Running Head: CERNER EMR 1

Cerner EMR implementation across Penn Highlands Healthcare

Laura Adams

Siena Heights University

June 28, 2017

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Introduction

This paper will examine the impact of an integrated Electronic Medical Record (EMR)

system across a healthcare system of four hospitals. Penn Highlands Healthcare (PHH) is

located in western Pennsylvania. The residents of western Pennsylvania have access to a

healthcare system that provides technologically advanced health care in a warm, friendly

environment. Widely recognized as one of the leading healthcare systems of its kind in the

commonwealth, Penn Highlands DuBois is an oasis of clinical and technical excellence, with

a focus on patient-centered care. The healthcare system provides residents with access to the

region's best hospitals, physicians, nursing home, home health agencies, medical supply

companies and other affiliates who believe that healthcare should be managed by local board

members who live and work in the communities they serve. By combining the best services

from Brookville Hospital, Clearfield Hospital, DuBois Regional Medical Center and Elk

Regional Health Center, Penn Highlands strives to provide exceptional quality, safety and

service. These facilities are now known as Penn Highlands Brookville (PHB), Penn

Highlands Clearfield (PHC), Penn Highlands DuBois (PHD) and Penn Highlands Elk (PHE)

(PHH, 2016).

Current Situation

Penn Highlands Healthcare was established in October 2011. Between the four hospitals

there were 4 different Electronic Medical Record (EMR) systems. Prior to these community

hospitals consolidating into a healthcare system there EMR systems met the direct needs of

physicians and staff. However, since forming a healthcare system this has caused several

barriers, inefficient processes, valuable physician time and delays in patient care across the

healthcare system. To date three of the four hospitals have converted to the Cerner
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Electronic Medical Records system that originally was implemented at PH DuBois in 2010.

Patients currently receive care at any of the four hospitals. However, the main campus is

located at Penn Highlands DuBois. The PHD campus houses the specialty services such as

the heart center, lung center, cancer center, and breast care services. The community has the

ability to visit their primary care physicians close to home in their area. When primary

diagnostic or specialty services are needed they are located in DuBois. Patients have access

to local emergency departments and urgent care facilities in their local community. If a

diagnosis required them to be transferred to the main hospital in DuBois, healthcare

providers were unable to access a patients record electronically. Healthcare delivery

systems today must provide high quality, timely care that attains full transparency related to

cost and quality (Glandon et al., 2014).

To provide more consistent care to the patients of PHH and reduce duplication of care it

was strategically decided to implement Cerner to last of the 4 hospitals in the healthcare

system. The implementation date for the last site, PH Elk will be March 1, 2018. The

potential benefits of electronic records, reduced storage costs, fewer errors, more complete

record transfer capabilities were known years ago in healthcare. However, the need to avoid

omissions or duplication of direct patient care is driving more healthcare providers to adopt

electronic medical records and systems (Giaedi, 2008).

Quality, Cost, and Access

Each factor, cost, quality and access will influence how care is delivered throughout the

continuum of a patients care in a healthcare system. These factors have a direct correlation

to Health Information Technology (HIT). The question related to HIT is, are we getting

value for the investment in healthcare goods and services?

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The national concern over the cost of care is due to the continues increase in healthcare.

Healthcare expenditures are taking an increasing portion of the goods and service produced

in the United States. These number rose from only 5.2 % of GDP in 1960 to 17.9 % in 2010

and to 18.2 % in 2015. Healthcare spending does not appear to be due to the expansion of

services but rather the complexity of price increases and greater income. Several studies

have shown that healthcare cost can be related to healthcare price or utilization but both

contribute a significant impact to the growth. The use of HIT can improve the cost of

healthcare by improving efficiency and productivity. HIT allows healthcare organization to

receive timely statistical information that impacts the decisions, growth of services, market

share, internal and external environments. All of these being components of organizations

strategic planning initiatives (Glandon et al., 2014).

The Chief Executive Officer (CEO), the board of directors for PHH, the Chief Medical

Information Officer (CMIO), and the Chief Information Officer (CIO) strategically evaluated

the need of an integrated EMR system across the healthcare system. Based on the healthcare

systems strategic plan, factors of quality, cost, and access across PHH, the decision was made

to implement a robust platform of Cerner at each of the PHH hospitals over a seven-year

period. The last of these sights as mentioned previously will complete the strategic initiative

of providing integrated healthcare to the patients of PHH. Over these last seven years the

role of the CIO has changed at PHH. The CIO is now involved and collaborating with the

executive team and tier 1 hospitals senior management teams. CIOs today no longer just

manage one of many operating units in the Information Technology Department. The person

is engaged in collaboration with the executive leaders in significant strategic thinking for the
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entire organization and the impact of IT to the goals of the organization (Glandon et al.,

2014).

In 2009, Penn Highlands Healthcare evaluated what they wanted to accomplish with an

EMR system. The evaluation involved an organizational, cultural transformation that

evaluated the benefits of the project. The following areas were used as objectives and

evaluations: 1. Which processes are going to be reengineered to take on a cultural change to

the status quo 2. What is the extent the organization is willing to invest in ensuring that the

process owners and end users are fully engaged and willing to invest in ensuring that the

EMR enables processes are completed and utilized 3? Ensure that end users are fully trained

using the EMR tools. The success of the project was based on proper project execution to

ensure that the healthcare system achieved the promise and value along with the return on

investment (ROI) for this capital expense. Glandon et al., 2014, outcome showed that for a

healthcare organization to accrue the benefits of an integrated EMR the leadership buy in as

well as project management expertise is paramount to effectively implement the EMR.

Penn Highlands DuBois (main site) was the first site to be identified for the initial

implementation. During the planning and collaboration with Cerner, a project management

office (PMO) was introduced in the healthcare system. The PMO was responsible to provide

planning, organizing, directing, and controlling the company resources. One of the primary

causes of failed HIT projects is a silo project management mentality, which is where

projects are initiated, planned and executed without an effective consideration of their impact

on other, preexisting systems, processes, and workflow (Glandon et al., 2014).

Project Management
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The Information Technology (IT) Department at Penn Highlands DuBois, led by the CIO,
created the following project management process according to Cerners project managers
suggestions.
Project Management Knowledge Area
Project integration management
Project scope management
Project Time Management
Project Cost Management
Project Communications Management
Project Risk Management
Project Procurement Management
Source: Information from Project Management Institute (2008).
6
Individuals Must Know How to
Developed a project charter, clearly
identified individuals from key stakeholders
to end users.
Developed the project management plan.
Monitored and controlled project work
Defined the scope of the Cerner Project at
PHD, specific to Inpatient documentation
and ancillary testing.
Created a breakdown of work structure.
Completed and verified scope of project
Defined activities of Cerner project
Estimated the needed resources
Defined activity resources needed for
Cerner implementation.
Developed a schedule with timelines
Estimated costs
Determined budgets
Submitted to CEO, and board of directors at
PHH
Identified key stakeholders
Planned communications
Distributed information
Managed the stakeholders expectations
through communication.
Reported performance of initiatives weekly.
Planned risk management by identifying
possibly risks and threats
Performed analysis, submitted to CEO
Monitored and controlled risk throughout
implementation with Cerner project
manager.
Planned procurements
Conducted procurements
Closed procurements during steps of
implementation
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The Project Communications Management step during the planning, training and

implementation of the Cerner platform resulted in reduced anxiety and buy in of frontline staff.

The steering committee for the Cerner project diligently communicated with all levels within the

organization. This communication was always related to the organization strategic plan of

implementing an electronic medical record across the healthcare system. Communication with

support and leadership is important. However, communication during project management is

equally important. Realistic goals should be set, and project management team members should

be assigned tasks, with timelines of scheduled completion. Accountability and active

participation from motivated team members is pertinent to accomplishing these goals (Bernstein

et al.,2007)

Data Integrity and Standardization

In a multi-system integration such as the Cerner implementation, it is important for data

integrity to be maintained. Quality information is essential to all aspects of todays healthcare

system since many errors and adverse incidents in healthcare occur as a result of poor data and

information. In addition to threatening patient safety, poor data quality increases healthcare costs

and inhibits information exchange, research and performance measurement initiatives. The

ultimate goal of any Health Information Exchange (HIE) is the accurate identification of the

patient by using patient identifier and patient administration management, knowing where the

patient is, was or is going (Manos, 2012). Data integrity will also ensure compliance with the

HIPAA Privacy rule to protect individuals medical records and other personal health

information. This rule also requires appropriate safeguards to protect the privacy of personal

health information and access (www.hhs.gov).

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The IT department upon consultation with the Cerner experts build a data dictionary or

tool that defined the format of each data element and the coding system associated with that

element. This designed the framework for historical records of patients. The creation of the data

dictionary allows computer applications from other systems such as the laboratory and radiology

to share information specific to a patient.

Control objects for information technology is an IT governance, oversight, and process

audit framework recently linked to Sarbanes-Oxley Act of 2002 corporate financial reporting

compliance law. This framework is made up of planning and organizing, acquisition and

implementation, delivery and support, and monitoring. Included in this process improvement

framework is information and IT resources. This framework describes comprehensive process

improvement that has internal control mechanisms in place (Glandon et al., 2016). The Penn

Highlands Healthcare IT Department depended on their IT governance to provide oversight and

the framework to plan and organize the implementation and delivery of the Cerner EMR system.

This governance team provided the recommendations for data integrity, communication and

messaging to the entire organization.

The impacts and influences of the Cerner EMR system on the delivery of healthcare

The Cerner EMR information technology impacted all areas of the delivery of a patients

care at Penn Highlands Healthcare. The ever growing challenges that face healthcare today

include; reducing preventable errors, improving communication among health care providers and

facilities, and controlling the cost of medical care. The transition from paper to an electronic

medical record have dramatically improved communication and patient safety without increasing

costs.
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The Cerner system was implemented specific to inpatient record keeping for clinical and

administrative patient information, this included laboratory and radiology results, pharmacy

orders, medical graphs, electrocardiograms, nursing and physician notes, and order entry. Bar

code medication administration system was also implemented using wireless point of care

technology with bar code scanning. The bar code scanning technology validates medications

administration and verifies the patients identity. This has continued over the last 7 years to

maintain an average 98% compliance rate and reduction in medication misadministration. This

has been the result of education and training to the nursing, physician, and pharmacy staff. Giadi

2008, states that this transformation to bar code scanning is not a result of purchasing a high end

information technology machine and installing it in a healthcare system, but a cultural

transformation that requires leaders provide a solid foundation through preparation and

education.

The Cerner EMR transformation has also had a positive impact on the coordination of a

patients care from inpatient discharge to the outpatient follow up appointment with the primary

care physician. The coordination of care has improved throughout the healthcare system for

patients with complications and are seeing multiple specialist needing multiple laboratory tests,

imaging tests, and medication prescriptions. Penn Highlands Healthcare also made the

investment in the evidence based decision support protocols which have also resulted in

increased efficacy of health information technology.

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Conclusion

The integration of the Cerner information system at Penn Highlands Healthcare improved

the delivery of care to the patients in the healthcare system. The improvements over the last

seven years is directly evident in the outcomes related to quality, safety, and efficiency measures.

Quality improvement and patient-centered care are concepts essential to the health reform efforts

that will require health information technology. The executive leaderships continued support

and message to staff of providing a patient centric EMR that is part of the organizations mission

and values continues to change the mindset and culture of the organization. Consistent

messaging that reinforces the benefit to patients and providers who serve them, is reflected in the

cost decrease and increase in quality and coordination of the patients care and experience

throughout Penn Highlands Healthcare.

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