How a Unified EHR Implementation Can Boost Interoperability, Efficiencies

As an early health IT adopter, Littleton Regional Healthcare in New Hampshire had amassed a portfolio of several different EHR platforms to support its suite of specialties. And a lack of interoperability between these systems made a unified EHR implementation nothing short of a necessity, according to Edward Duffy, MD, MBA, FACEP, CMO, CMIO, and executive vice president of Littleton.

"For a long time, we've felt as though we've needed one platform," Duffy told EHRIntelligence in an interview. "Finally, about two years ago, it was just unsustainable. That's when we started looking for a product that could handle the entire suite of specialties and practices we have."

Littleton Regional has different EHR systems for hospital settings, acute care providers, office clinics, physical therapy offices, and orthopedic care delivery systems.

"While there is some interoperability, it is not functionally practical," Duffy said. "If you make your day half an hour longer because you're having to click out and back into another system, that's just not efficient, and it's not good patient care because you're spending a lot of time with the machine rather than with the patient."

Duffy noted that a lack of interoperability was also an issue for the revenue cycle.

"They're billing in five systems with a different process for each one, which leads to errors of remission and things falling through the cracks," he said.

When Littleton set out to implement a unified EHR, it first investigated the possibility of working with a larger health system that could extend a connection to Epic. However, organization leaders found that this wasn't practical.

"It wasn't the fault of any of the systems," Duffy said. "It was just too expensive and too daunting. I know there are companies out there that will extend for you. Still, for the non-entrepreneurial, it just seems too complicated to be hitched to the decision-making at a large hospital that you're not affiliated with financially."

From there, the community hospital assessed products from three EHR vendors: Allscripts, MEDITECH, and Cerner.

"Number one for us was, if the doctors and the advanced practice professionals are not happy with it, we're not buying it," he said. "We wanted their preference. Nurses as well, because the nurses live in it, no matter what product it is. It needs to make sense so that their productivity is not heavily handicapped by using the system."

Littleton saw demonstrations from all three vendors, and Duffy said Cerner was the clear winner regarding end-user preference.

He said the medical staff did not like some of the functionality in the other options, and the nursing staff found workflow issues with the other platforms.

However, Duffy emphasized that Cerner's CommunityWorks EHR didn't win by default.

"We were quite impressed with Cerner in terms of its functionality, reportability, and the ability of the product to give people what they wanted," Duffy explained. "The end-users, physicians, and other medical staff members were very taken with it, and the nursing staff liked it also."

CommunityWorks is a cloud-based deployment of Cerner's EHR, tailored to meet the needs of community, critical access, and specialty hospitals. It provides an integrated digital record of a patient's health history, including clinical and financial data.

"Cerner looked good, functioned well, and gave us everything we needed at a reasonable price," Duffy said. "It's going to make it quite convenient and easy to see patient care across the enterprise without going into another system like we did in the past. With the unified platform, you just navigate from place to place within the platform."

In addition to advancing interoperability within Littleton Regional, the EHR implementation is set to support interoperability with the hospital's partners.

"We have a particular tertiary care partner geographically close that we do a lot of business with," Duffy said. "They're able to build a bridge into Cerner so that we can see their records, and they can see a report from our records quite easily. They could not do that in the other platforms in the past."

Duffy pointed out that since all data has a home in Cerner, the system can easily create reports.

"There's a huge treasure trove of reports already made in CommunityWorks, but you can also create them," he explained.

Another feature that stood out to Littleton in the CommunityWorks platform was its cloud hosting.

"We were always a hosted system for our acute, and that can be an extremely complicated undertaking for a critical access hospital," Duffy pointed out. "You have to have sophisticated network support, storage, and hardware."

"We were drawn to the 100 percent cloud hosting of the entire platform," he added. "We had had that with eClinicalWorks, which was our platform for the office practices, so we felt comfortable going in that direction."

Duffy said that the implementation will also help enhance the patient experience.

"Currently, we don't really have functional patient portals," he said. "You have to go on three different systems to see where all your information is for your healthcare at LRH. So, as you'd imagine, everybody is overburdened with passwords and logins. With Cerner CommunityWorks, you'll be able to have one, and you'll just log into that."

He pointed out that this improvement will make communication with patients easier and enable them to engage with their healthcare better.

With go-live expected later this year, Duffy said Cerner has a comprehensive training program for the implementation and "a lot of at-the-elbow support."

"We have some wonderful folks that are very accessible to us that help us follow the plan they laid out with us," he said. "When I pick up the phone and talk to a person in the inner circle of corporate leadership, they may not be on the other end right when I call, but within a few hours, I'll get a callback, and it'll be meaningful."