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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 third party, 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, 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 begin 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. 


Miller Report for the Week of April 18th, 2022; by William Miller, MD

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.

4 Comments

  1. jonah raskin April 19, 2022

    Thanks, Doc!! Much appreciated.

  2. chuck dunbar April 19, 2022

    The Cerner transition and the very frustrating issue with disrupted prescription refills was one issue I particularly noticed for a number of months, as one person who participates in this local health care system. What especially frustrated me was the utter lack of official communication (other than frustrated pharmacy staff and clinic staff complaining to me that the new system did not work) about this issue. Why did the clinic not send a clearly stated letter to all clinic patients about this issue, with special attention to addressing how patients should respond to obtain important medication refills. In my case, for a number of months, i resorted to sending my primary doctor a note, asking for needed refills. I began this practice after several delays of weeks without receiving refills and no communication from the pharmacy or the clinic.I am certain that many other folks did the same or developed some other work-around.

    It was a ridiculous circumstance that meant patients, not the system itself, took on the burdens of this task. Why did the clinic and pharmacies not immediately revert to using the FAX system for medication refill requests, a method that worked quite well in the past? Has digital technology–often so poorly vetted before it is sent out into the real world– so weakened our problem-solving ability that digital malfunctions subvert important functions for months when system work-arounds could have been put in place. This was one example of an inexcusable loss of function by the clinic with no help for patients for months and abysmally poor communication. It was a damn mess.

    I have no faith at all in promises for a better future as another digital transition occurs. Sorry.

  3. chuck dunbar April 20, 2022

    I’ll add this:

    I felt great empathy with all the direct services staff who had to deal with this really screwed-up digital system. It made their work that much harder during a time that was already terribly hard, even dangerous.
    Dr. Miller writes: “One lesson we learned is that it is important to ensure that all Cerner system functionality is working correctly before flipping the switch.” This comment just floors me. How can it be that no one at the higher levels of management DID NOT KNOW THEY NEEDED TO CHECK THE SYSTEM TO SEE IF IT ACTUALLY WORKED? That actually scares me and wonders what the hell they were thinking….

  4. Uthinkweredum April 24, 2022

    Wow, the lack of accountability is extraordinary. The lack of employees due to COVID-19!! How many meetings did AH administrators have to come up with that line of garbage? Then after several more meetings, they decided to add, “let’s also blame it on employees not getting vaccinated!” I can see the fake smile on Shauna DeMarquez’s lying face.
    The administration made a point to cut employees hours in the clinics due to low patient productivity, leaving staff overwhelmed with patient care. All while not educating or notifying providers, customer care associates, and clinical staff of major changes with cerner. Everyday seemed to be worse than the next. Patients were upset, scared and frustrated. Staff would reach out to management without a response. Employees dealt with poor administration that did not care about employees or think about repercussions this would have on patient care in huge ways.
    Recently providers have quit, leaving a great deal of patients without a primary care provider, gynecologist and rheumatologist.
    The prescriptions, there has been a “bug” in this department for at least 2 years. It is no fault of the pharmacies, administration knew this, the issue fell on deaf ears.
    The referrals. The referrals were working great before administration decided to change it, now it is a mess.
    This administration only cares about 1 thing in regards to the clinics. QUALITY MEASURES!!!!! Now quality measures sounds like a grand title. They get paid from partnership when quality measures are met. This means Pap smears, mammograms, colonoscopies, diabetes controlled, blood pressure in range, and routine maintenance. It sounds great, keep people healthy. But not with Adventist Health, it’s a big fat pay check. They will do anything to get that poor patient that suffered a horrendous car accident and didn’t have insurance, who applied for partnership into the clinic for a Pap smear. Including having a stranger call them, telling them “looks like your due for a Pap smear.” Yep folks that’s why people are calling you or sending letters. It has nothing to do with you, it’s all about money.
    This silver lining bull$&@“, is not a silver lining, it’s excuses for this poor administration to make more money, for this not for profit organization. I do believe that AH employees care about there patients. In a rural town where Adventist Health Ukiah Valley is one of the main employers, they do not have many options.

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