Nurse Administrator Discusses How EHRs Helped Patients in Joplin

Parmeeth M.S. Atwal | June 29, 2011

Dottie BringleDottie Bringle, R.N.,  was on her way to Ireland when the tornado hit Joplin, MO, the town where she has worked as the Chief Operating and Chief Nursing Officer at St. John’s Mercy Hospital for 24 years.  Standing in line at the Atlanta airport waiting to catch her connecting flight to Dublin, she heard the news that a storm had struck Joplin, and that it was bad. Dottie rushed back to Joplin, and when she arrived, she found that the hospital staff were up and running in a temporary facility, since the hospital building in St. Johns had been destroyed.  All patient records were retrieved, however, due to the electronic health record (EHR) system the hospital had transitioned to only three weeks before the storm.

ONC talked to Dottie about St. John’s transition to EHRs and how they proved to be invaluable after the storm.


Tell us about St. John’s Regional Medical Center and your role there.


I am the Chief Operating Officer and Chief Nursing Officer at St. John’s and have worked there for almost 24 years. St. John’s is a 367-bed hospital that offers high-end specialty type care. Although located in a small community of about 50,000, it serves a larger population of about 600,000 who come to St. Johns from the surrounding rural areas.


After the hospital building was destroyed, how were staff from St. John’s able to treat patients?


A command center was set up at Memorial Hall, the local auditorium, along with a mobile tent that the Army helped to construct. Having an EHR system allowed us to:

  1. Account for all of the patients that were in our hospital; we were able to locate each and everyone fairly quickly after the tornado hit.
  2. Forward patient records to other facilities within two hours of the evacuation due to our EHR system. (This included previous and current medical histories.)

This was especially important for our sister hospital in Springfield, where many of our patients were transferred.  It would have been difficult to help manage the care of our patients without EHRs.


St. John’s transitioned to EHRs only three weeks prior to the tornado. Can you describe the transition process and the approach the hospital used to implement an EHR system?


We decided to go with the “big bang” approach and transition the entire hospital to EHRs at once. We also implemented a new lab system at the same time and a few months prior had completed a Smart Pump implementation, all of which were very important in providing safer care for our patients.

The “Red Shirts”

When St. Johns went live with EHRs, we had tremendous support from the Mercy hospital system. On the first day, 250 Mercy staff who had been working with, and were familiar with EHRs, descended upon our hospital to provide support. We referred to them as “red shirts.” For about two to three weeks, the “red shirts” answered questions and helped staff maneuver through the requirements. They then began to taper down and allow the local “super users” to step up and provide assistance to their fellow co-workers. It was a very collegial approach.

This was a critical piece in the initial phase of implementation. There is a learning curve, and you’ve got to have the manpower available to make sure your staff has the information they need to effectively use EHRs.

Training is really important.

I established “playground time” for my staff, where they would practice using an EHR on a mock patient. They had to complete at least eight hours of “playground time” in addition to the other training they received.

Training, preparation, and readiness are critical for success. Once you’ve completed those steps and worked out the bugs, it’s [EHRs are] a huge safety net for patient care.


How did you view EHRs before this experience and how has your view changed since?


I wasn’t convinced – I knew that EHRs were important for patient safety, but thought that it would slow down patient care.

When St. John’s transitioned to EHRs, it was somewhat overwhelming and was fairly time consuming.  A lot of training took place prior to the actual implementation to ensure that hospital staff were as prepared as they could be before going live.

Now I am an absolute believer!

People at St. John’s are excited to have EHRs in place. In fact, one of my nurses told me:

“That very day [when the tornado hit Joplin], I had decided that maybe I like this EHR thing,” and then the storm hit.

When the storm hit, [paper] medical records were flying all over the community.  This experience has changed people’s minds – 99 percent of the people in the Mercy community are now believers too.


Would you recommend EHRs to other health care providers and hospitals? Do you have any advice for people who may be skeptical about EHRs?


I absolutely do recommend EHRs to other health care providers and hospitals.

It can be a difficult transition; however, I believe it gives providers quick and easy access to patient information, which allows them to provide comprehensive care.  If people are skeptical, they should remember that:

The patient should always be the most important thought we have as we deliver care.