Though running a best-of-breed shop presents some unique challenges for the hospital IT department, Theresa Meadows says the big benefit is being able to give clinicians the exact tools they want. So the answer is no, she doesn’t envy her single-vendor-for-all colleagues. To learn more about how Meadows is melding her Meditech and athenahealth environment, healthsytstemCIO.com recently caught up with the Texas-based executive.
- About Cook Children’s
- “We are, probably, the poster child for best of breed”
- Meditech inpatient, athena for ambulatory
- Taking an upgrade (no 6.0)
- Managing two repositories of data
- Integrating the independents
- Unique best of breed challenges
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We are probably the poster child for best of breed.
… for us to go to 6.0, it really is a rebuild and start over process and we’re not ready for that.
The biggest challenge that we have is the age-old one of integration, and how do you keep the systems in sync and provide the right knowledge at the right time to the person who’s trying to care for that kid when they’re here.
Guerra: Good morning Theresa, I’m looking forward to chatting with you about your work at Cook Children’s Healthcare System.
Meadows: Good morning Anthony.
Guerra: Let’s start off with an overview of Cook Children’s, if you would — acute facilities, ambulatory, joint ventures, all these kind of fun things.
Meadows: Cook Children’s Healthcare System is an integrated delivery system. We have our inpatient business, our acute care business, which is a 400+ bed hospital and then two joint ventures; one is an ambulatory surgery center and the second is a smaller hospital with an urgent care and a surgery center as well. And then we also operate our physician practice business, our physician network. We employ about 300 physicians and have about 70 clinics throughout six counties in Texas. The counties that we support, including the city of Forth Worth, are about the same size as New Mexico. So that’s our coverage area, pretty large and spread out.
We also have our own health plan, so we manage the Medicaid and SCHIP population for the State of Texas, and then we have a pretty large and growing home health business. So when you start looking at our companies, we’re pretty diverse, and we span the whole gamut from inpatient to outpatient and post-acute care. So we’re in a pretty good position as we start to look at pediatric care going forward and how we manage that population.
Guerra: So in addition to the 300 employed physicians, are there independents that are referring into the hospital?
Meadows: There absolutely are. We probably have about 700 providers that we work with overall, and so we support those as well. We take a lot of pediatric referrals throughout the state of Texas and then even outside of Texas sometimes.
Guerra: So that’s a referral where they’re now being cared for by your physicians. Does it work the same way as a physician who has privileges and goes into your hospital as an independent practitioner but uses your hospital as a place to give acute care?
Meadows: Sure, with some of our physicians, yes. For some of our physicians, they’re credentialed and they can actually come here and practice and, for others, we’re strictly a referral location and then once the referral is complete, we’ll send them back to their location for that physician to take care of them. So it depends, we do both.
Guerra: There’s a lot of different strategies that come into play with engaging all the different constituencies we talked about. Let’s start by talking about your clinical application environment and we’ll go from there.
Meadows: We are probably the poster child for best of breed. We have on our inpatient side, we’re primarily a Meditech shop. All of our hospital-based business, we use Meditech to support that.
For our ambulatory business, we use athenahealth, so that’s more of a cloud-based tool for all of our physician practices and any of our specialty clinics that we have on campus. And then we, of course, have a home health system which is Mediware, and then our primary system in our health plan is DST Health Systems to run all of our claims management and those types of things.
So we pretty much have taken on the best-of-breed approach just through our growth and the need to be able to provide different applications in different settings.
Guerra: That means you’re really earning your money. (laughing)
Meadows: Absolutely. Absolutely. It’s a good challenge.
Guerra: That’s right. What version of Meditech you running?
Meadows: We are on Meditech client server 5.64, but we go to 5.65 on the 15th of September.
Guerra: Now that’s a small on a numerical scale, but what does that mean practically speaking?
Meadows: With Meditech, it sounds small but none of their releases are small, so it’s a pretty significant upgrade with a lot of enhancements. That particular upgrade is the Meaningful Use certified version, so that was one of the primary reasons why we need to get to 5.65. We have been testing, probably, since about the April timeframe, and we go live in September. So it’s not huge but not small, by any means.
Guerra: Did you look at 6.0?
Meadows: We have looked at 6.0. Right now, our biggest issue with 6.0 is just the transition. We have pretty much all Meditech modules live, so we’re live on CPOE, we’re live on bar-coded med administration, we’re implementing physician documentation and so for us to go to 6.0, it really is a rebuild and start over process and we’re not ready for that. We’re really trying to just stay stable on the version that we’re on, and we know with Meditech that they are going to have a 5.66 version and they’re going to continue to enhance the current platform.
So until we see a dire need to make that shift, we’re going to kind of stay put with where we are. Now talk to me in a month and that may change, but at least that’s the current plan.
Guerra: We’ve had a CIO blogging for us every month and I don’t know if you’ve seen it..
Meadows: I have.
Guerra: His 6.0 journey so it’s not for the faint of heart, right?
Meadows: It is not. The more you read that, the less you want to do it. But it’s wonderful material because it’s helped me kind of go through that decision making process. When we have something that works, that Meditech supports, that they’re going to continue to enhance so we can meet Meaningful Use requirements, it makes it really hard for me to want to make that change, at least right now.
Guerra: Right, especially since there is a Meaningful Use upgrade short of 6.0.
Guerra: athenahealth, do you have any integration going, any data flows going between your Meditech and athenahealth systems?
Meadows: Yes, we actually do. What we do is we keep the MPI in sync. We have integration, so when a patient is registered either in athena or in Meditech, we actually send that registration over to the sister system. So if it’s done in athena, it goes to Meditech; if it’s done in Meditech, it goes to athena. So that way if a patient shows up in either location, and they’ve been at least to one of our locations, they’re already registered. So that’s very helpful, and we have some starter information to be able to start sharing information between the two systems.
We also are sending athena CCDs into Meditech as well. So we have that integration setup, and we’re working on order integration and results integration over the next year or so.
Guerra: Does that mean that there is a record of the patient in each system and hopefully they stay mirrored? How do you know if you’re looking at the complete, most updated, record?
Meadows: Our goal is to keep those in sync, but one of the things that we’re also doing with our best-of-breed strategy is that we’re in the process of implementing a physician portal with a company called Harris, and they provide a consolidated patient view where we’re going to consolidate all the key elements of a patient – their allergies, their problems, their med history, their immunizations – from Meditech and athena in a consolidated view where the physician can log into a website and see everything already combined. The beauty of that system is it actually uses API calls to those databases, so it’s real time.
So if I make a change in athena, the next time the screen refreshes, I’ll see that updated information in the physician portal. So that’s how we’re sort of bringing those systems together versus sending all of that athena data into Meditech and all the Meditech data into athena; we’re going to bring it together visually through a portal.
Guerra: I guess you don’t want all that data duplicated.
Meadows: Absolutely, and that’s what we’re trying to prevent by using this portal. So the athena data stays in the athena storage and the Meditech data stays in the Meditech storage and we’re not creating a third storage location with the data combined.
Guerra: Especially with images, right?
Meadows: Absolutely. Our goal is to replicate data as little as possible. But for some of our reporting and business intelligence needs, when we want to combine data sets from our home health system and our health plan system, and inpatient and outpatient, you would need to replicate some of that data.
Guerra: How are you handling some of the independents that you deal with if they’re either not on a system or if they’re on a different ambulatory system?
Meadows: The nice thing with athena is, though it’s not the best thing, when they fax their records or send them electronically into athena, those records will be part of the outpatient medical records. So we have that connection. So whether the physician office is faxing or whether they have an automated system, we can have those feeds into athena which we’re doing today mostly with faxing because most of our practitioners are one and two doc practices who haven’t made a decision on systems yet. So we receive a lot of faxes into athena. It’s not ideal because it’s not discrete data, but at least that information is coming in for our doctors to see the ones that are on athena. And then what we’re going to provide to our referring physicians is portal access so that they’ll be able to see what happened with the kids that they refer or have credentialed here. So they can see data through the portal. So once our portal is live, they’ll have access to the data that way.
Guerra: How would you describe the challenges that come with running a best-of-breed system?
Meadows: The biggest challenge that we have is the age-old one of integration, and how do you keep the systems in sync and provide the right knowledge at the right time to the person who’s trying to care for that kid when they’re here. Having some of this visual integration I think helps with that. I think some of the Meaningful Use standards around sharing data are going to help some of that, but it’s still a journey.
Most of our things are interfaced, which is not ideal, but we seem to make it work for us in the setting that we are, so that’s the blessing and the curse — just dealing with all the interface transactions and making sure those things stay in sync.
Guerra: Do you have a particular vendor you’re working with on the interface side?
Meadows: We actually use Corepoint as our interface engine, and we are new to the interface engine world. I have been at Cook about two years and, because we’re a Meditech shop, we use an interface engine for very little.
We were using scripting and those types of things mostly, but now with Meditech, almost everything they have is in HL7 interfaces. So we’re actually gaining a lot more value over the last couple years through our interface engine than we were previously, so that’s been a huge shift. We sort of cut back our scripting and really try to do only HL7 connectivity today.
Guerra: When you look at other organizations that are spending tens or even hundreds of millions of dollars to get on one enterprise system, do you envy them? Do you say it would be a lot easier being the CIO of one of those places?
Meadows: I came from a world where we were a single platform, and it has different challenges. I don’t envy them. I think their challenges are just different. I think some of the Meaningful Use requirements have leveled the playing field a bit and that you don’t have to have a single vendor providing everything because the requirements are the same across vendors if they want to be certified. They’re required to allow sharing of data. So some of those limitations that we had being best of breed are slowly going away with some of the Meaningful Use requirements because of the sharing of data and the requirement for that.
I go back and forth. There are days where I say I wish we were all on one system but then there are other days that I think, “Wow, this is really great; we’re able to give our clinicians what they want, in a system that they want to use, and we’re making it work.” So I kind of waver back and forth, but I think both jobs are hard.