Small Size an Advantage to Critical Access Hospital's Successful EHR Implementation

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CHIME case study highlights how one small hospital beat the odds in EHR implementation.

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As a small critical access hospital in central Iowa, Henry County Medical Center overcame many of the key obstacles facing small healthcare providers who are now facing challenges in implementing electronic health records (EHR) systems.

However, the 25-bed hospital in Mount Pleasant, Iowa, didn’t buy into the defying belief that small size precludes success. Rather, participants in the process at Henry County agreed that its small size provided advantages in moving ahead with its EHR implementation.

The story of Henry County’s efforts to gain wide use of clinical records systems is the subject of a case study published by the College of Healthcare Information Management Executives (CHIME). The study, Electronic Health Records Help Henry County Prepare for Change, is the second in a series by Ann Arbor, Mich.-based CHIME, developed to highlight benefits and best practices of successful implementations of information technology.

Henry County Health Center is a critical access hospital located in Mount Pleasant, Iowa, a small town with a population of nearly 8,700, about 50 miles due south of Iowa City. Founded in 1921, the hospital operates 25 hospital beds, and it provides long-term care through 49 beds set aside for residents needing assistance with essential activities of daily life.

Henry County anticipated the challenges it would face as a small organization working on a project as large as implementing a new electronic records system. From the beginning, it sought input from staff and their assistance in reviewing potential products.

One of those helping to review information systems was Robb Gardner, the current chief executive officer of the facility.

“From a clinical standpoint, we had a voice in the decision,” said Robb Gardner, who became Henry County’s CEO in November 2009. During the selection process, he was the organization’s rehabilitation services director and helped review various brands of information systems. After the staff-assisted selection process, the facility chose to implement a system from Mobile, Ala.-based Computer Programs and Systems Inc. (CPSI).

The new records system engendered greater trust among staff that patient information would be available, and improved the ability to access information throughout a patient’s treatment, said Stephen Stewart, Henry County’s CIO, and a member of CHIME.

Physician adoption has been facilitated by executive efforts to provide consistent, direct and honest communication, various efforts to assist them in training and ongoing use. Small size worked to Henry County’s advantage, Gardner said. “When you have a small medical staff, is you get to know them as individuals,” Gardner said. “They know your values and work ethic, and they’re willing to work with you. In a larger facility, you may not get the opportunity to know someone personally. Here, we have the opportunity to have a more compassionate approach.”

Henry County also found that it’s also critically important to provide training and ongoing assistance for nurses on staff, and it has made significant investments in the people needed to support the shift to use of the new system. Henry County had two “super users” from the nursing staff, said Marcia Jamison, who also has a clinical IT coordinator role. “We helped with version upgrades, testing and training,” she said. “Having clinical IT positions is beneficial for the facility and the nursing staff; this way, you always have a ‘go-to’ person if you have questions.”

In gaining staff support, small size again can be an advantage, said Maureen Ewinger, director of inpatient nursing and a floor nurse at the facility. “We have the advantage of being smaller; we need absolutely every person here to make this successful. There is a tremendous amount of transparency in this organization. To gain staff support, the way it’s presented to them will make or break the project.”

At any size of organization, hospital leadership must fully back the initiative, Stewart said. “Does your leadership really support what you’re doing or are they just providing lip service? Do they really buy in and support it? This is not an IT journey or project. It is a clinical project enabled by IT. Leaders have to really embrace this and carry this message all the time.”

Recognizing the unique challenges faced by small hospitals, this September the federal Office of the National Coordinator for Health Information Technology (ONC) issued a Call to Action to see 1,000 rural and Critical Access Hospitals and small, rural hospitals meaningfully using certified EHR technology by the end of 2014.

To better support CIOs and other senior healthcare IT leaders at small and rural hospitals, CHIME is offering full membership to the highest-ranking IT executive at critical access hospitals or those facilities with annual revenues of less than $34.5 million at the reduced rate of $99. “In keeping with its mission to advance the role of the healthcare CIO, CHIME is dedicated to making its educational resources on EHR implementation and the details of Meaningful Use regulations available to all healthcare IT executives, including those with limited resources,” said Richard Correll, CHIME’s president and CEO.

About Henry County Health Center
Henry County Health Center provides care you trust and compassion you deserve by combining personalized care with the latest in medical technology. Our extensive programs and services are staffed by highly trained and dedicated healthcare providers who are compassionate and committed to those they serve. From maternity services to our long-term care facility, emergency services to surgery, inpatient and outpatient services, HCHC offers the breadth and scope of services to treat patients of all ages and stages of life. Visit our web site at to learn more about Henry County Health Center.

The College of Healthcare Information Management Executives (CHIME) is an executive organization dedicated to serving chief information officers and other senior healthcare IT leaders. With more than 1,400 CIO members and over 85 healthcare IT vendors and professional services firms, CHIME provides a highly interactive, trusted environment enabling senior professional and industry leaders to collaborate; exchange best practices; address professional development needs; and advocate the effective use of information management to improve the health and healthcare in the communities they serve. For more information, please visit

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