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Small Community Hospital EMR Best Practices 2021
What Can Hospitals Do to Invest in Their Own Success?
Author
Tyson Blauer
Author
Paul Warburton
With budget and resource constraints that necessitate strategic investment, it is imperative that small community hospitals (1–200 beds) understand how to drive success with the technologies already in their tool belt, especially their EMR. While EMR vendors are accountable for the quality of their technology and support, satisfaction with the EMR is also strongly influenced by factors within each organization’s control, including setting proper expectations, proactively addressing potential challenges, and empowering internal resources to overcome relationship and product gaps. What are the top EMR challenges faced by small hospitals, and what best practices can help them achieve satisfaction?
Note: This report includes only primary, go-forward solutions. Excluded are supported yet not primary solutions such as athenahealth athenaClinicals for Hospitals and Health Systems, Allscripts Paragon, CPSI Centriq Clinicals (Healthland), and legacy MEDITECH solutions.
MEDITECH’s Community Focus and Prescriptive Implementations Deliver Most Consistent Customer Experience
Consistent satisfaction across a customer base is a key indicator that customers are able to rely on their vendor for help and guidance. With the release of Expanse, customers feel MEDITECH has provided updated technology and instituted a more prescriptive approach to implementations and guidance, leading to MEDITECH customers being the most likely to report satisfaction. Epic and Cerner lead in performance among large organizations but don’t deliver as consistently for smaller hospitals. Their approaches to the community market—hub-and-spoke relationship (Epic) and shared server (Cerner)—create less flexibility and more opportunities for misalignment between the technology and customers’ individual priorities. Small hospitals using Allscripts Sunrise Acute Care report a middle-of-the-road experience. The technology is fairly robust, but customers say Allscripts is not proactive in helping them optimize the solution or resolve gaps. Allscripts recently announced Sunrise Community Care, an offering specifically for small hospitals; KLAS has not interviewed any live organizations. Cost keeps some CPSI customers from adopting product advancements, including updated physician workflows, resulting in lower satisfaction. MEDHOST has improved the physician user interface. Development of other customer priorities (e.g., improving the hosting platform and ancillary solutions) has been slow.
CPSI Customers Can’t Consistently Rely on Vendor for Success
Some customer bases face more product and relationship gaps than others and must therefore invest more of their own time and internal resources into achieving success. CPSI is slow to respond to support and development requests, so their customers are the most likely to resort to workarounds for bugs or workflow issues. Despite some product development, the most frustrated MEDHOST customers view the product as stagnant. Customers have seen more collaborative support from MEDHOST in recent years but must still use their own internal resources to maintain and support customization and integration between the EMR and the ED. Although Allscripts Sunrise customers value the technology’s breadth and flexibility, the vendor is not proactive with their guidance, leaving customers to figure out success themselves. Epic’s robust technology and interoperability are key drivers of customer satisfaction. Cerner’s community customers appreciate having a broad technology stack and a direct relationship with Cerner. MEDITECH customers say strong collaboration from the vendor helps address challenges. The most successful MEDITECH customers budget for training and additional implementation resources to help with interfacing.
All EMRs Present Challenges, but Not to the Same Degree
Note: Top challenges and best practices listed below come from customer interviews and KLAS observations.
CPSI Evident Thrive EHR
Top Challenges
- Poor clinician usability (many customers have yet to update to the most recent physician documentation tool)
- Inconsistent user interface across the platform’s various modules
- Not all customers have adopted product developments (e.g., the new patient portal), citing cost as a barrier
- Enhancements/nonessential functionality slow to be released
Best Practices for Success
- Set realistic expectations; the technology may work best supporting only essential workflows (i.e., clinical and revenue cycle)
- Invest in CPSI’s most recent modules and updates (e.g., physician user interface, patient portal)
- Invest in resources to maintain interfaces
Allscripts Sunrise Acute Care
Top Challenges
- Allscripts is not proactive with their guidance, preventing customers from utilizing the solution’s full functionality
- Lack of proactive improvement of workflows and ease of use
- Updates/developments can be hard to implement/maintain
Best Practices for Success
- Invest in internal IT resources that can support interfaces and updates
- Invest in end-user training
- Work strategically with Allscripts to optimize the technology to your organization’s goals
MEDHOST Enterprise Clinicals
Top Challenges
- Product modules limited in breadth (e.g., there is no ambulatory module), and development to address gaps is slow
- Many organizations feel MEDHOST is not proactive
- Physicians need additional training on how to use MEDHOST’s user interface and set up personalization
Best Practices for Success
- Set realistic expectations about slow speed of development; implement releases once they are available
- Proactively schedule strategic meetings with MEDHOST to talk through your organization’s goals
- Invest in internal training for end users
Cerner Millennium PowerChart/CommunityWorks Clinicals
Top Challenges
- Implementation and ongoing training inadequate to ensure customers are able to fully leverage all capabilities; customers must contribute significant amounts of their own resources
- Making material changes to the shared instance of CommunityWorks requires working with Cerner and getting agreement from the CommunityWorks community
Best Practices for Success
- Invest in internal end-user training and optimize the personalization that is available
- Set realistic expectations about being on a shared environment
Epic Community Connect EpicCare EMR [C]
[C] Component
Top Challenges
- Less direct interaction with Epic
- Relationship challenges with host site (e.g., lack of training or report resources, slow response time)
- Customers may lack input into product customization and development
Best Practices for Success
- Set realistic expectations about being hosted
- Make sure contract with host clearly defines your organization's needs
- Ensure you will have access to the right individuals at the host site to collaborate on a strategic level
MEDITECH Expanse Acute Care EMR
Top Challenges
- Development has been slow (only the physician module has received updated user interface)
- Poor user interface for patient-facing tools (portal and scheduling)
- Expanse’s cost (especially the operational costs) can be prohibitive for MEDITECH’s legacy customers
Best Practices for Success
- Invest in IT resources that can customize the solution and also support implementations
- Focus on internal training
- Budget for training and additional implementation resources to help with interfacing
Organization Culture and Training Key to Driving Clinician Success with the EMR
KLAS’ Arch Collaborative† research shows that strong clinician success is possible for any size organization with just about any EMR. Below are two practices identified by the Arch Collaborative as key to driving strong clinician satisfaction with the EMR.
Create a Culture of Success
What organization a clinician is employed at tends to be a better predictor of EMR satisfaction than which EMR that clinician uses. The following stakeholders all play a part in creating a culture of success:
- IT/organizational leadership: Architect regular opportunities for the IT/informatics teams to receive feedback from frontline clinicians. Invest in training to help IT/informatics team provide quality support and communication with clinicians.
- EMR vendor: Build trust in the EMR vendor by establishing a collaborative relationship with regular touch points.
- Clinical end users: Communicate high expectations that clinicians will master the EMR.
Provide Customized Training
Data from over 100,000 clinicians clearly shows that good training has a profound and lasting impact on satisfaction with the EMR.
- The quality of the trainer matters more than the structure of the training (e.g., whether the training is in person, remote, broken up into multiple sessions, etc.).
- Expect engagement from clinicians in mastering the EMR—require at least seven hours of initial EMR education and at least three hours of annual follow-up education.
- Deliver training that adds value and yields high demand.
† The Arch Collaborative is a provider-led effort to unlock the potential of EMRs in revolutionizing patient care. Through standardized surveys and benchmarking, healthcare organizations collaborate to uncover best practices and move the needle in healthcare IT.
About This Report
Each year, KLAS interviews thousands of healthcare professionals about the IT products and services their organizations use. These interviews are conducted using a standard quantitative evaluation, and the scores and commentary collected are shared in reports like this one and online in real time so that other providers and IT professionals can benefit from their peers’ experiences. To enable readers to more quickly understand high-level differences in vendor performance and give better context as to how each product compares to other offerings in the market, KLAS has organized the questions from the standard evaluation into six customer experience pillars—culture, loyalty, operations, product, relationship, and value.
The data in this report was collected over the last 12 months; the number of unique responding organizations for each solution is given in the chart below.
[C] Component
Note: Some organizations may have rated more than one product.
† Market share data comes from KLAS’ April 2020 US Hospital EMR Market Share report.
What Does “Limited Data” Mean?
Some products are used in only a small number of facilities, some vendors are resistant to providing client lists, and some respondents choose not to answer particular questions. Thus a vendor’s sample size may vary from question to question and may not reach KLAS’ required threshold of 15 unique respondents. When a vendor’s sample size for a particular question is less than 15, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 6, no score is shown. Note that when a vendor has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.
Overall scores are measured on a 100-point scale and represent the weighted average of several yes/no questions as well as other questions scored on a 9-point scale.
Product Designations Used in This Report
Component [C]: Product that typically serves only a subset of the market or includes most but not all components that comprise a complete system. Epic Community Connect EpicCare EMR is marked as a component product in this research because customers contract with a host organization rather than directly with Epic.
Writer
Elizabeth Pew
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.