments within the hospital. They weren't allowed to say, 'We're not going to do this.'"
When Banner was formed in 1999, Lemelson recalled, four of its hospitals were in EMRAM Stage 1, which meant they had lab, radiology and pharmacy systems. Then, in 2005, when Banner built a new hospital in Phoenix, it decided that it would be paperless from the start. "That hospital became the footprint for what we knew we had to do with all our other facilities," he said.
In general, Banner followed HIMSS Analytics' roadmap, stage by stage, rolling out particular components to all of its hospitals at the same time. One exception was closed-loop medication administration; Banner piloted that challenging technology in a single hospital, and it's still phasing it into the last few of its facilities.
The hospital chain diverged from the HIMSS roadmap when it introduced computerized physician order entry (CPOE). Although CPOE comes in an earlier stage than physician documentation, the doctors in the first Banner hospitals that launched CPOE complained that the process was backward, Lemelson recalled.
"It's hard for doctors to do CPOE first and then do documentation, because it doesn't fit into their workflow well," he explained. "They order some meds and order a lab, and then they have to go back and document it in a paper progress note."
As a result of this feedback, Banner decided to roll out both CPOE and documentation simultaneously. Today, around 85% of Banner's medication and lab orders are placed through the electronic ordering system, Lemelson said.
Banner has an internal health information exchange that connects its Cerner inpatient EHR to its NextGen ambulatory care EHR. Any employed physician anywhere in the system can view inpatient and outpatient data on any patient. In addition, Banner has built a special Web portal that allows private-practice physicians to see inpatient data on any of their patients who has been hospitalized.
The healthcare organization also has aggregated all of its clinical information into data warehouses. By mining this data to populate dashboards, Banner allows management to see how well it's doing in areas such as CPOE. Moreover, the analytics applications have helped improve care in areas such as sepsis and glucose monitoring in the ICU, Lemelson said.
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