Mountain Region Family Medicine (MRFM), founded in 1994 includes 17 primary care physicians, three nurse practitioners and 100 employees. With offices in six locations, MRFM decided the time was right to build a larger office and bring most of the offices into a single large facility in downtown Kingsport, Tennessee.
MRFM determined that preliminary to this move, they needed to move forward with an Electronic Medical Record (EMR) deployment. Rather than designing their new building to support hardcopy processes, they wanted the design to fit a computer-based patient care model. MRFM Administrator, John Paul Linke shares, "There are powerful drivers for EMR adoption. The reimbursement rates for Medicare and Medicaid are to be tied to the physician's "meaningful use" of EMR technologies".
"Our decision was equal part strategy and necessity. We were using hospital-tethered systems and there were three different environments that caused real problems in reporting and operational management, as well as an obvious duplication of effort. Strategically, it makes sense for the organization to use one system," Linke shares. "The hospital had also decided to pull back on some of these extended systems as well, that was the necessity driver".
MRFM formed an IT Committee, led by Eric Harman, M.D. The Committee connected with Tammy Scott, Vice President of Strategic Initiatives for BCTI in Johnson City, Tennessee. Scott's experience with Enterprise-scale projects provided both insight and guidance in the crucial early stages of the project.
Scott helped the Committee select three EMR vendors with the best fit for MRFM. As an independent consultant, not affiliated with any particular EMR vendor, but familiar with many, Scott helped streamline this process.
Once the three vendor candidates were determined, Scott arranged site visits and arranged for the vendor teams to present different models to MRFM shareholders. "One thing we definitely learned from these sessions was that there was no way we could do this without Tammy leading the project. We didn't have the breadth of IT expertise to handle it," says Linke.
MRFM selected Greenway Medical Technologies Prime Patient EMR system.
"Our decision wasn't driven as much by price as it was by our confidence in Greenway's system. They are a strong and rapidly growing vendor and they have a web-based system rather than an older client-server model".
"Then we starting talking hardware, and Tammy connected us with other resources within BCTI," says Linke. BCTI is a Microsoft Gold Certified Partner, a VMWare Professional Partner and a Cisco Premier Certified Partner. BCTI System Architects introduced the concept of infrastructure virtualization which enabled the organization's entire infrastructure to fit within a single server cabinet.
Even with the larger space available in the new building, Linke felt there was no reason to carve out the space required for a server room and all the backup power and cooling equipment that would require. "We just can't see the logic in setting aside space that could be put to more productive use; this space is for patients, not servers."
Virtualization of the servers gave MRFM a small footprint which fit into a single server cabinet. "Tammy introduced us to one of their business partners, OnePartner," shares Linke.
OnePartner's ATAC (Advanced Technology & Applications Center) data center in Duffield, Virginia is located 25 miles from Kingsport. The OnePartner ATAC is the only commercial data center in the U.S. with a Tier III Certification by The Uptime Institute. It is designed, down to the last detail, for high-availability applications.
"EMR is obviously a great candidate for a commercial data center," says Tom Deaderick, Director of OnePartner. "The ultimate goal of any EMR deployment is to reap the full value from that investment, which requires meshing the system with every patient interaction. That's great, until the day the system is unavailable - and then it's a disaster."
Linke shares, "In partnering with OnePartner we know our data is secure. New HIPAA requirements have tightened up even more with regard to PHI (Protected Health Information). We feel much more confident knowing that our data is in such a secure facility". The MRFM EMR is secured behind six separate access control panels, including four that require a combination of fingerprint and proximity cards. There are 26 digital video cameras with motion-activated recording inside and outside the ATAC data center, preventing the type medical data theft in recent news.
Deaderick compliments the team, "this project was about as smooth as any EMR deployment I've ever heard of. That's a testament to every organization involved and it says something really special about the leadership of MRFM".
Three weeks in
"By the second day of our deployment, the Greenway training staff felt we really didn't need them any longer. At first there were just minor issues, like forgotten passwords, and locked accounts. There weren't any major issues at all," says Linke. "After the first three weeks we weren't seeing any major issues". By the end of the initial deployment, MRFM had only used 1/2 of the time allocated for training.
Credit is due for MRFM staff. They understood that success would require working harder than usual for the first few weeks, as they maintained both paper and EMR systems. MRFM developed a creative phase-out process for the paper patient files. When a patient is treated, the paper file is marked with an "E". When a physician sees a paper file with an "E", they mark the parts of the record that should be keyed into the EMR. When the physician completes this process, they put an "M" after the "E" and the paper file is delivered to the Medical Records Department. Medical Records keys the marked data into the EMR and adds an "R" to the "EM". Once this is complete, the paper file, marked "EMR", is ready for storage.
Looking back
Linke pinpoints a few decisions that were key to the project's success.
"First, be sure you approach the selection process, not just of EMR, but of your support team, with due diligence".
"Swallow your pride and get professionals to help you. This saves a tremendous amount of both dollars and headaches. It's important to realize that you have to have people who can do this. You can run to Best Buy to get desktop help, or read "Troubleshooting Your PC for Dummies" for your home equipment, but most health care Administrators can't design or maintain an enterprise system. The decisions we've made have all been the right ones, we'll come out way ahead in the next few years".