Broadlawns Medical Center (BMC) is a teaching acute care community hospital of 200 beds located in Des Moines, Iowa. As other safety net providers across the nation, the hospital operates in a difficult environment with a growing number of uninsured patients and simultaneously dwindling tax support. By 2005, George Washington University and several Joint Commission reports had publicly highlighted the hospital's challenges of financial sustainability and the provided quality of care. The hospital's senior management team decided to adopt an Electronic Health Record (EHR) system in an attempt to gain access to real-time performance data. The EHR adoption project posed many organizational, managerial, and technological challenges but also provided numerous eventual benefits. BMC had not only successfully resolved the stated problems of healthcare quality, financial stability, and patient satisfaction scores, but also became one of the national leaders in healthcare information technology.
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The Joint Commission (TJC) is a not-for-profit health care quality accreditation organization based out of the United States. Many state governments recognize TJC accreditation as a prerequisite to Medicaid reimbursement. Healthcare providers participating in the TJC accreditation program are subjects to triennial accreditation cycles. TJC accreditation hinges on surveys, which are conducted impromptu 18 to 39 months apart. Hospital accreditation decisions and potential Requirements for Improvement (RFIs) are made public with the date accreditation is awarded. TJC updates the standards it uses on a yearly basis and posts them on its website. Broadlawns Medical Center surveys of 1998, 2001, and 2004 did not result in TJC delivering full three-year accreditations due to quality problems. Instead, The Joint Commission issued RFIs with tentative follow-up focus surveys meant to correct the revealed quality deficiencies.
In June 2005, George Washington University released a comprehensive study, which raised doubts about “the continued viability of Broadlawns Medical Center (Jenner, 2011).” The study highlighted such problems as the increasing numbers of uninsured patients, insufficiency of funding sources, and absence of a clear sustainable model for delivering safety net services to the uninsured patients of Polk County, Iowa (Nolan, et al., 2005). University researchers interviewed more than thirty area informants and drew secondary data from a variety of official sources. The study stated that Des Moines healthcare safety net offered few specialty services, which were highly fragmented and poorly coordinated when matched with the national statistics. The study mentioned several failed attempts to create an electronic collaboration system, which would assist the uninsured patients in navigating the highly fragmented and increasingly complex healthcare environment. Broadlawns Medical Center learned from the report that it was considered the county’s core safety net healthcare provider. The hospital also gathered that even though the community wanted BMC to survive, taxpayers and officials were reluctant to guarantee the hospital’s future financial stability. Broadlawns needed to act quickly by raising the focus on healthcare quality, reducing fragmentation of the specialty services, strengthening partnerships with other healthcare providers, promoting the positive image of the hospital, and increasing public support.
Until recently, the hospital’s information systems solution was Siemens software suite originally implemented in 1984. By 2004, the software lacked many of the needed updates and was a significant impediment to the future operations of the medical center. The same year, BMC senior management decided that a technological transformation was necessary.