A 242-bed acute care facility based in the beach town of Cape May, N.J., Cape Regional Medical Center serves a patient population that hovers under 100,000 during the off-season before swelling to more than one million during the summer. But for CIO Rich Wheatley, the operational challenges associated with a fluctuating patient base pale in comparison to the complexity of New Jersey’s HIE environment, which is about as “clear as mud.” Throw in Cape Regional’s plans to bring on physician practices, the challenges of juggling different systems, and the Meaningful Use timelines, and it’s safe to say that Wheatley’s job is no vacation. In this interview, he discusses his plans to integrate physician practices with the inpatient Siemens Soarian system, the use of Allscripts in the ED, his thoughts on the merits and weaknesses of Meaningful Use, and how he docked in Cape May.
- Allscripts in the ED (but looking at Siemens for the future)
- The Allscripts/Soarian integration, “is one of the things keeping me up at night”
- Moving off Meditech Magic 5.6 — “It’s not sexy, bottom line”
- Deciding against 6.0
- “Siemens did an outstanding job of cultivating our relationship”
We looked at Siemens, Eclipsys, and Cerner and solicited some proposals from them, just to see if the organization was ready from a budget standpoint. That was a three- or four-month process in terms of gathering those numbers together and presenting them to senior management before we then said, ‘Okay, it’s worth our time and effort to go into a full-blown, formal selection process.’
We also looked at the maturity of their revenue cycle solutions. While that wasn’t on the table initially, we did believe—and we still do believe—that no matter who we partner with on a clinical information system, it is our desire to eventually be on a single platform.
As we look at the future of our hospital and those hospitals and health systems that we could potentially partner with in the future, we want to make sure that we’re consistent in terms of technology.
It’s not enough to print a report the next morning that tells you that certain nurses didn’t do a pain assessment after they provided a certain medication within an hour, as our policy requires. We need systems that are proactive.
I think Siemens did a good job of bringing in the right people at the right time and bringing in physicians to talk to physicians. And they have also demonstrated that once the contract was signed, those people didn’t go away.
Guerra: Let’s go back a little bit. We talked about you having a busy ED. Do you plan on using a Soarian module in the ED?
Wheatley: No, we have Allscripts in our ED. That’s been live in our ED for about a year and a half. It’s well received in our ED, and for the foreseeable future, we intent to keep that. We certainly are interested in speaking more with Siemens in the future, beyond what we’re currently doing, because we recognize that it certainly is going to be in our best interest to have a single integrated solution, both the inpatient and the ED. But our focus today is really on the inpatient setting.
Guerra: Right. What kind of discussions would you have with Siemens—are there certain things you think you might need the Siemens module to do in order to be able to make the argument to the physicians, ‘We’re going to gain a lot by switching to Soarian and we’re not going to lose a lot of functionalities.’ Is that basically argument you’re going to have to make someday?
Wheatley: Absolutely. And that’s going to be a painful discussion, because they certainly participated and were part of the Allscripts ED decision, as well as the fact that they have a lot of skin in the game now with the implementation. But I think that they’re a smart bunch of docs and they understand the benefits. It’s just a matter of communicating that to them and ensuring that they’re on board.
Guerra: In the short term, are you looking at some Allscripts Soarian integration to get that data flowing?
Wheatley: That is correct, yes. It’s one of the things that keeps me up at night.
Guerra: What are your thoughts on how you’re going to do that? I don’t want to get beyond my depth of technology here, but as far as HL7 type interphases,– how do you do that?
Wheatley: We currently have integration in place today with Allscripts and our Meditech Magic system. So we already have it today, and it’s just a matter of switching. And that sounds easy, but it’s switching Meditech with Siemens.
Guerra: What version of Meditech Magic were you on?
Wheatley: We were on 5.6.
Guerra: And why did you make the decision to go with Soarian instead of sticking with Meditech or upgrading to 6.0?
Wheatley: We’re fairly advanced in terms of our use of the Meditech Magic system. We have all of our clinical documentation online today. We have med administration and barcode checking being done at the bedside. From a clinical standpoint, we’re doing everything with the exception of CPOE and physician documentation. When Meaningful Use was announced, understanding that the Meditech Magic solution would not be well-received by our physicians, we kind of informally went out looking at vendors. We looked at Siemens, Eclipsys, and Cerner and solicited some proposals from them, just to see if the organization was ready from a budget standpoint, understanding what this was really going to take. So that was a three- or four-month process in terms of gathering those numbers together and presenting them to senior management before we then said, ‘Okay, it’s worth our time and effort to go into a full-blown, formal selection process.’
Guerra: Did you look at Cerner?
Wheatley: Yes, we did.
Gerra: As far as Epic, you’re a little too small, but did you look at Epic?
Wheatley: We did not, no.
Guerra: And you didn’t think Meditech was going to work with the docs. Tell me why.
Wheatley: It’s character-based, and it’s not sexy, bottom line. One of the reasons we did not put Meditech in our ED was that the physicians rejected it out of hand. So we went into this knowing that Meditech Magic was not a solution for our physicians. And that’s not to say that we didn’t evaluate Meditech’s next generation system and offering, which is their 6.0 platform, and that was absolutely a part of our evaluation process.
Guerra: What can you tell me about why you didn’t go with 6.0?
Wheatley: I would say we almost had two tracks going on. The first track was looking at those CIS vendors—the Cerners, McKessons, Eclipsys’, and Siemens’ of the world, and then we also had another track looking at the 6.0 upgrade. From a CIS standpoint, our selection criteria were features and functionality, with CPOE certainly being a big focus within that. For those vendors, we were also looking at their experience interfacing with Meditech.
We also looked at the maturity of their revenue cycle solutions. While that wasn’t on the table initially, we did believe—and we still do believe—that no matter who we partner with on a clinical information system, it is our desire to eventually be on a single platform. So we wanted to make sure that that vendor we partnered with had a viable solution for financial systems, whether we’re looking to do that three or five years in the future.
Another key criterion was the ability and the commitment of those vendors to get us to Meaningful Use. Cost was certainly an issue, along with culture and fit, recognizing that we expect that this is a partnership that’s going to be 10-plus years in the making.
Guerra: Right, certainly.
Wheatley: From that standpoint and with those criteria, we narrowed it down to Siemens as being the preferred vendor. Parallel to that, we were looking at the Meditech 6.0 solution. And then between the two of those, that really became a question of strategy, because these are two very different strategies. The Meditech 6.0 solution requires a fork lift of every application, not just our clinicals. So it would require us to replace our revenue cycle system and our general financial systems, as well as our clinical information systems.
So the impact of the different solution was really a key consideration. We had our choice—we could have a smaller focus on clinical information systems and achieving Meaningful Use, versus having a much broader impact to the organization as a whole, and then have our focus somewhat deluded because then we would be required to upgrade every application within our environment.
Guerra: Would you say that going from Meditech 5.6 to 6.0 would have been as a big of a project as switching over Siemens Soarian, or would have been even bigger?
Wheatley: It is bigger because it is all of our applications as opposed to being focused on clinical information systems and pharmacy.
Guerra: Is it also hardware?
Wheatley: Absolutely, yes.
Guerra: Now why specifically, did Siemens rise to the top, if you want to give a few points?
Wheatley: I think that, going back to our selection criteria, they certainly did well from a feature and functionality standpoint, and they demonstrated their experience and functionality with CPOE and physician documentation. They were able to demonstrate proven experience with interfacing with Meditech. Their revenue cycle solution is there, and it’s working in other healthcare facilities.
They have a big presence in the South Jersey area with South Jersey Healthcare, Kennedy Health System, and Virtua, and as we look at the future of our hospital and those hospitals and health systems that we could potentially partner with in the future, we want to make sure that we’re consistent in terms of technology.
We had, again, a good culture and fit with the Siemens organization. I think that they did an outstanding job of cultivating our relationship, and then I think that the thing that really won them over was the workflow capabilities of the Soarian solution. We believe that with that and the Siemens solution, we’re really going to not only position ourselves for Meaningful Use, but be able to leverage that workflow to exploit and take advantage of all aspects of healthcare reform in the future and value-based purchasing, etc.
It’s not enough to print a report the next morning that tells you that certain nurses didn’t do a pain assessment after they provided a certain medication within an hour, as our policy requires. We need systems that are proactive and tell us after 45 minutes that a nurse didn’t provide that pain assessment, and then after 50 minutes, alert the charge nurse to ensure that we are actually meeting those requirements, and not wait until the next day to tell us after the fact.
Guerra: You mentioned Virtua—did you talk to Al Campanella over there?
Wheatley: Absolutely, yes. Al has been a great resource to us in terms of helping us through our decision.
Guerra: You mentioned how effective Siemens was in communicating, and you used the term ‘cultivating the relationship.’ That brings some interesting thoughts to my head. You certainly want to deal with a vendor that can communicate. If we think that sales, in its best sense, is just a process of effectively communicating, then they did a good job. But you don’t want to get sold, right? So it’s not that they were slick, they were just good at communicating. And I wonder, with other vendors that are not as good at communicating, is it your job to dig it out of them, or does that give you some sort of signal that something larger is wrong over there?
Wheatley: I think that your comments are right on. From a sales perspective and a sales team perspective, I think Siemens did a good job of bringing in the right people at the right time and bringing in physicians to talk to physicians. And they have also demonstrated that once the contract was signed, those people didn’t go away. Those physicians that were here and talking to us then are still available and still talking to our CMIO and continuing those relationships.
They also brought in the service people during the pre-sale cycle so that we were able to begin developing that relationship earlier rather than later. We spent a lot of time digging into interfaces as we recognized that our interfacing with all Allscripts was going to be a challenge and interfacing with Meditech was going to be a challenge. They brought the right people at the right time to make sure that we had a good plan moving forward once the ink was dry.
Guerra: Yeah, you don’t want to deal with that situation where you get a whole team of people coming in to sell you, and then they’re all gone.
Wheatley: Absolutely. I’ve seen that happen many times.