The Harbin Clinic: Early Adoption of EMR Advantages and Challenges

The Harbin Clinic: Early Adoption of EMR Advantages and Challenges Introduction Dr. Ken Davis leaned back in his desk chair, one ankle hooked on his knee, and reflected on the events of his day. Once again, the decision had been made to make another big change at The Harbin Clinic in order to improve patient care. The Clinic had made the decision to move from their current electronic medical record (EMR)1 vendor and select new software, a new electronic medical record, and a new vendor. Dr. Davis, along with the Information Technology director, Angie McWhorter, had taken all things into consideration- the support staff, the size of the company, how dedicated the company would be to The Harbin Clinic, and whether the new technology would allow The Harbin Clinic to successfully comply with the federal government’s meaningful use mandate. When he accepted the position of CEO in 2002, Davis had told the board of directors that he would only do this for two years. And yet here he was, ten years later. Davis sighed to himself. He realized that while they had made many advancements in the past decade, in some ways the Harbin Clinic was about to face the same issues once again. While the physicians and staff were now accustomed to using an electronic medical record, the Clinic would still have to undergo another implementation process, one that would include many difficulties. Given the amount of pressure on him today, he could only imagine how Dr. Ferguson, his predecessor, had felt when he had made the decision to introduce electronic medical records into the daily operations of the Harbin Clinic for the first time in 1999. 1 EMR: Electronic Medical Record, The 2003 IOM Patient Safety Report describes an EMR as encompassing : 1. A longitudinal collection of electronic health information for and about persons 2. Immediate electronic access to person- and population-level information by authorized users; 3. Provision of knowledge and decision-support systems [that enhance the quality, safety, and efficiency of patient care] and 4. Support for efficient processes for health care delivery. © 2012 by the Georgia Tech Research Corporation. This case was prepared by Professor William J. Todd and Margaret Singletary, Scheller College of Business, Georgia Tech. Cases are developed solely as the basis for class discussion. Cases are not intended to serve as endorsements, sources of primary data, or illustrations of effective or ineffective management. 1 Dr. Ferguson’s Epiphany Dr. J. Paul Ferguson, CEO of the Harbin Clinic in 1999, realized that he was able to vastly improve patient care. Years ahead of other hospitals and clinics, Ferguson decided that the best way to continue to provide superior patient care was to adopt electronic medical records. He knew that having this new technology would greatly reduce medical errors, but he didn’t have a way to prove it. He would have to find a way to convince the board and the shareholders, who relied on making the financial bottom line make sense for the business part of the clinic, that this was the right investment to make for the patients. He knew that it would be difficult because there was no other incentive for making this change for the Clinic. An EMR implementation would require much more than the Information Technology budget allowed for improvements. He would also have to convince the physicians to agree to change the entire flow of their workday as well as persuade them to participate in multiple days of training for the software. It would not be an easy adjustment for the Clinic, but he believed that it was a necessary change in order to improve patient care, patient safety, and would allow the Harbin Clinic to continue to effectively serve the Rome community. Harbin Clinic History The Harbin Clinic, founded in 1908 by Rome, Georgia natives Dr. Robert Harbin and Dr. William Harbin, is the product of five generations of medical history. Both brothers attended medical school at the Bellevue Medical College in New York City and decided to return to the south to practice medicine. The Harbin brothers established a surgical practice situated in northwest Georgia in the city of Rome in 1897 and practiced together until Robert’s death in 1939. In 1908, the brothers established the Harbin Hospital. By 1920, the hospital was the largest building in Rome and was recognized by the American College of Surgeons as one of only four hospitals in Georgia to meet the board’s quality standards of excellence. The Harbin Hospital continued to improve and innovate, and in 1919, after a generous gift from a local cotton broker, the hospital acquired a deep X-Ray therapy machine. The Harbin Hospital became one of the only medical facilities in the country to offer this treatment to cancer patients. The Harbin Hospital quickly became known both in Georgia as well as among the medical community across the nation as a leading facility. In the coming decades, the hospital established a department of internal medicine and diagnosis, an innovative orthopedic program, and performed new surgeries such as Cesareans, blood matching, blood transfusions, and one of the first goiter operations. Floyd Hospital, a county-owned medical facility, opened in July of 1942 and was direct competition for Harbin Hospital. In 1948 Floyd Hospital expanded its hospital to 120 beds. With this development, the Harbin Hospital made the decision to transform itself into a medical clinic. With this drastic change, the physicians would now only treat patients on an outpatient 2 basis with no overnight care. In 1969, the Clinic built a brand new 34,000 square foot building in Rome on land obtained from Berry College on Martha Berry Boulevard. This new facility provided office space for doctors as well as central services and a pharmacy. In 2007, the Clinic opened the Harbin Clinic Specialty Center that currently houses the vascular lab, vascular surgery, and ophthalmology. In 2010 The Harbin Clinic completed a brand new cancer center focused on patient-centered care and support. The new cancer center is designed to meet patient needs throughout all points of cancer care including diagnosis, patient navigation, radiation and medical oncology treatment, follow up care, and patient support. The Harbin Clinic Today Today the Harbin Clinic is the largest privately owned for-profit multi-specialty group in the state of Georgia. The staff includes 140 doctors representing 30 different medical specialties with a governing board comprised of 12 on-staff physicians. Its main location still resides in Rome with 20 satellite offices throughout Rome, Calhoun, Cartersville, Cedartown, Adairsville, and Summerville. The Clinic offers full lab and radiology services, CT and MRI scanners, and will soon acquire a dialysis facility. Because of its rich history of innovation, the Harbin Clinic is still known to take risks while offering superior patient care. The Clinic had established itself as a leading medical facility and earned the trust and respect of the Rome community. Dr. Ferguson’s introduction of electronic medical records, while radical at the time, seemed to fit into the natural advanced progression for the Clinic. Managing a Change for Quality Care After speaking with his colleague, Tony Warren, Ferguson realized that something must be done. Warren was right; having nine different charts for one patient was absolutely ludicrous. The current system allowed too many opportunities for mistakes that could include prescription drug interference with patient allergies, incorrect medical histories, and multiple separate paper charts made coordination of care among the different specialties too difficult. It didn’t allow for proper patient care, so a change was necessary in order to serve the patients more completely. He considered Warren’s suggestion of introducing an electronic medical record into the Clinic’s daily work activities. He knew about this new technology but would need to do some more research. He was easily convinced that it was the right thing to do for the patient with regards to patient quality of care and patient safety. The electronic medical record would allow The Clinic to coordinate care, completely eliminate expensive duplicate testing, and prescribe medication with accurate information about patients’ medical history and allergies. An electronic medical record could also allow the Clinic to streamline procedures such as patient check in and patient prescriptions in a more efficient manner. He realized that the Harbin Clinic had a unique opportunity. The Clinic was a microcosm of our entire health system, but because of its smaller size and private governance, they would be able to more quickly and easily implement this radical change to better serve their patients. 3 Ferguson now needed a plan to convince the board, the shareholders, and most importantly, the other physicians. This would be a big change in the daily lives of each physician and Ferguson knew it would be a hard sell. He reflected on the past decade. The 90s had been an era of change for the Harbin Clinic. The Clinic entered 1990 as medical arts group, acting as separate mini-clinics. They were simply affiliated physicians with individualized governances sharing one facility. Gradually, the physicians began to share personnel and eventually combined insurance plans. The Clinic began to grow and expand, adding four satellite clinics. They had attempted to join Floyd Medical Center under a PHO2, but this campaign had miserably failed due to differing philosophies between the two providers. Would a change in technology as big as an EMR implementation affect the unity the Clinic had finally achieved? He knew he would need outside consultation from someone with experience in new product implementation. In the fall of 2001, Dr. Ferguson approached Tom Fricks with his new idea- he did not know the costs involved, did not know if the doctors in the clinic would commit to the project, and had not yet built a business plan.

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