• A Winning EHR Strategy at HCA

    An interview with Mary Mirabelli Aug 10, 2015

    When a single hospital attains meaningful use, it's an accomplishment. When all 155 hospitals in the same system earn that designation at the same time, as HCA did, it's astounding.

    Mary Mirabelli, healthcare IT consultant and secretary/treasurer, HFMAWithin a few minutes of talking to Mary Mirabelli, it is apparent how she has managed to succeed at five careers in the time it takes most people to establish one.

    The health industry veteran bubbles over with enthusiasm and energy for her work. An occupational therapist with an MBA who became a hospital administrator, revenue cycle leader, health system IT executive, and now consultant, Mirabelli is driven by the mission of health care.

    "What I do now is not so different from what I did as an occupational therapist: We observe. We evaluate. We develop a treatment plan, and then we implement that plan," she says.

    Listen to a related audio interview with Mary Mirabelli on lessons learned in EHR compliance.

    Mirabelli is in her element when she can dig into a challenging idea and see it through to execution. Probably the most complex initiative she has overseen was HCA's compliance with stage 1 meaningful use, rolling out electronic health records (EHRs) to 155 hospitals and ensuring everything was copacetic with federal requirements.

    "To have a leadership role in making that happen was really exciting," Mirabelli says. But she is quick to acknowledge that it took a village-which leads to another of her favorite projects: HCA's hCare University, which trained a core group of young professionals to play a vital role in the EHR initiative.

    Attitude and Aptitude

    Mirabelli and her team recognized they needed a cadre of talented people to roll out the EHR systemwide. Uniquely, they decided it didn't matter if these new hires-called EHR implementation specialists-had IT, business, or even healthcare experience. What they wanted was people with attitude and aptitude.

    "The job description reflected a lot of general functional skills in terms of an ability to organize, communicate, and collaborate," Mirabelli says. "Attitude relates to a willingness to learn and be positive about opportunities that come up."

    HCA ended up hiring 120 EHR implementation specialists, in groups of 25 over a few years' time. All of the specialists were under age 30 with degrees that varied from English to biomedical science to marketing.

    To train the specialists, HCA launched hCare University. All of the new hires went through four to six weeks of classroom and hands-on training taught by HCA leaders. They learned how to collaborate with clinicians, ways to manage projects, and other vital skills.

    HCA's approach is based, in part, on the book What Color Is Your Parachute, which emphasizes that 80 percent of most jobs revolve around functional skills, such as the ones taught by hCare University. The other 20 percent relates to content or knowledge skills, such as how an EHR works. "We figured we could teach them the content skills, as long as they had good aptitude and attitude," Mirabelli says.

    Consistency and Inclusiveness

    Another vital content skill the specialists were taught was HCA's EHR methodology, which was developed through trial and error. Mirabelli and her team started with one pilot hospital. The lessons from that were applied to the next two hospitals. Then they continually refined the EHR methodology, rolling it out to 20 to 40 hospitals at a time.

    Assigned to specific HCA hospitals, the implementation specialists were charged with working with the CEO, physicians, IT, and other leaders to implement HCA's EHR methodology. "The specialists were instrumental not only in helping us succeed with meaningful use, but also with energizing the initiative," Mirabelli says.

    Another success factor in HCA's journey was an attention to inclusiveness and communication. "We probably spent as much, if not more, time on the people aspects as on the technology," she says. "Because you're expecting clinicians to exhibit new behaviors and embrace a system that is sometimes not well designed for their needs, you have to figure out ways to give them control and involve them in decision making. We had a physician advisory group at every hospital, which made a lot of decisions about how the system would be built and configured."


    Mary Mirabelli, FHFMA, is secretary/treasurer, HFMA, and a consultant for a major IT company.

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