Case Studies

Implementing an EHR Against All Odds

Electronic Health Records (EHRs) are extremely difficult to implement in the very best of conditions. In today’s healthcare environment, last-minute surprises, changing requirements, and even personal issues are inevitable. It is easy to get distracted by emergencies and lose focus when an initiative is as complex and all-encompassing as an EHR. In one of Afia’s many successful implementations, on top of the normal issues, it seemed like the whole world was falling down around our client. The following is a story of how Afia partnered with this client to deliver their EHR against all odds as we faced almost every imaginable issue that could affect an implementation.

Starting from behind

Afia was called by a large Community Mental Health (CMH) organization to help support the contracting process with an EHR vendor they selected after two years of looking at other systems. We provided recommendations on how to proceed with the contract to ensure a strong agreement, but our point-of-contact did not follow our recommendations and ended up signing a very one-sided contract with no commitments from the vendor to actually meet their needs. At that point, their Information Technology (IT) team ran the project while we helped in parallel to map out process flows across their organization.

A short time into the project, we started to ask questions of the vendor and IT team that no one else was asking. Based on those interactions, it was clear that those responsible for the project were not ready to handle an initiative as complex as an EHR implementation. After three months, the executive leadership of the CMH asked Afia to try to salvage the implementation. The Afia team quickly identified issues with the implementation and system functionality and escalated to the vendor, but in the end the system was not a good fit for the CMH and the poor contract left everyone with little options. An entirely new vendor was needed.

Using Afia’s proven vendor selection process, Afia and the CMH were able to choose a new vendor in seven months. Afia’s process aligned the client and the vendor to effectively support all of their clinical, support, administrative, and financial needs. It was a new beginning with the right vendor and the right contract, but between the two years of initial selection with the internal IT team, a year and a half with the wrong vendor, and seven months to pick a new vendor, the CMH was already two years behind where they should have been with the new system.

All hell breaks loose

As the implementation began, the first unusual and extreme hurdle that the team had to contend with was a significant financial restructuring. While this process began during the Afia-led EHR selection process, the effects started appearing during implementation. The restructuring was a matter of life and death for the agency and by itself could have derailed the EHR. It pulled at key executive’s valuable time and was effecting a great deal of change across the organization, including turnover and problems hiring qualified new staff.

The second unusual and extreme setback was significant turnover. The CFO, CIO, and A/R Manager of the CMH all turned over 3 times during our work together. After deciding to outsource their third-party billing, the entire billing team left the CMH organization. Even the software vendor experienced turnover when the lead staff supporting the Practice Management module of the implementation left, along with several of their supporting staff.

The third unusual and extreme obstacle was a complete revamp of Medicaid in the state. During the time of the implementation the state went through a large shift from a single Medicaid payer to Medicaid Managed Care. So, as the implementation was occurring, the codes, rates, modifiers, and providers were completely shifting and needed to be continually monitored and updated to ensure that the billing system would work once the system went live. It was truly building the airplane while midflight.

As these changes were sweeping across the halls around us, our client relied on the Afia team to keep their EHR implementation moving forward. During this time, our implementation team kept their heads down and filled in the gaps that were being left by exiting staff, both at the client and vendor. At times, Afia had to even step in and run the day-to-day operations for the client’s Finance/Billing activities, while bridging that knowledge into the setup and configuration of the new EHR. Afia did anything necessary to keep the project on track.

Despite the odds, the system is a success

Thirteen months after the project kickoff, the system went live. Today, the system is stable and supporting staff with many functionality and process improvements that are advancing client care every day. The organization has been able to hire the lost positions and has even brought billing back in-house with a new team due to the efficiencies gained with the new system.

Every partner in the implementation had an important role to play in this client’s success. But, the fact is that the system would not have gone live without Afia providing consistency and stability in very unstable times. Our availability and dedication to the project allowed the organization to stay focused on their business while Afia made sure the implementation stayed on track.

While this is an extreme case, there are always distractions that will stretch in-house staff time – executives, billing, IT and on. In our healthcare landscape where regulations seemingly vary from day to day and talent is in high demand, a long EHR implementation leaves plenty of room for instability. Having a partner like Afia committed to your implementation is a great way to ensure that the project stays on track – even if all hell breaks loose.

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