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Embracing change to improve performance

January 1, 2010
by Neil Gruber, Jim Darragh, Pamela H. Puccia, Doreen S. Kadric, and Susan Bruce
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Implementation of an electronic health record system
The implementation team: neil gruber, pamela puccia, doreen kadric, susan bruce, and jim darragh
The implementation team: Neil Gruber, Pamela Puccia, Doreen Kadric, Susan Bruce, and Jim Darragh


The identification and implementation of a new electronic health record (EHR) system at Helen Porter Healthcare and Rehabilitation Center (HPHRC), a 105-bed hospital-related facility in Middlebury, Vermont, spanned nearly two years, cost approximately $250,000, and was led by a multidisciplinary team of clinical, technical, and administrative staff.

Five implementation elements

The HPHRC team decided at the beginning of the project to pursue a system that integrated both clinical and financial information, with the specific goals of improving quality, advancing operational efficiency, and enhancing revenue. After identifying its goals and selecting the software program, the team recognized that to be successful it would need to incorporate five key elements for implementation of the new system:

  • Establish a strong/diverse implementation team

  • Prepare staff and other stakeholders for change

  • Create a dedicated classroom/training space

  • Communicate frequently and widely to all stakeholders

  • Be persistent…implementation is hard!

Key element 1: The implementation team

Our implementation team was comprised of the administrator, the director of nursing, assistant administrator/business office manager, rehabilitation director, and our administrative assistant. This group included individuals with clinical, administrative, financial, and technical (computer savvy) skills; thereby creating a diverse and well-rounded team with considerable depth and the ability to see the big picture while still understanding how the day-to-day changes were affecting frontline staff.

Having the implementation team with a broad range of skills was perceived as a vital element in our success.

Key element 2: Preparing staff, key stakeholders

The team decided early on that an important goal would be to not lose a single nurse because of the conversion to a computer-based EHR; thereby becoming a major focus of the team to totally prepare the entire staff for implementation. This preparation included providing staff a vision by which the new EHR would require less time completing necessary documentation giving them more time for direct care with the residents. Before introducing staff to the new EHR software, all were assessed for their computer skills. During computer boot camps, users were aggregated at similar levels. Only when staff developed and demonstrated basic computer competencies were they then introduced to and trained on the EHR system.

Having the implementation team with a broad range of skills was perceived as a vital element in our success.

Key element 3: Create a dedicated training space

The assessing of the staff's computer skills and the requisite staff training required a space. Our main conference room was converted to an “as needed” classroom by installing an LCD projector, screen, dedicated computer workstation, and wireless capabilities. Group training was provided using laptop computers connected to the wireless network. Having a well-equipped training space was essential to our success.

Key element 4: Communicate, communicate…

Concurrently, the team created a special newsletter, drafted frequent written updates, practiced “CBWA” (communication by walking about) and constantly provided positive and encouraging feedback to employees.

In addition to the frontline staff, the implementation team recognized the unique and important role of the physicians who would be required to use the EHR. Physicians' support was determined to be paramount. To that end, the facility's medical director was invited to play a key role in planning, implementation, and communication. There were special training sessions for physicians. Their feedback was solicited and appropriately responded to. Communication among all staff/stakeholders was a critical element to our success.

Neil Gruber has been an administrator since 1980. He has been the administrator for 12 years at HPHRC. During his tenure he has overseen four major nursing home software conversions. In December, he completed his third term as President of the Vermont Health Care Association. He has just completed paddling Lake Champlain end to end (110 miles) as a special fundraiser for his nursing home residents.

Jim Darragh has 25 years of physical plant maintenance experience including 21 years of U.S. Navy shipboard engineering experience, including master trainer certification, physical plant supervisor at Porter Hospital, director of maintenance at HPHRC, and most recently assistant administrator.

Pamela H. Puccia is a registered nurse with 30 years of experience in healthcare. She has held a community college faculty position and has remained close to academia as the long-term care representative on the Vermont-based Freeman Nurse Scholarship Governing Board, recently joined the Vermont Nurse in Partnership Board, and is a longtime member of the Vermont Technical College Advisory Council.

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