Posted by: Knightbird | July 22, 2010

Electronic Health Records

The U.S. Government has made adoption of Electronic Health Records a priority through the granting of incentives and penalties. The incentives come through medicaid and medicare increases conditioned on the meaningful use of an EHR system. After 2015, Doctors who are not meaningfully using an EHR will be penalized 1% of their Medicare payments. There is no current penalty for Medicaid.

Chugachmiut is implementing its choice of an EHR, Allscripts.  So far my medical staff are learning the use of Allscripts, troubleshooting, and will be upgrading with a practice management addition to the EHR. They are planning to deploy the EHR to our Village based clinics (4 of them) starting in August.

When we made the decision to adopt an EHR, I chose the Lean method of planning. I anointed a team, and met with them to explain the goals. In order for us to communicate effectively with the Alaska Native Tribal Health System, we would need to adopt and implement an EHR. Their task was to explore the universe of EHR’s for the one they felt was most suitable for our type of practice. They were to adopt a package, ensure that our network was appropriate and recommend upgrades for our computer systems. They also had to plan for maintenance of the system, training for staff and deployment of the EHR throughout the organization. In return for the work they were doing, I committed to accepting and paying for the package they wanted. In other words, I stated the long term goal, and the blazed the path.

It worked. I am incredibly proud of the team that worked on the project. When I visited the Seward clinic, I was given a demonstration of the EHR. The CNA demonstrating the EHR for me was knowledgeable about the package and even better, enthusiastic about it. Other staff who used the record were equally enthusiastic. And instead of grumbling about adopting an EHR, they were fully engaged in working through the problems that occur with implementation of any new software package. They acknowledge problems, and work to fix them.

Other health care organizations in Alaska have their EHR selected for them, and they are supposed to accept it and make it work. I have heard about a lot of grumbling going on. My team selected what would work for them, and as a result, they are relatively happy. They have nobody they can complain to. What would be the purpose. They selected the package, they have the authority to make it work delegated to them, and they are responsible for adoption, implementation and continually improving it. All of this is done in the name of improving the care for our patients.

My conclusion: delegation of authority and responsibility works.


  1. That’s great, Patrick. They made it their own. I’m just curious… When I have a project like this where it is an implementation of a new process and there is no current state, I explain to teams the principles of a future state and let them plan, with a little guidance. Is that what the team did? Love to hear back from you on this one. Thanks.


  2. Mark. We actually defined our future state when we mapped our billing and coding process almost 5 years ago and have been working towards it since. This project was pursuing the future state we identified as an extension of the poor paper record. This also meshed with our Electronic Document Management future state for our paper document management system that I wrote about which started with our “infamous Quonset Hut.”

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