Lessons Learned, Opportunities for Improvement

One of the advantages of the affiliation with Adventist Health that we looked forward to was updating our antiquated electronic medical records system. In August of last year, we took the first step in this transition by implementing the Cerner software in our clinic. Cerner is a thirdparty, software vendor whose electronic medical record is used by many hospitals and health systems across the nation. Many of our physicians and providers are familiar with this system. Cerner promises to bring to us many improvements over our older system, such as facilitating communication between specialists and primary care providers, an improved patient portal for ease of accessing your own medical information, and better tracking of quality metrics. Once the hospital is also put on Cerner, then there will be automatic sharing of information between the in-patient and out-patient settings. As a physician and as a resident of this community, I am excited to finally see this happening.

Both Adventist Health and Cerner are experienced in successfully transitioning medical records to the Cerner system and both prepared for months to make the transition. We anticipated any potential issues and how to address them should they occur, based on this past experience. However, as with any change, you can’t anticipate every issue, no matter how good the plan is. One of the problems we did not anticipate was how difficult it would be to make this change during one of the most challenging times in healthcare — during a pandemic.

We quickly realized that challenges to this transition coalesced simultaneously and created a perfect storm, as described below. As a result, this affected the excellent care we always strive to provide. Patient care is always our priority and drives every decision we make. That’s why we decided to make this transition because we knew how much it would benefit our patients. However, I heard from many of our patients and their family members about their frustrating or unsatisfactory experiences during the transition. We would like to reassure you that we heard you and we are determined to address these challenges.

I want to share more about what happened and in part 2, I’ll share the steps that we are taking to address the issues that have been brought to our attention.

The greatest challenge we faced was the loss of staff in the clinic due to the impact of COVID-19, including staff, themselves, getting sick or having to stay home to care for their sick family members, as well as burnout due to staffing shortages and frustrations by some stemming from the State-mandated vaccination policy. As a result, we moved into the implementation of Cerner with less staff than we usually have. Cerner is usually a turn-key implementation, but in our case, there were several unforeseen bugs that dramatically increased the workload for the staff that remained, instead of reducing the workload as expected. These bugs included the prescription refill function that did not communicate with local pharmacies as it was supposed to and problems associated with making referrals to specialists. Due to the increasing workload on an already reduced staff, the phones went unanswered and time on hold dramatically increased.

Patients began to call looking for answers as to why their prescriptions weren’t refilled or to find out about delays in getting their referrals, but could not get through. The process of moving data from our old system into our new one also turned out to be more labor-intensive than expected, thus reducing the efficiency of our providers in their ability to see their patients. As a result, we saw the time to get an appointment with a provider begins to stretch out from a few weeks to over a couple of months.

It’s important for us to learn from our experience with the clinic transition so that we can be prepared for a more successful implementation when we make our Cerner transition to the hospital later this year.

One lesson we learned is that it is important to ensure that all Cerner system functionality is working correctly before flipping the switch. Another lesson we learned is that we did not do a good job in communicating to our patients that the transition to Cerner was occurring and what to expect. If we had communicated to the community ahead of time, patients could have helped us look for issues and alerted us accordingly so we could address problems sooner.

When we move to the hospital transition to Cerner, we will make sure the community knows that it is occurring ahead of time, and we will provide easier access for our patients to reach a staff member to help them solve their problems.

The silver lining in all this is that we are better prepared for the hospital phase of the transition. I’m also happy to report that thanks to our community’s help, we now know the issues they are facing and we have since implemented a plan to address them. I will share the steps we are taking to correct the problems in the next column.

As always you can access this and previous Miller Reports at www. WMillerMD.com.

Dr. Miller is a practicing hospitalist and the Chief of Staff at Adventist Health Mendocino Coast hospital in Ft. Bragg, California. The views shared in this weekly column are those of the author and do not necessarily represent those of the publisher or of Adventist Health.