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September 18, 2006
Mississippi’s Waveland Medical Center emerges from the devastation of Hurricane Katrina with assistance from the HIMSS Katrina Phoenix Project. Through late August 2005, historic Waveland, Miss., remained a thriving, though small, Gulf Coast community of 7,000 citizens, many whose families had lived in Waveland or surrounding Hancock County for generations. Waveland was known for its spectacular Mardi Gras parade and as a tranquil summer retreat for vacationers from nearby New Orleans. Then, on August 29, Hurricane Katrina slammed into the region, its vehemence sending a 40-foot tidal wave surging over this small, quiet, picturesque town, leaving it in rubble and ruin. Given the utter devastation, Waveland became known as Mississippi’s “ground zero.” Its population plummeted to less than 500, and homes, churches, community centers, municipal buildings, and businesses were razed. Those who remained in and around Waveland after the storm were faced with pressing needs for food, shelter, and basic services, not the least of which was medical care. Physician practices, such as the Waveland Medical Center, suffered the same fate as the majority of the town’s other businesses. The tidal wave that decimated the area submerged the building that housed the practice in 91/2 feet of water, destroying its more than 10,000 paper-based medical records and rendering what remained of the building and its contents unusable. Left with only their medical knowledge and experience and their determination to provide what services they could to what was left of the community, the medical center—better known to residents as its physician owner, Roberta Chilimiagras, MD; Practice Manager Lynn Murray; and Kim Ladner, RN—began the slow, arduous process of rebuilding, literally from the ground up. For weeks, the practice operated in the open, humid air and brutal 90-degree heat, without the benefit of electricity or phone service. Lawn chairs and folding tables accommodated patients—mostly those from other practices—and staff. Every patient seen was treated as a new patient and a new medical record was started. By necessity, the new records, like the old, were paper. “I bought paper from Wal-Mart and Dr. Chilimiagras
brought prescription pads from where she had been staying in Ohio,”
says Murray. “It was all we could do.” Katrina Phoenix Takes Flight Taking as its symbol the mythical bird that rose from its own ashes to live another life, the Katrina Phoenix Project is dedicated to assisting paper-based medical practices destroyed by the hurricane rebuild with an electronic health record (EHR). The Katrina Phoenix Project coordinates donations of EHR, practice management, dictation, and all types of electronic record system hardware, software, and consulting services—including mentoring and transition services—to project recipients. A 27-member, multidisciplinary advisory board oversees and helps drive Katrina Phoenix with input from the HIMSS EHR Vendors Association. HIMSS leaders, physicians and healthcare administrators, and Louisiana, Mississippi, and Alabama quality improvement organization (QIO) representatives also participate on the board. Katrina Phoenix operates as a volunteer effort, providing affiliated grants through the HIMSS Foundation, the philanthropic arm of the society dedicated to furthering professions in HIT. Through Katrina Phoenix, grantees such as Waveland Medical Center, receive software licensing for one year, discounted hardware, back-up services for varying periods of time depending on the vendor, training, technical assistance, and mentorship. QIOs in Louisiana and Mississippi play a key role in the project, helping not only to identify grant candidates but also to compile information that helps match donations to grantees, such as a description of the candidate’s practice pre- and post-Katrina and workflow assessments. The project’s advisory board then maps EHR vendor donations of equipment, software, and services to in-need practices. Project Goals Grantees, however, have strong motivation for embracing a digital approach to patient records. “If we can convert these practices to believe in digital records being superior to paper records, they will become strong advocates for digital records to their peers,” says Dave Collins, manager of the HIMSS’ Davies Awards Program and project manager for Katrina Phoenix. “The project’s mission aligns well with the overall mission of HIMSS—to spread the adoption of health information technology through education and peer-to-peer advocacy.” Peer-to-peer advocacy lies at the heart of Katrina Phoenix. Donations are one form of such advocacy, as vendors stepped up to the plate out of a belief that a strong EHR infrastructure would have lessened some of the posthurricane chaos, and saw their contributions, in part, as facilitating the development of that infrastructure in the Gulf region. To date, Katrina Phoenix has received more than 15 software packages from vendors. “Each donation is different and is matched to a practice based on the practice’s unique needs,” says Collins. Other vendors, such as True North Technology, provide related software services, such as application maintenance and secure off-site file storage. Mentoring is another form of advocacy. Once a practice is awarded a grant, it is paired with a volunteer physician mentor, usually a HIMSS Davies Award winner, who functions as a systems champion and helps ensure site success. “Katrina Phoenix is far from a plug-and-play project,” Collins stresses. “The job of mentors is to allay fears and offer the benefit of lessons learned from their own EHR implementation.” A large part of sharing lessons learned is explaining the workflow adjustments necessitated by the EHR system being implemented and any corresponding practice changes these adjustments may entail—which is no small undertaking. Transitioning to an EHR presents an enormous challenge for any organization under the best of circumstances, but for one that is rebuilding every other aspect of its practice and caring for a population still suffering the effects of a major hurricane, the project takes on new dimensions and additional challenges. “It’s the human factor that makes or breaks EHR success,” Collins maintains. “What made Waveland such a good candidate was that the people were very enthusiastic and willing to try something outside the realm of their experience. They saw the value in [an EHR] and have continued, persistent enthusiasm about the system.” That enthusiasm and a vision of protected patient information going forward energizes the Waveland team on easy days and buoys them on tough and frustrating days. Waveland Embraces a Brave
New Electronic World • two new Apple MacBook computers at a substantially reduced price; • a printer; • three years of fully managed data and software services from True North Technology; • EHR software from SOAPware with a one-year license and training; and • mentoring and technical assistance from Loveys. Waveland’s goal is to implement a disaster-proof system, which is one of the reasons the practice was matched with a donation of software services from True North. Its Northstar technology will enable Waveland’s EHR data to be fully backed up at four different off-site locations. By late July, Waveland’s hardware had been installed, a wireless network connected, and training on the new system started. “We’re taking it a day at a time, one patient at a time,” says Murray. “At this point, almost all the patient demographics have been entered into the system. We’re starting with H&P [history & physicals] information, entering that information for patients as they’re seen, then entering the same information for other patients as time allows.” Murray shared the data entry work with Ladner until Ladner left for a four-week maternity leave in mid-August. Further progress on transitioning more patient information into the system will slow down until Ladner returns. “Right now it’s stressful,” Murray says, who is doing double duty while Ladner is on leave. “It’s slow moving forward, but everyone with the project has been very understanding and helpful.” The Waveland staff knows it will take approximately one year for its EHR system to be fully functioning, which means it operates not only with all patient data intact but also with all its components, such as results reporting, up and running. In the meantime, Waveland is running parallel systems, a time-consuming and often stressful process, especially while the staff is learning the ins-and-outs of the hardware and software and new functions are brought online in a modular fashion. “Today was an especially hectic day, as we were without our nurse, had a full patient load, the phone’s been ringing off the hook, and Dr. Chilimiagras had two admissions waiting for her at the hospital,” Murray says, adding with some frustration, “and it took me 30 minutes to key in the lab results from one of the patients we saw today.” In the very next breath, though, Murray reminds herself that Katrina Phoenix staff and volunteers allow her, Chilimiagras, and Ladner to move forward with implementation at their own pace. Loveys, Waveland’s mentor and technical advisor from Katrina Phoenix, has coached them to learn one thing at a time and learn it well before moving on to something new. “We learn new things every day about what this system can do, and we can see where it’s going to be extremely useful, make our lives easier, and help us provide better care for our patients,” Murray says. Defining Success Despite the periodic stress of implementation, it’s clear that Waveland staff have embraced a belief in the benefits of digital records, one of the outcomes those behind the Katrina Phoenix Project hoped grantees would realize. This is a critical step in helping it envision life beyond the grant period when it assumes full responsibility for the costs of system maintenance. “We try to help practices realize the costs of going forward [after the grant period] so they can be realistically prepared,” says Collins, who believes successful EHR implementations don’t have a specific endpoint. “When is an EHR implementation ever really finished?” he asks rhetorically. “Success can be defined in different ways. We believe that getting a practice far enough along that they believe that going digital is to their and their patient’s benefit is a measure of success, and that each [implementation] milestone met is a success.” For more information about the Katrina Phoenix Project, visit www.himss.org or contact David Collins at dcollins@himss.org. — Aggie Stewart is a freelance writer and an editor, specializing in HIM and HIT. She also serves as consulting editor of Health Information Management Manual, 2nd edition.
• Case Notes, an integrated electronic shared
care records system from CSW • Companion Technologies • Greenway Medical Technologies • Health Language, Inc. • InteGreat Concepts, Inc. • JMJ Technologies’ EncounterPro • Lakes Health Systems’ MerCure • MD Synergy, Inc’s Synerios • MedcomSoft • MedicAlert Foundation • MediNotes Corporation • Medpracticeflow.com • MedQuist • Misys Healthcare Systems • Optimal Practice Solutions, LLC • Optimize I.T. • Practice Partner • REDmedic, Inc. • SOAPware EMR • Sobha Renaissance Information Technology • TeleVital, Inc. • True North Technology
Practice Criteria 2. Type: Target is primary care (specialty practices will also be considered) 3. Predisaster: At minimum, must have been using electronic practice management system 4. Location: Must currently be operating from a facility, not mobile Donation Criteria 2. Type of donation: Hardware, software, consulting, etc 3. Length of time: First year of primary donation expected to be provided, otherwise please provide alternate scope (length of time, dollar value, etc) 4. Practice responsibilities: Designate what costs,
such as maintenance, training, etc, the practice will be responsible
for (cost sharing, discounted rate, etc).
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