Teresa Weber, clinic practice manager, Wickenburg Community Hospital
Photo: Teresa Weber
Teresa Weber is clinic practice manager at Wickenburg Community Hospital, a critical access facility located 60 miles outside of Phoenix in Wickenburg, Arizona. Rather than rip out its EHR and replace it with a new one, the hospital conducted a significant EHR optimization initiative.
Weber strongly believes hospitals – especially rural facilities – can maximize work with vendors and optimize systems rather than rip and replace. She has been in health IT for 25 years and was a key driver of Wickenburg's EHR optimization effort.
Healthcare IT News sat down with Weber to discuss why the hospital optimized versus replace, tough conversations with the EHR vendor, simple ways small hospitals can start optimizing, strategies to build rapport between clinicians and vendors, and some of the optimization outcomes.
Q. What prompted Wickenburg Community Hospital to pursue EHR optimization over a complete system replacement?
A. We extensively evaluated our options, including demoing various EHR systems. Through this process, we realized we were not using the full functionality of our TruBridge EHR. We needed to understand where and how to create efficiencies to maximize our investment.
Finances played a major role in our decision of whether to optimize or undergo a complete overhaul. A full system replacement is expensive, and that doesn't account for the costs of data migration, potential hardware upgrades and workforce training.
We also considered the significant time commitment involved in learning an entirely new EHR. This would inevitably affect our clinical workflows and staff productivity. Given these considerations, optimizing our current system offered a more fiscally responsible and less disruptive path forward.
Q. What were some of the toughest but most valuable conversations you had with your EHR vendor? How did its staff respond?
A. One of the most valuable conversations we had involved openly addressing specific pain points and identifying areas where we needed more support. We recognized enhancing communication from both sides was necessary to improve trust and productivity.
Our team also understood our responsibility to refine internal processes and clearly convey our challenges, allowing our vendor to better pinpoint where it could provide greater assistance.
Once we raised these concerns with our vendor, we felt confident they would help us succeed. Their team was just as dedicated to the optimization as we were, which reassured us. Dedicated resources helped us address the roadblocks we were facing. Open and honest dialogue brought immense value as we moved forward together.
Q. What are the easiest, most impactful ways small hospitals like yours can start optimizing their EHRs? What should be the first areas of focus for EHR optimization?
A. One of my biggest pieces of advice for other hospitals beginning this process is to start small and practical. Go after the low-hanging fruit. These are areas where you can make relatively small adjustments but see significant improvements fast.
We started by assigning someone to "own" and represent the EHR system. This person must speak both the clinical language and the IT language, engaging and motivating colleagues in the process. This individual became the central point of contact and an advocate for the system within the hospital.
Ask your EHR vendor to demo the system in its current state, even if you've used it for years. This helps identify areas of untapped capabilities and upgrades you may be paying for but are not even aware of. Incorporate current releases, new products and applications within your EHR and update your system on a regular basis.
Create subcommittees to manage processes that aren't working and take time to listen to the needs and wants of employees across your organization. This approach fosters shared ownership and ensures optimization efforts solve real challenges faced by clinicians and administrative staff.
Q. What strategies helped you build rapport and keep engagement high between clinicians (including visiting specialists who may only be familiar with using other EHRs) and IT vendors, especially during this period of change and training?
A. We developed a steering committee to effectively build rapport and improve engagement between clinicians – including visiting specialists familiar with various other EHRs – and IT vendors. Two of our executive leaders served as sponsors for the committee, which helped ensure buy-in and demonstrate the strategic value of optimization across the organization.
The steering committee met weekly to discuss ongoing needs, identify pain points and push us forward. We worked together and aimed to make everyone feel heard and valued while emphasizing the importance of adhering to best practices.
We did and continue to have struggles with engagement; however, standardization and well-documented processes have been incredibly helpful. Clear, documented workflows allow everyone to feel empowered, correct mistakes and stay up to date on our specific system.
For example, when a visiting specialist encounters a workflow different from what they're used to, readily available, standardized documentation helps them adapt and minimizes frustration.
Q. What have been some of the outcomes of your EHR optimization?
A. Our optimization delivered tangible improvements in operational efficiency. For instance, automating account creation in the clinic now saves approximately two hours of administrative time daily. Our use of personal digital assistants in materials management also saves our team about two to three hours of manual work each day. These devices make our processes more electronic and efficient.
Additionally, the clinic now uses Patient Connect for easier patient communication regarding appointment reminders, confirmations and emergencies. This helps keep our clinic no-show rate under 4.5%.
The operational gains extend to patient safety and financial accuracy. We introduced scanning for patient armbands and medications throughout the organization to enhance patient safety and continuity of care. We regularly monitor these outcomes and key performance indicators with reports from our EHR.
Additionally, we standardized infusion visit workflows. This change prevents duplicate visits and potential double or incorrect documentation.
On the financial side, we adopted nTrust. This eliminated multiple third-party clearinghouses and boosted our billing processes. We also improved charge capture by scanning items whenever possible. Our item master clean-up supports these efforts, removing unnecessary supplies that would never be charged to a patient and preventing incorrect billing.
Our EHR equips us with strategic insights, and we continue to move toward best practice wherever possible. We updated and revised preference cards in the operating room with current information, making surgical procedures more efficient.
Our team also assists with reporting. We thoroughly review all reports for each department, and now department leaders receive tailored daily, weekly and monthly reports. The relationship with our vendor has been core to our success – we continue to stay informed and keep our systems updated with each new release, working hand-in-hand to drive further advancements.
Follow Bill's health IT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.
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