The healthcare system has its share of issues, some of which will take years to fix, and some — like the amount of inefficiency embedded into processes — that can be solved much sooner, according to Chuck McDevitt, CIO at Self Regional Healthcare. McDevitt sees a great deal of potential in implementing lean methodologies to drive down costs and boost patient satisfaction. In this interview, he talks about how his organization is using evidence-based medicine to streamline processes, the challenges of straddling the ACO and fee-for-service worlds, and the cultural change taking place within Self Regional to improve employees’ health. He also discusses integrating the acute and ambulatory environments, his device management strategy, and how he is applying lessons learned from working in other industries.
- Allscripts in the owned physician practices
- Working with the independents
- Integrating the hospital & physician practice worlds (using RelayHealth)
- BYOD — iPad strategies for the workplace
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We look at it as a way to strengthen the relationship with the community physicians, and so we host a number of those practices here. We charge them fair market value for that service. And it’s gone pretty well.
One of the things I noticed between healthcare and manufacturing in particular is healthcare much more fragmented in terms of the systems that are out there and everything is so little bit different, so that’s a challenge. But I think you’re going to see stuff standardized more over time, certainly in the HIE space.
We looked at it and said the risk of having everybody bring their own type of devices in here was difficult, particularly with having our data on it. We wanted to control the infrastructure.
We thought if we put tablets on each of these floors, they’re going to walk from floor to floor. They may walk out of the building — how do you manage that? So we’re taking, I think, a little bit of leading edge strategy on the iPads.
For us, the ability to control the devices, the ability to standardize the solution and set up Citrix on the iPad so that they could actually work the AllScripts solution — for the physicians that are going back to their office — or they could work CPOE internally was a big benefit to us.
Guerra: Let’s talk a little bit about Allscripts. You said you had Allscripts in the ambulatory environment?
McDevitt: Yes, we do. We’ve got about a 120 owned physicians, so there are about 12 to 15 practices around town. We’ve put them all on Enterprise, version 11.2. We’ve been a partner with Allscripts since about 2009. We’re doing what we call a community model here where we are actually hosting not only our owned physicians but we host practices in the community. We do it as five-year, arms-length contract so we don’t have any start issues, and we got a pretty significant discount from Allscripts to do that. We actually resell their licenses at cost to the physicians in the community and we look at it as a way to strengthen the relationship with the community physicians, and so we host a number of those practices here. We charge them fair market value for that service. And it’s gone pretty well. We have a couple of Greenway sites, one Athena site and obviously else pretty much in the community is Allscripts so that’s about another 10 to 15 different physicians practices across the six or seven counties.
Guerra: So there 12 to 15 you own and another 12 to 15 are independents that you got a hosting contract with.
Guerra: Do you have much going on in the way of integration between these ambulatory products — mostly Allscripts Enterprise and the McKesson inpatient Horizon system?
McDevitt: Yes, we are looking at RelayHealth as our solution there. I think we are one of the first sites in the country that has actually gotten full-loop orders and results going. We’ve heard a lot about HIEs and we think really HIEs on a local level or a private HIE makes a lot more sense than necessarily being a part of the state or a national one, which they do have SCHIEx (South Carolina Health Information Exchange), but we’re more focused on the thousands of transactions that happen every month here among us and our physician practices.
So what we started about nine months or a year ago with Relay Health was looking at how do we fully make the process electronic for a physician at an Allscripts site to order a lab from us, have that information go to RelayHealth — they keep the patient identifier, which is a key thing, because there are different patient IDs between Allscripts and the hospital — and then we send that over to the hospital. McKesson wrote an electronic inbound registration into Star, which they never had before, so as RelayHealth sends an order over to the hospital, we register that patient electronically, and then when the specimen or patient comes in, the registration clerk just really confirms the insurance, and then the order goes right to Sunquest. Once we result it, it flows back to the exact patient record that came out on the Allscripts side, which is key because you used to have to match up; when you get the result back into Allscripts, you have to work a queue with hundreds of these, and there would be mismatches. We have a large Spanish population here and the spelling of the names won’t be correct during the registration, and some people didn’t have a driver’s license or social security number.
There are only four or five things you can really key on to try to match patients, and so what you end up doing is you have to work each of those results individually to make sure you didn’t assign a result to the wrong patient. What RelayHealth has allowed us to do is fully allow an order to come in, get results that electronically flow right back into the same record in Allscripts, and it matches up the patient IDs from McKesson Star and Allscripts enterprise. But we’re hoping to expand that into a lot of other things too. The Stage 2 rules definitely put more of a focus on communications with physicians and communications with patients, and I think RelayHealth offers us a lot of solutions there.
Guerra: When you look at these types of HIEs scenarios, do you think everyone does it a little bit differently and that’s just fine, in terms of how things get matched and the different parts and moving pieces involved?
McDevitt: One of the things I noticed between healthcare and manufacturing in particular is healthcare much more fragmented in terms of the systems that are out there and everything is so little bit different, so that’s a challenge. But I think you’re going to see stuff standardized more over time, certainly in the HIE space, and CCD obviously will help standardize some of that.
From a process perspective, the example I always use is the odds of me being in Myrtle Beach and breaking my leg and having both at my local provider and my family physician here all being connected on the same HIE and having my records available. That’s not a scenario I think would happen all the time. We’re still in the fax mode of sending orders and results and all that stuff in our local communities. I think that’s where the focus of the industry has shifted to, and I think that’s a good thing. There’s a good value in having the national HIEs for people who are relocating and stuff.
Guerra: Let’s talk a little bit about iPads. You mentioned the use of iPads in your facility. A term they use these days is ‘bring your own device strategy’. How is your organization working around that — empowering physicians to either use their own devices or the hospital furnishing them with some sort of handhelds or iPads?
McDevitt: Well in our case, the hospital is furnishing it. We looked at it and said the risk of having everybody bring their own type of devices in here was difficult, particularly with having our data on it. We wanted to control the infrastructure, and so as a part of the CPOE project, we’ve held a couple of physician fairs. You come in to the physician fair, you go through a series of booths and training, and at the end of that, we give you your iPads. It’s a hospital owned device. It’s got an acid tag on it; you sign custody documents saying that if you lose it, you’ll let us know so we can remote wipe it, and also that we’ll buy the first one — if you lose it, you buy the second one.
We realized early on that you can’t necessarily dictate only one way to do this. We’ve given our physicians computers in the room. We’ve got medication administration carts that our nurses push around. We have PCs at the desk, and we also have handheld iPads. Because we thought if we put tablets on each of these floors, they’re going to walk from floor to floor. They may walk out of the building — how do you manage that? So we’re taking, I think, a little bit of leading edge strategy on the iPads.
We also have single sign-on where they come up and they can tap their badges. We’ve got cards that have wires in them. You couldn’t do a proximity one because if you get two clinicians close to the thing at the same time, it would get confused, but we’re a Citrix environment. You come up and you tap the little block that’s next to the computer in the room and that will log the physician in. If they move from room to room, their sessions can move with them, and so that’s our strategy there.
Guerra: Did you not think that it was feasible to allow them to use their own devices?
McDevitt: Not at this point. And obviously with Citrix you’ve got more control over that, but for us, the ability to control the devices, the ability to standardize the solution and set up Citrix on the iPad so that they could actually work the AllScripts solution — for the physicians that are going back to their office — or they could work CPOE internally was a big benefit to us.