June 30: Today on TownHall Sue Schade, Principal at StarBridge Advisors has an intriguing conversation with Carrie Rahman, Applications Supervisor - Electronic Health Systems of Douglas Omaha Technology Commission (DOTComm) to talk about going from pencil and paper to an EHR system at the county’s youth centers. This episode provided a short and sweet dive into the implementation of communication tools and how an entire staff was able to adapt to digital health. What were the leading drivers to implement an EHR system? What key challenges and results did she discover throughout the process? What lessons would she share with other organizations embarking on a similar project?

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Today on This Week Health.

I have been a part of many, many implementations, and there are always many people that you have to drag along. One of the things that I try to do is make sure just to make it a positive thing. Make sure they realize that, it's not just change for them. It's change for everybody, but it's change for the good.

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Good morning. I'm Sue shade. Principal at star advisors. And one of the hosts for the town hall channel today's guest is Carrie ramen. She's the application supervisor for the electronic health systems at Douglas county as the county seat to Omaha and the most populous county in the state Douglas county is a major health in human services provider.

In the state of Nebraska, the Douglas county youth detention center serves 900 at risk youth per year. Delivering a range of care and interventional services for a. With no EHR system and a care staff made up primarily of contract providers, Douglas county needed a care collaboration solution, capable of bridging gaps in technology and administration.

And I think we're gonna learn all about this today from Carrie. So welcome Carrie.

Hi Sue. Thank you.

Good to have you here. So let's start by describing Douglas county more than I did in the intro, who all you serve in the community and your specific.

Yeah. So I am the application supervisor of electronic health systems.

I actually work for DOTComm the Douglas Omaha technology commission. They provide it services for all of the city and county entities in organizations within Omaha and Douglas county specifically I provide services for the Douglas county youth center. So with our youth detention center, it serves ages 13 to 18.

And then we also have the community mental health center and the long-term care center.

Great. And I was really excited to be able to talk to you today. Cause I think this is a little bit different than we often hear about when we think about health systems and hospitals and outpatient settings, more traditional outpatient settings.

So, glad that we're having a chance to talk about what you do. So what were the key drivers for the EHR for Douglas?

county

So for the Douglas county youth center, it really is. It's really a special place. Not only do we have healthcare services that we have to provide for them, but mental health.

And then it is a detention facility. So you have that aspect as well. So the biggest driver for us was that they were on paper for everything. All of their communications were phone calls. All of their doctor's orders were written on paper and faxed So when COVID hit we were not able to allow those outside providers into the building and communication really was difficult and it stalled a lot of our care.

So finding a solution for that during COVID in particular, and to get us up to speed on technology in general, but mostly during that COVID time, we really had to find something that would provide communication tool to give those kids the care that they needed.

Okay. And did you actually do the implementation during the pandemic?

We did. So that was another key aspect too. Right. So we had to do everything via zoom and email and phone calls. And so to work with a group of people who didn't use a lot of technology and then to have to toss in not only a system, that they were going to be learning, but they had to learn it online as well.

It sounds like that was definitely one of the key challenges. Were there other challenges that you and your team had to overcome that were maybe unique to this system?

Just also, so we have a lot of outside providers, a lot of contracted employees throughout the different hospitals that provide care.

So just getting everybody kind of on board and just informed, trying to get ahold of everybody, to make sure that they got signed up and registered and then also trained and had to use it. It. It's not like at a hospital where you can do mandatory training and everybody comes into your it training room to reach out and to give those providers, the training and education they need in a time that worked for them.

Okay. So, I need to kind of a clarification question. You can educate me. Yep. In terms of your care settings, your care settings include care settings that are part of other health systems within the geographic area, is that. Yeah.

So the youth attention center has their own place. And outside of COVID outside providers would come in during clinics.

They would have clinics Monday, Wednesday, Friday, and those outside providers would actually come in and see the kids do any kind of, assessments or care that they needed. So they're all contracted employees that. That work at like Charles drew or Nebraska medicine that provide the care.

So we have nurses on site at the youth center all the time to be there for anything that happens while the, youth is there. But then the actual medical care, we have that contracted out.

I see. So did you also have to deal with interoperability with some of the health systems in the area?

Well, since we don't have anything else electronic at the moment there wasn't really anything because Dr. First is its own platform and it's just web based or cell phone. It was super easy for them to just hop on and in, access that on any computer or on their cell phone. Douglas county youth center mostly uses the chat feature in the group.

Chats, which really has increased the communication speed instead of calling and getting, unit secretary where they have to take a message because the provider's seeing, 20 patients today, somewhere else. And then the provider can just get that chat immediately. And if they have a question or a concern, they can just respond via chat.

And so it's really. The communication, the turnaround time on just questions and getting answers has really, really increased since we've started this.

That's great. The next question I was gonna ask you are there key results and you started talking a little bit about them in terms of the communication improvements.

You wanna expand on that?

Yeah, absolutely. So before they were seeing, maybe 10 kids a day in, in, on the clinic days and there are I can't remember how many, but there are a bunch of kiddos there. And now that's doubled they can see an average of 20 kids a day just because the providers can ask any important questions before clinic , and the nurses can give them that information.

So. Just having that ability to see those things, instead of showing up and saying, okay, give me an update. They can get that information ahead of time. And so it's really increased communication and the ability for them to see more patients, which is good.

That's great.

And what's the satisfaction level for the clinicians and other.

staff

They love it. For the outside providers, they work in systems that have all of the things, all the bells and whistles. So it was really tough for them to, have to go back a couple of decades when they step into the youth center, because they don't have the electronic health chart, they can't just sit down at the computer and have everything at their fingertips They have to manually flip through papers and try to decipher handwriting which can definitely, definitely be difficult. So, and then the staff themselves I was kind of worried because they didn't use any electronic health record. They didn't use anything much more than email. So they were very.

Nervous to have a new technology to have to learn while also in COVID. But they did so amazing. They were just excellent. They were excited about it nervous, but excited. And then once they started using it I think they wonder how they ever. Survived without it.

That's a common response. If you get past the initial issues is like, how did we mm-hmm how did we do this before?

Right? Yeah. So were there any particular tips techniques that you did in terms of training and adoption for the staff, where it was all new for them and they were used to paper.

Yeah. So one thing really unique about the youth center is that how just welcoming and excited their staff are for change.

I have been a part of many, many implementations, and there are always many people that you have to drag along. One of the things that I. Try to do is make sure just to make it a positive thing. Make sure they realize that, it's not just change for them. It's change for everybody, but it's change for the good.

And, then to also get those end users involved at the very beginning, I think is important even with selecting the product, right. It gives them ownership and pride. And it makes them feel like they are doing this implementation, that they're, the ones that it just, it really helps.

So then they take that back and then they, sell it to and encourage their team members. And so that really helps.

That's great. That's great. Well, we all know that change management is critical in any kinda new system or migration from once to the next. So are there other key lessons that you would wanna share with colleagues in other organizations who might be embarking on a similar project?

I think one thing that we've really realized with the youth center is that they are such a unique setting. It's really hard to find something that fits exactly what they need. So, don't be pigeonholed to just one product, make sure you do your research. Most of the time a product isn't gonna fit every need, but when you're selecting that make sure that, it has the ability to be, tweaked or that you can make it fit for your needs.

I think that's, a big part of it as well.

Excellent. Excellent. So, is there anything else you wanna highlight from your experience there lessons for others, or any, anything else that you wanna share about the project?

Well, this particular one, like I said, was pretty unique in many ways, but also just working with the people at the youth center, their desire and just their appreciation in how much they care for the kids.

And for each other was really, really amazing their really solid team and you can just see their dedication. So that makes. So much easier. It makes me wanna do a better job for them as well. One thing that, by using this backline product they're now embarking on their actual EHR. And so since they had such a slam dump with using that product, it makes them way more excited and eager to learn and to adopt the fully HR.

That's great. Any and anything coming yet that you wanna talk about? Any future?

Yeah, we're just in the very beginning. Stages of trying to build out. And it's not very often in this day and age where you, have a, a from paper implementation again, usually you're from one to another. So to, to dial back and think about all of those processes and workflows and getting the paper to the electronic health record you know, we're just in those very, very beginning stages and it's, it's been a fun project.

I love them. I love implementations and the chaos of it. So it's, it'll be good.

Great. Great. You have a positive attitude. You've got people with a positive attitude and a passion for what they do. So to me, those are some of the critical success factors. So that's great. So I just wanna thank you for sharing your story.

Maybe we talk again when you've gotten further with the EHR and again, thank you so much for everything you've shared with us today.

Yeah. Thank you, Sue. Thanks for having me.

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