An EMR implementation is an opportunity for so much more than upgrading technology. Rural healthcare leaders, CEO Lynn Falcone and CIO Ismelda Garza, recap the tangible and intangible results from their multi-year long journey on The CereCore Podcast. What began with infrastructure upgrades to prepare for their Expanse implementation set them on the path to becoming a more highly reliable organization (HRO). The guiding principles of their quest were to improve patient safety and clinician experience so that community members continue to have confidence in the quality of care delivered at Cuero.
Stream the full episode to hear their answers to questions like these:
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Healthcare leaders often are called to defend the “why now” question during technology roadmap and budget planning sessions and to their board of directors.
Ismelda Garza and Lynn Falcone explained the impact their lagging technology was having on their people and knew it was the right time for Cuero to transition to a different EMR.
Our legacy systems were getting in the way of patient care. | Ismelda Garza, CIO Cuero Regional Hospital
Cuero had been using two different EMRs—one for ambulatory and one for the hospital. Providers were treating patients at both care settings and were frustrated with the inconsistency. EMRs are meant to be a tool to help clinicians take care of patients, not a hindrance.
“When I look at it in the why, it's not about technical requirements. It's more about how are we taking care of our neighbors, how are we providing them trust, how are we looking at safety and providing excellence, which is part of our mission,” explained Garza.
Cuero needed more from their EMR: flexibility, scalability, mobility, and ease of use.
Implementing Expanse in acute and ambulatory settings would help reduce duplication and minimize potential errors.
"Why we decided now—there wasn't a day that didn't go by when someone wasn't saying, ‘Can we make this change? Can we do this? Can we get this? Can we get this integration? Can we have this talking?’ said Garza.
“Every time we'd say, ‘Let's wait, let's wait.’ We basically were asking staff to come up with some manual workarounds or maybe they're rekeying data or chasing down charts. A lot of that was going on. When you look at it from that perspective—that cost, it's very invisible. So, it's not something that you see, but it's such a real challenge,” explained Garza.
The expectation for healthcare technology is that it supports patient safety by providing accurate clinical information for clinical decisions that help enable quality patient care.
“We embarked on truly high reliability organization (HRO), which is developing a culture of being obsessed with no patient harm. And part of that culture is when you have a near miss or you catch something and it doesn't get to the patient,” said Falcone.
She reflects on how there was a time when people didn’t talk about errors and mistakes.
We are more successful in our high reliability, I call it HRO quest, coming through our EMR build, because that was a time that we built teamwork and we built communication. | Lynn Falcone, CEO Cuero Regional Hospital
“We are blessed with the opportunity to care for this community in this county. We need to do the very best we can. As I mentioned, safety was one of my key quests going into it...it's nice to see how the team has grown, staff that have been involved, as well as our leaders. That to me is very exciting and the benefit is ultimately for our patients,” shared Falcone.
With focus on teamwork and open communication, the Cuero leadership team established governance processes and took steps to gather feedback from frustrated providers, supported day-to-day workflow pain points with training, and examined improvement requests with a wide lens.
Everybody needs to understand your EMR isn't going to be this magic bullet that fixes everything, because you create other challenges as you go. | Lynn Falcone, CEO Cuero Regional Hospital
Helping doctors adapt to change, Falcone seized the opportunity to foster collaboration among EMR experts and clinical departments to connect the right “people who can help talk their language.” It’s not uncommon for doctors to turn to the CEO explains Falcone, "because she'll fix everything. That's not my specialty. I'm not the clinician. I want my doctors happy, but I don't necessarily want to have a system that doesn't have fail safes in it.”
The team continues to pursue optimization, and staff feel empowered and are proactive as they refine the EMR. “We look at how something got built and say, ‘Oh, wow, this isn't happening. We can't have that.’ People are quick to say, ‘Hey, how can we fix it?’ Versus, oh, there's a whole other issue that can't get fixed,” said Falcone. “I tell them every day it takes a village. It's not just one person.”
Many technology initiatives contributed toward the high reliability goal, from infrastructure to replacing computers and scanners.
“We talk about the Expanse implementation, but it's so much more than that...We had that one example in the ER, replacing one computer, and how much it had improved a clinician's experience in taking care of a patient,” said Garza.
The multi-year technology journey was more than Cuero could manage alone. Once they had their infrastructure in place it was time to bring on MEDITECH implementation experts and they chose CereCore.
“We're not looking for someone to just install software. We wanted individuals, a company, a vendor that understood our realities, our challenges, our staff shortage needs. Somebody that could walk with us from our planning of go live until today,” said Garza.
[You have] all the competing priorities. You have this big project going, but nothing else stops. | Ismelda Garza, CIO Cuero Regional Hospital
Both Falcone and Garza reiterated that CereCore consultants brought MEDITECH expertise but also deep operational understanding.
“They have been at other hospitals, they've been at other clinics, they see what it takes,” said Garza. “It was really instrumental in our success to have them help us stay on track, meet our deadlines and supplement some of the staffing we were having some shortages in."
Here’s where to start:
Stream this full episode for more leadership advice about navigating AI, realities and misconceptions of rural healthcare leadership.
Many thanks to the Cuero Regional Hospital leadership team for sharing their viewpoints throughout their MEDITECH Expanse implementation. Hear more in previous episodes on The CereCore Podcast:
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