Most healthcare CIOs and other hospital and health system IT leaders greet implementing a new electronic health record system with a degree of dread. It's far from a simple task. But while most of these executives are up to the job, it's still always worth learning new tips and tricks for EHR switchovers.
Ismelda Garza is CIO at Cuero Regional Hospital, a 49-bed general acute care facility in Cuero, Texas. She has performed a number of EHR implementations in her career to date. We spoke with her about her recent EHR deployment at Cuero Regional and to get her advice for her peers at other provider organizations preparing for the same task.
Q. What motivated Cuero Regional Hospital to move forward with a new EHR, and why was now the right time? How does this decision support broader goals like advancing high reliability or improving clinical operations?
A. Our old technology was getting in the way of patient care. We operated with two different systems, one for our hospital and another for our ambulatory clinics, which created a lot of inconsistency.
Clinicians who work in both settings had to navigate different workflows, and nothing was connected. My focus isn't just on technical requirements; it's on how we care for our neighbors. We wanted a system that serves as a tool for our clinicians to provide safe, excellent care, not a hindrance that forces them to use manual workarounds and chase down paper charts.
The timing was driven by a real, practical need. Not a day went by when someone didn't ask for a change, an integration or a new feature that our legacy systems just couldn't support. We were asking our staff to manage inefficient processes, which created invisible costs and very real frustrations.
Before we could even consider a new EHR, we had to spend years building a modern infrastructure to support it. It was like performing surgery on a patient without anesthesia. Once that foundational work was done, we were finally ready to move forward.
This decision is a cornerstone of our journey to become a high-reliability organization. The primary goal was to get everyone onto a single platform, Meditech Expanse, to create one unified patient record. Having that single source of truth is incredibly important for patient safety. It helps us reduce duplicate tests, minimize the risk of errors and ensure that a provider in the clinic has the exact same information as a nurse in the hospital.
This integration directly supports our mission to create the safest possible environment for our patients.
Q. For a project of this scale, what kind of support structure has been most critical to your success so far? Are there lessons you would share with peers about building the right team around a major initiative?
A. For a project this large, you need a partner, not just a vendor who installs software. We chose our consulting partner, CereCore, to help us implement Meditech because we needed a company that understood our reality as a rural hospital, including our specific challenges, our staff shortages and our culture.
It was critical to have a team that could walk with us every step of the way, from the initial planning meetings all the way through go-live and into the optimization phase we are in today. They were there to help us stay on track and meet our deadlines.
The most critical factor was that their team brought both Meditech expertise and deep operational understanding. Their consultants have worked in other hospitals and clinics, so they know what it takes to get something like this done in the real world.
That experience was instrumental to our success. A major implementation is a massive undertaking, but the daily needs of the hospital don't just stop. The partnership helped us supplement our own staff and manage all of the competing priorities that never seem to go away.
My advice to other leaders is to prioritize finding a partner who gets the operational side of healthcare. Technical skill is important, but it's not enough. You need people who have been in your shoes and can offer practical guidance based on experience.
Your implementation partner should feel like an extension of your own team. They need to understand this isn't just a project – it's a transformation that affects every single person in your organization and, most important, the patients you serve.
Q. What changes are you seeing, whether in safety, workflow or satisfaction, as a result of your recent technology efforts? Are there any moments or metrics that help tell that story?
A. The most significant change is the consistency we now have across the organization. With our hospital and five rural health clinics all on a single EHR platform, we've vastly improved both efficiency and patient safety.
Before, a patient moving from the clinic to the hospital created documentation challenges. Now, with a single patient record, the care team has a complete and accurate picture of the patient's history, which helps reduce errors and supports our high-reliability goals.
A great example of the impact is seeing how our physicians now talk about and use the system. The transition was a big change, especially for our clinic staff, but we are in a much better place today. The story isn't always about the big EHR, either. Sometimes it's the small things.
We recently replaced an old, slow computer in the ER, and the feedback was immediate. That single hardware upgrade made a huge difference in a clinician's workflow and their ability to care for a patient efficiently. It highlights how every piece of technology contributes to the overall care environment.
While we had a shaky start in some areas, we are seeing a steady improvement in satisfaction. Before, every provider had their own customized order sets, and moving to a standardized system was a difficult transition. But by providing continuous support and listening to their feedback, we've built trust.
I am confident that every day will be better than the last. Seeing our clinical teams adapt and become more comfortable with the new tools is the best metric for success.
Q. How are you keeping up momentum after go-live, especially when it comes to clinician feedback and continued optimization?
A. Our strategy is built on constant communication. We have an open-door policy because we can't get better if we don't hear about the problems. We still hold weekly change control meetings to manage requests formally, but we also have daily huddles to address immediate needs.
More importantly, we've made sure our physicians know they are supported and can reach me or my team at any time, whether it's a quick text, a Teams message or a call. We want them to see actionable results from their feedback.
Today we are in full-blown optimization mode, and it's a continuous marathon, not a sprint. The wish was one patient record, but the challenge is also one patient record. A change in one department can have unintended consequences in another.
So, we have a clear governance structure. When a provider requests a change, we don't just flip a switch. We put it in our test environment and have everyone involved test it thoroughly. This disciplined process prevents us from breaking something while trying to fix something else.
Keeping our clinicians engaged is about making them feel heard. Initially, some were frustrated with new workflows that required more clicks. Instead of just telling them that's how it is, we sat with them, walked through the system, and explained the "why" behind certain safety features.
When we could make a change to improve their workflow without compromising safety, we did. Having an IT team that understands clinical operations is key to having these productive conversations and maintaining forward momentum.
Q. What kinds of conversations are you having internally about AI, and how are you approaching such opportunities or concerns, particularly in a rural setting?
A. Like everywhere else, AI is a hot topic at our hospital. The main conversation revolves around using AI as a medical scribe. Our doctors feel they could be more efficient if they had help with documentation.
In a rural area, recruiting staff is incredibly difficult, so finding a person to be a scribe is a real challenge. From that perspective, an AI-powered system is very appealing as a potential way to support our physicians and help them focus more on patient care.
My approach is to be both open-minded and practical. One of our doctors and I have demoed several AI scribe products. They are slick and do a great job of parsing out the important clinical information from a conversation. However, based on what I've seen so far, they wouldn't actually save our doctors time just yet.
The technology still requires a lot of cutting and pasting into the EHR, which could interfere with our quality reporting and even force us to add more hard stops, defeating the whole purpose.
While we're keeping an eye on scribe technology, my biggest concern with any AI tool is cybersecurity. It is a massive and very real threat we have to address with any new product. We are also exploring AI for internal uses, like for our IT help desk, which could be very helpful for our busy team.
Ultimately, it's my job to balance the excitement around new innovations like AI with the practical realities of our workflows, our budget, and, most important, the security of our patients' data.
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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