Are Virtual, Hybrid EHR Implementations Here to Stay?

The First Virtual EHR Implementation

With Macon Community Hospital, a rural 25-bed critical access hospital in Tennessee, unable to lead an in-person EHR implementation, its health IT leader initiated a conversation with Cerner to explore other possibilities.

“They wanted to postpone, and we said that's not possible,” Scott Tongate, chief financial officer at Macon Community Hospital, said in an interview with EHRIntelligence. “They came back with the option of the virtual go-live. Because of the coronavirus, we still had to go live even if we weren’t able to have Cerner’s in-person support.”

The hospital and the vendor worked together to develop a virtual plan to successfully navigate the virtual implementation, highlighted by a specialized communication plan and support for the inpatient, emergency, laboratory, radiology, and IT departments.

“They wanted to proceed and hit their scheduled conversion date, and we felt like they were in a good place,” Lindsay St. Germain, Cerner CommunityWorks director, said in a recent interview with EHRIntelligence. “We had worked collaboratively throughout the project, and we all felt confident that they could have a successful virtual go live.”

“It was a collaborative process to work with the client to make sure that they understood, due to COVID and both the social distancing and safety precautions, we couldn't support them on site. But we did feel confident we could do it together virtually.”

The implementation process at Macon Community Hospital began at the beginning of the pandemic, and the technology officially launched on March 30.

While most would think that a remote implementation could result in technical issues along the way, Tongate credited the hospital’s technical team and Cerner’s roadmap for a smooth transition, even though Cerner was unable to send its associates to Lafayette, Tennessee.

“Macon’s back was up against the wall and it forced both of us to get comfortable for our very first virtual implementation,” Mitchell Clark, president of Cerner CommunityWorks, added in an interview with EHRIntelligence. “We ran into one another as we went through it, but now our teams are polished with virtual implementations.”

Virtual Implementations Evolve into Hybrid Implementations

Although the rural hospital in Tennessee was 100 percent virtual, it helped kick off a series of what Cerner now describes as “hybrid EHR implementations.”

“The hybrid implementation allows us to go on-site for our testing events and our conversion events,” Clark said. “Those are the two events that we feel are the most imperative for us to be on-site and work with the client for a successful outcome. But, the majority of the implementation stages are done remotely.”

For example, Cerner and the client complete the design phases of the project remotely, Clark added.

Following client consultation, the vendor will send a limited number of staff members to the site based on hospital and implementation size.

Before COVID-19, Cerner would send an average of 15 to 18 staff members to a rural hospital implementation. To limit exposure during the average hybrid implementation, the vendor will now send single-digit staff members to conduct the testing and conversion events.

That’s what happened at Huron Regional Medical Center (HRMC), which completed a hybrid EHR implementation to connect its main hospital and women’s health and physicians’ clinic.

“When I joined the organization in July, we were already in the midst of the COVID-19 world,” Farid Faruqui, interim chief information officer at South Dakota-based Huron Regional Hospital, said in an interview with EHRIntelligence. “This was really our only option and once we decided to move forward with the hybrid implementation, this was going to be the way we had to do it.”  

Rural hospitals have always had a disadvantage in interoperability and EHR implementation, primarily due to a lack of funds compared to larger hospitals.

“The primary reason that a hybrid implementation can be beneficial is that you're able to control your costs,” Faruqui added. “In any implementation of this size, the vendor travel costs take up a large chunk of your budget. By limiting the travel and holding some of these events virtually, those costs can become significant.”

Similar to Macon, Faruqui said proper planning is critical for either a virtual or hybrid implementation.

“You have to make sure that you're prepared adequately,” Faruqui said. “You need to make sure that your staff has the right hardware, laptops, and multiple monitors, and ensure that you've got a strong internet connection because sometimes in a rural setting, that can be hit or miss.”

“The most important thing is, you've got to have a partnership with your vendor to understand that things are going to be more different than a normal implementation and that you've got to be able to operate under these odd scenarios. You may have people that get technical issues, hearing the occasional barking dog or crying baby, you've got to kind of take that in stride,” Faruqui continued.

Overall, the hybrid go-live ran smoothly for HRMC. Faruqui said consultant communication was even better because vendor consultants are not stationed inside the medical facility for the entirety of a regular in-person implementation. With the consultants being remote, it was easier to find specific times that aligned for both the hospital and the vendor.

“We all realized that we were in a very different environment and this isn't something that we were used to,” Faruqui concluded. “Ultimately, the goal was to get this EHR implemented, and it is for the benefit of our patients and our community. I'm proud of the work we did and the work that we did with Cerner as well.”

The Future of EHR Implementations

So far, Cerner has completed 37 hybrid EHR implementations since March 2020. Looking into the future, Mitchell said the vendor plans to still offer the hybrid or even the virtual approach, even in the post-COVID world.

“We see an advantage to both of our organizations; for both the client, as well as ourselves,” Clark concluded. “We can make them more economical and we can do a better job of sharing resources.”

“We'll continue to look for opportunities to do things like this in our market to the advantage of our clients. It's something good that actually came out of this horrible pandemic. It showed that when your back's up against the wall, you can do some things that you didn't think you could do because you had always done it one way.”