Adventist Health Mendocino Coast (AHMC) hospital will go live with its new Cerner electronic health record (EHR) on December 1st. This is an exciting time for staff and doctors at the hospital as it will greatly improve the ease of providing care and the quality and safety of that care. The $12 million cost is being borne by Adventist Health (AH), a fact that underscores AH’s long-term commitment to providing hospital services on the Coast. Cerner is the EHR standard used throughout the AH system. Bringing the hospital onto the AH network will allow access to many of the care redesign initiatives that assist each AH facility in providing best practices of care. It also makes sharing of medical records between AH facilities simple. For example, if a patient gets a procedure in Ukiah and needs to follow up with their provider on the Coast, all the medical records will be available to both Ukiah and the Coast.
For a hospital, an electronic medical record is much more than just a computer for note taking. It is a comprehensive system that integrates every aspect of the hospital’s functions from patient registration, to test results reporting, physician orders, and insurance billing. It will combine the hospital’s clinics with the hospital system making things like lab and x-ray results easy to access for the providers. It also will make these results readily available to patients through a web portal and to providers who may not be working in one of the hospital clinics. The web portal can also be used by patients to communicate with their providers and schedule appointments. The AH clinic in Ft. Bragg went live with Cerner last year and bringing the hospital onto the software will complete the integration of the clinic and hospital systems.
From a historical perspective, the first truly effective EHR was developed by the US Department of Veterans’ Affairs in the early 1980’s. Named the Decentralized Hospital Computer Program (DHCP), this EHR included such groundbreaking features as physician order entry, maintaining an up-to-date list of a patient’s medications, access to dictated reports and included a list of the patient’s diagnoses. A summary of a patient’s admission to the hospital was dictated and thus could be accessed in the computer. Perhaps the most powerful aspect of DHCP was that the patient’s medical record was accessible at every VA hospital and clinic across the entire United States.
The healthcare system Kaiser Permanente is responsible for much of the early research into development of computerized systems to assist healthcare delivery starting in 1960. In 1972, Kaiser began to experiment with using its early EHR to assist primary care providers in tracking health screening and vaccination requirements for their patients. This started with tracking referrals for sigmoidoscopies for colon cancer screening which was another technology that was just being developed. In 2004, Kaiser became the first healthcare system to fully integrate all of its facilities under a modern EHR system. This was when it adopted the EHR software Epic. Epic was founded in 1979 by Judith Faulkner in her Wisconsin basement with a start-up investment of $70,000. Epic has grown to be the largest EHR system, boasting over 300 million patient records worldwide. In 2013, Forbes named Faulkner “the most powerful woman in healthcare”, and listed her personal wealth at $5.5 billion.
Cerner was founded as a health information technology company in 1980 starting in a computer lab in St. John’s Medical Center in Tulsa, Oklahoma. Cerner got it’s boost in the industry when it secured $1.5 million in startup from venture capitalists in 1984. Cerner has been the primary contender with Epic for top place as an EHR and currently ranks number two with 24.4% of market share versus Epic’s 32.9% according to Forbes. Both systems are considered state of the art and meet the federal government’s “meaningful use” requirements.
Adoption of EHRs by American hospitals began to gain widespread acceptance when Congress passed the Health Information Technology for Economic and Clinical Health Act (abbreviated HITECH) in 2009. As part of efforts to help the US economy recover from 2008, Congress appropriated $25.9 billion to the US Department of Health and Human Services to promote and expand the use of health information technology across the country. Large grants were given to software companies like Epic and Cerner to develop software that met “meaningful use” standards. Grants were also given to hospitals, especially rural hospitals, to help them purchase such expensive programs. The list of specifications to meet meaningful use requirements is quite long, but key elements include e-prescribing, improving coordination of care across all spectrums of healthcare, reducing healthcare disparities, must be easily engaged by patients, improve public health, provide tracking/reporting of quality and safety metrics, and ensure adequate privacy and security of personal health information.
Like many small hospitals, Mendocino Coast was an “early adopter” of an EHR system taking advantage of a HITACH grant to purchase Opus by MediTech. This was several years ago when the hospital was under management of the Healthcare District. This was a source of pride and was hoped to help attract staff, doctors, and patients. These early EHR systems were usually in the test phases, so called “beta software”, which had the benefit of coming at a reduced cost making them more affordable. However, the downside has been that these systems quickly became antiquated and do not meet the current needs of modern hospitals.
AHMC’s move to Cerner on December 1st will be an important step in improving the quality and safety of care provided at the hospital. It is expected to improve provider and staff job satisfaction leading to increased employee and provider retention. It is also expected that patients will experience better efficiency and timeliness in their care. A great deal of planning has gone into this implementation, including testing of the system and training staff and providers. While any such conversion may carry unexpected challenges, much effort has been spent on ensuring that the transition will go as smoothly as possible. It is indeed an exciting time for our hospital.