John Stanley is no rookie when it comes to health IT. The senior VP and CIO at Riverside Health System, a 5-hospital network based in Newport News, Va., has been deploying technologies for 35 years. What has his experience taught him? To position his organization ahead of the curve when it comes to initiatives like Meaningful Use, and to have a ‘bullish’ attitude about meeting requirements. In this interview, Stanley talks about his organization’s long-standing relationship with Siemens, how he and his team are working to create an environment of interoperability, and why sometimes you need to bring in help to deal with the complexities of order sets.
- Siemens ambulatory question — Riverside is longtime GE Centricity (Logician) customer
- Looking at some Centricity-Soarian integration
- John Glaser takes the helm
We have information that flows up to Soarian, and returns back to that office record. For example, if a patient is in the emergency room, we’ll send a note out to the physicians who may not know their patient was in the ER.
We built this Record Link so that if you really want to go into the physician office record, you just click on the tab and you’re already signed in. If there was a patient record in an office-based practice, you have access to that information. And likewise, you can come back and look at the PACS without having to sign on.
That was more from peer pressure standpoint of ‘We’re using one record in the office practice. It would be so much easier if you change.’ So our strategy has been that we have 95% of the physicians all using the same record. And I wouldn’t say it’s a mandate, but it’s been pretty close.
You might go to the hospital or have a procedure done once every two years or so, but generally you’re going to the office practice. And tracking chronic disease is so much easier to do in the primary care setting, so it’s definitely the goldmine.
Guerra: Let’s talk a little bit about the ambulatory environment. Refresh my memory—what does the health system own in terms of ambulatory sites?
Stanley: In our case, when we say ambulatory, we’re talking about those 450 practitioners. We started building primary care, but we really have all specialties represented. And if we’re talking about Meaningful Use, we’re really basically talking about the physician’s office record. That’s what we’re talking about in the ambulatory setting. In Riverside’s case, we have a different partner—General Electric, and we use Centricity as our electronic health record. We actually began using that record before GE even owned them in 1995-96, so we have 15-16 years of experience there, and again, bullish is the word. We’ve been automating offices for many years; doing order entry in the office, electronic prescribing, all of those things. And when we looked at the regulations, we said the same thing—that we need to move left a little bit and right a little bit to possibly meet the numerators and denominators, but overall, I think we’re in pretty good shape.
GE got certified a little bit later than Siemens did, and so we installed their version back in February or March, and so we’re in the process of attesting in various phases with the physicians. It’s in a way, it’s a little more difficult, because of the 450 physicians, if you remove the hospitalists and you remove the ER physicians and the other hospital-based physicians, we end up with close to 300 physicians being eligible—but they are 300 individual physicians.
Guerra: Are we talking 300 offices or 300 individual physicians?
Stanley: Three hundred physicians. And the way Meaningful Use works, you could have one office with 10 docs in it and you have to do 10 separate attestations because their numbers may be different individually. So rather than doing four hospitals, we’re literally tracking close to 300 individuals and saying, ‘What’s your e-prescribing percentage?’ Now some of time it’s, ‘You’re using Centricity. It’s an infrastructure,’ and as long as you’re using a decision support rule, for example, that’s an easy one. But there are several individual indicators, and you have to measure it by doc, not by practice. So it’s a little more onerous in the details, but again, we’re feeling pretty good. The window is a little different; for hospitals, it goes to September 30th for the first year. For physicians, it goes to December 31st for the first year.
Guerra: Was the Logician or was it IDX?
Stanley: It was Logician. We were one of the early Logician users way back. We continue to automate physician practice, and we have information that flows up to Soarian, and returns back to that office record. For example, if a patient is in the emergency room, we’ll send a note out to the physicians who may not know their patient was in the ER. We send the documents, lab results, dictation and so forth to the office physicians.
Guerra: Did you upgrade to Soarian from a previous version of Siemens software?
Stanley: Way back when, we were on an Envision user, and we had done some clinical automation, obviously, but not CPOE. We had done some nursing assessments and had our orders there. Now the fourth hospital that joined our system a year and a half ago did not; they had a QuadraMed system that was being sunsetted, so we had to make a harsh decision. And because of Meaningful Use, it put a little more pressure on the timeline, and so we brought them over to Soarian on most everything.
Guerra: Where are you with any sort of Centricity-Soarian integration?
Stanley: Well you have to be careful, because in the hospital, there is so much data generated every single hour, every single day, and if you’re in an office practice, the primary care physician doesn’t necessarily want to see all of that. So you want to make sure they have the necessary information available, but if they need to see the details, they can switch.
On the integration side, we have some feeds that go back and forth. We’ve also done some work with what we call ‘Riverside Record Link.’ We also do this with our PACS system, and we do have right now a separate electronic record for the emergency room. We take those four systems, and if you are, for example, an ER physician, you use single sign on. And let’s say you’re living in your ER record. We built this Record Link so that if you really want to go into the physician office record, you just click on the tab and you’re already signed in. If there was a patient record in an office-based practice, you have access to that information. And likewise, you can come back and look at the PACS without having to sign on. You could pull up the image, and it does context linking where, again, if you have a patient in front of you or you have access to patient on one system and you click on the other one, it sort of follows you. Now we haven’t rolled that out completely throughout the health system; we’re in the process of doing that, but we have successfully deployed it in the emergency rooms. The hospitalists like it because if they need to, they can go into the office practice and get more information about the patient. It links right over there.
Guerra: I know that Siemens has a relationship with Next Gen; I don’t know what level of integration is there, but it’s a relationship where it’s sort of the preferred solution for their customers. Is that anything that tempts you, or is that not that much of a change from you have in place in terms of the integration with Centricity?
Stanley: Because of our history of 15 years with Centricity and the maturity that we have with that, it’s not something where we said, ‘Let’s drop that and go to NextGen.’ We actually do have a practice that has NextGen—it’s a gastro practice. And I have to tell you, there was peer pressure from all of the other physicians wanting the gastro docs to use Centricity. And yes, we can send some documents back and forth, but being able to capture the flag—the immediacy of communication actually has worked. My understanding is the gastro group is now ready to switch, and so we’re making plans to bring them on Centricity. But that was more from peer pressure standpoint of ‘We’re using one record in the office practice. It would be so much easier if you change.’ So our strategy has been that we have 95% of the physicians all using the same record. And I wouldn’t say it’s a mandate, but it’s been pretty close to a mandate for practicing in the group.
Guerra: So what if Siemens were to come out with a home-grown, off-the-same-database Soarian Ambulatory record?
Stanley: Yeah, we’d take a look at that, certainly. And I do encourage them, and have from the first time I met John Glaser, and everyone at Siemens knows that that is something they probably need to and will be, from what I understand, shoring up here. Now our issue, once again, is that we are so mature having the EMR experience, and in some cases, 15 years of patient history. And I don’t want to underemphasize that at all, because that’s where the goldmine is, and we realized that when we started looking at hospital records and office practices. The goldmine is in the office practice, because that’s where you’re going to go as a patient; they’re going to have more information. You might go to the hospital or have a procedure done once every two years or so, but generally you’re going to the office practice. And tracking chronic disease is so much easier to do in the primary care setting, so it’s definitely the goldmine. We have to be careful and make sure that we stay solid there because of the medical home and ACOs. It’s going to be about to prevention and that starts with the office space primary care practice, if not the patients themselves in the home.
Guerra: How did you feel, as a customer, when John Glaser took the CEO role?
Stanley: As a customer, I thought it was a very interesting move. And after thinking just a few minutes, I said, ‘Wow, this is a great thing.’ And I didn’t know John, but considering his history and what he could potentially bring to the organization, I was very encouraged, and I have to say, so far it’s been good. He came down to visit us one time, and I had the chance to chat with him in Malvern once or twice, and we’ve exchanged e-mails. I think he’s got the right vision. He’s a very busy guy, but I know that certainly the ambulatory and acute care technologies have to be on top of his list, as far as shoring up what the strategy is going forward.