Doctors Hospital Health System Bahamas [Doctors], is the most modern acute care, privately owned healthcare facility in the Caribbean. Doctors, accredited by Joint Commission International, pioneered the use of such state-of-the art medical equipment as the 16 slice CAT scanner, MRI scanner and nuclear medicine. Known for its commitment to providing technologically advanced healthcare services, Doctors embarked on a journey to update its Electronic Health Record (EHR) system. This case study explores the challenges faced during the implementation process and highlights the strategies employed to overcome them. The successful implementation of the EHR system has significantly enhanced patient care, data management, and disaster recovery capabilities for Doctors Hospital.
SITUATION
Unified Record:
Although doctors technically had a unified record, they had used software modules creatively for their clinic audiences. Since Doctors Hospital aimed to expand its healthcare system across the islands, they recognize the need for an improved solution to enable seamless information sharing and ensure continuity of care, ultimately leading to improved patient outcomes.
Data Conversion:
To ensure uninterrupted patient care and operational efficiency, Doctors prioritized the conversion of their existing patient and financial data. This step was crucial in seamlessly transitioning to the new EHR system, preserving historical patient information, and maintaining data integrity.
Disaster Recovery:
Given the inherent risk of hurricanes in their island location, Doctors Hospital required a robust system that could safeguard their data even in the face of hardware damage. To address this concern, a cloud-based solution with comprehensive disaster recovery capabilities was deemed essential. This would ensure the accessibility and safety of critical patient data, allowing Doctors Hospital to provide uninterrupted care even during challenging circumstances.
ACTION
After conducting a thorough search for the most suitable EHR system to support their expanding health system, Doctors Hospital Bahamas carefully evaluated several options. Ultimately, they determined that MEDITECH Expanse best aligned with their needs and requirements.
However, embarking on a massive implementation project is never an easy task, especially when operations cannot be halted for the 18-month duration of the implementation. Doctors Hospital was well aware of the challenges posed by competing projects, staffing constraints, and financial considerations. To navigate these obstacles successfully, they sought an experienced implementation partner who possessed the necessary expertise and talent to guide them throughout the project.
Recognizing the importance of comprehensive preparation, Doctors Hospital engaged medSR to conduct a Readiness Assessment. This assessment aimed to provide a clear understanding of the existing state and the desired future state of the hospital’s operations. It also focused on establishing connections and interfaces with third-party vendors, identifying the staffing requirements for the project, establishing a realistic budget, and outlining actionable steps that Doctors Hospital could take immediately to enhance their readiness for the implementation project. By undertaking this assessment, Doctors Hospital ensured that they were well-equipped to embark on the implementation journey with confidence and a clear roadmap for success.
“From the very beginning, medSR’s expertise was evident. Their team’s depth of knowledge and experience was incredible and their ability to transparently meet us at our point of need gave us the confidence we had found our partner.” – Samantha Lockhart, Assistance Vice President
CHALLENGES
Limited I.T. & Clinical Staff:
Doctors faced the common challenge of limited I.T. and clinical staffing, a topic of concern for many healthcare institutions. This issue has significant implications for budgets and can impact staffing in other crucial areas. While Doctors Hospital had a knowledgeable I.T. team, their size and roles were limited. As a result, medSR, the implementation partner, took on an expanded role as the site Project Manager. They not only assisted with the building of the new EHR system but also aimed to help Doctors Hospital develop and grow their own I.T. team, ensuring long-term sustainability and self-sufficiency.
“medSR not only helped us get approval for FTE’s we had struggled to get approved in the past, but helped develop our team throughout the project to prepare us to support ourselves. Outsourcing to medSR was key to success.” – Margaret Kemp, Manager Clinical Analyst
System Growth:
While the I.T. team was focused on implementing the new MEDITECH EHR system, the hospital’s CFO was actively involved in expanding the healthcare system. Initially, Doctors Hospital had one hospital and a number of clinics, but during the project, they added an additional hospital, a retail pharmacy, and multiple clinics across various islands. This substantial growth posed challenges for the I.T. team and the MEDITECH Project teams, necessitating flexibility and effective coordination to accommodate the evolving needs of the organization.
“medSR was flexible and scaled to meet our needs at every turn. They met us where we were by laying out the most relevant obstacles with possible solutions so we can address the issues.” – Dr. Charles Diggiss, CEO
COVID-19:
The COVID-19 pandemic presented additional hurdles for the project, as travel restrictions made it impractical for on-site work during the early stages. However, Doctors Hospital and medSR exhibited diligence in communication and collaboration, allowing them to complete a significant portion of the work remotely. By leveraging effective remote communication and coordination, they not only overcame the challenges posed by the pandemic but also managed to save budgetary resources in the process.
Web Responsiveness:
The project encountered a specific challenge related to web responsiveness, which required urgent attention. The uniqueness of being on an island often presents obstacles when it comes to coordinating with third-party vendors and ensuring the smooth progress of a project (deliveries takes twice as long and often get held up at customs, work visa’s for 3rd party vendors need advance planning, infrastructure of ISP’s (or lack thereof, etc.). While addressing the issue of web responsiveness should ideally have been addressed earlier, Doctors Hospital and medSR swiftly resolved the problem with the assistance of their partners at Cloudwave, ensuring that the project could proceed smoothly.
In summary, Doctors skillfully navigated challenges stemming from limited I.T. and clinical staff, system growth, the impact of the COVID-19 pandemic, and web responsiveness. Through effective collaboration with medSR and other partners, Doctors Hospital successfully addressed these challenges, ensuring the implementation of the new EHR system while maintaining budgetary efficiency and project momentum.
OUTCOMES
Amidst numerous challenges, this project showcased remarkable achievements, with one standout being its timely completion within the allocated budget. The unwavering support and effective governance from Doctors’ executives played a pivotal role in keeping the project on track. Whenever issues arose, leadership promptly made decisions and implemented recommended actions.
Doctors boast a dedicated team of providers and strong physician leadership. The Chief Medical Information Officer (CMIO) personally reached out to each provider to ensure their participation in training. Access to the system was granted only upon completion of training. Daily provider huddles, conducted during the initial three weeks, witnessed excellent attendance. Providers recognized the patient care benefits associated with the system and exerted substantial effort.
While there are numerous achievements worth mentioning, here are a few notable ones that Doctors takes great pride in:
- The project was completed on time and within the allocated budget.
- The project successfully improved their unified patient record across all hospitals and clinics by implementing additional modules. Data conversion was carried out successfully, and the clinics now possess a tailored tool to meet their specific requirements. This improvement significantly enhanced proficiency and improved patient care outcomes.
- The introduction of Web Delivery now ensures disaster recovery capabilities. Even in the event of hardware damage during a hurricane, the data remains secure.
- Prior to implementation, the baseline for Computerized Physician Order Entry (CPOE) stood at 0%. In the first month post-implementation, CPOE compliance soared to an impressive 79%.
- Doctors attained 100% electronic documentation before the system went live, and they maintained this exceptional level of engagement, showcasing terrific physician involvement.
- The successful conversion of Billing, Accounts, and Registration (BAR) was completed within a remarkable four days and balanced perfectly.
- Clinic staff and providers have now transitioned to electronic documentation at the time of patient visits, resulting in increased proficiency, accuracy, and improved patient outcomes and satisfaction.
- These achievements demonstrate Doctors’ commitment to excellence and the significant advancements made through this project.
CONCLUSION
Doctors Hospital Health System, Bahamas (Doctors) stands as the most modern acute care, privately owned healthcare facility in the Caribbean, renowned for its commitment to providing technologically advanced healthcare services. In this case study, we explored the challenges encountered during the implementation of Doctors Hospital’s Electronic Health Record (EHR) system and the strategies employed to overcome them. The successful implementation of the EHR system has significantly enhanced patient care, data management, and disaster recovery capabilities for Doctors Hospital.
Through the dedication and collaboration of Doctors Hospital, medSR, and other partners, the project achieved noteworthy milestones. Doctors Hospital demonstrated exemplary executive support and governance, promptly making decisions and acting when issues arose. Their strong physician leadership and engaged provider team played a crucial role in the success of the project.
Notable achievements include the establishment of an efficient record system across all hospitals and clinics, ensuring enhanced proficiency and improved patient care outcomes. The introduction of Web Delivery ensures robust disaster recovery capabilities, safeguarding critical patient data even in the face of hardware damage. The implementation of Computerized Physician Order Entry (CPOE) resulted in a significant increase in compliance, and Doctors Hospital achieved and maintained 100% electronic documentation, showcasing exceptional physician engagement.
Additionally, the successful conversion of Billing, Accounts, and Registration (BAR) was completed swiftly and accurately, and clinic staff and providers transitioned to electronic documentation at the time of patient visits, resulting in increased efficiency, accuracy, and improved patient outcomes and satisfaction.
Doctors Hospital Health System, Bahamas’ journey towards updating their EHR system exemplifies their commitment to delivering cutting-edge healthcare services. Through their collaboration with medSR and other partners, they have successfully overcome challenges, achieved remarkable milestones, and position themselves as a leader in providing advanced healthcare solutions in the Caribbean.
“The medSR team was the most professional group of consultants we have ever worked with and the project would have failed without them.” – Dr. Charles Diggiss, CEO
