Since becoming CIO at Albemarle Health in 2005, Stephen Clark has made great strides in helping to advance the organization. But for facilities based in rural areas, it’s becoming increasingly difficult to compete, which is why Albemarle is turning to Sentara Healthcare to help strengthen its presence in the community. If the deal goes through, it could be a game-changer, says Clark, who offers his thoughts on the challenges of recruiting and retaining staff in a rural area, the importance of transparency, and the telepsychiatry HIE that is setting the gold standard in North Carolina. He also talks about the hurdles to CPOE adoption, his biggest beef with MU, and the pains of dealing with seasonal fluctuations in patient volume.
- About Albemarle Health
- Joining forces with Sentara
- Staff retention
- “When you affiliate with a larger system, it’s a game-changer from an IT perspective”
- Transparency during uncertain times
- Meditech in the hospitals, Allscripts in the practices
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Our payer mix has changed. We’re seeing a surge in self-pay patients and we have a high Medicare/Medicaid population as well.
My focus has been primarily on what’s best for our community. I am sensitive to the needs of the entire workforce, but especially for my staff, and typically when you affiliate with a larger system, it is a game changer from an IT perspective.
As far as opening the RFP responses to the community and to our employees, and having open forums with our medical staff, with the board and the task force and so on, all those things have been very transparent in the community.
You have to be able to name it. You need to embrace it and name it and say ‘There are things we don’t know. The future is somewhat unknown, but we’re trying to create our future. We can either have it done to us, or we can create our own future.’ And that’s basically the posture we’ve been taking.
Being financially challenged, we have to flex our staff according to our volumes. That is probably not the most ideal situation, but it’s the reality of where we live.
Gamble: Hi Stephen, thanks so much for taking the time to speak with us today.
Clark: Sure, no problem.
Gamble: To give our readers and listeners some background, can you tell us a little bit about the organization?
Clark: Albemarle Health is a regional medical center located in North Carolina. We service a seven-county area in the far northeastern corner of North Carolina, which ironically is considered to be a rural community. Out of the seven counties, we service about 130,000 year-round residents here. We do have a number of satellite facilities that cover the geography, but our main campus is in Elizabeth City. We’re certainly not a Level 1 trauma center or anything like that but we do have good referral relationships with hospitals up in the Hampton Roads area, as well as in Greenville and then toward the Raleigh Triangle area.
Gamble: And the hospital itself, how many beds are there?
Clark: We’re licensed at 182 beds, but like many other hospitals these days, we’re operating at significantly lower than that. We’re running a census of about 100 right now. We do surgery, OBGYN, general medicine, and cardiology. We do have a foundation that we support as well, which has community-based clinics for those that are either under insured or have no insurance.
Gamble: It seems like you have a high population of indigent patients in the area. Is that something that’s kind of a big focus of your organization?
Clark: Well actually, I wouldn’t necessarily say that it’s a focus. Our focus is to care for the entire community in northeastern North Carolina, but it does present challenges for us. Again, this is something that we’re seeing in a lot of our peer organizations across the state and across the country — we’re seeing patients coming in that have high deductibles in their insurance. Even if they do have commercial insurance, we see people that have deferred getting care because they can’t afford it. We are seeing increasing volumes in our emergency department because people just don’t get the kind of primary care that they need. Consequently, our payer mix has changed. We’re seeing a surge in self-pay patients and we do have a high Medicare/Medicaid population as well.
Gamble: One of the things I saw on your site was that Albemarle Health has a partnership with Vidant Health. How does that work? What does that partnership entail?
Clark: We’ve had, for almost five years now, a management arrangement with Vidant Health — formerly known as University Health System — down in Greenville, N.C., with the main tertiary center being Vidant Medical Center. They actually provide management services for us, but we do have a firewall. We’re not really owned by them so there are certain limits as to what we can do with the system, but we try to affiliate with their brand.
That said, interestingly enough, for about a year now we’ve been engaged in an RFP process to engage in a long-term lease with a larger system. Vidant Health made a proposal, as well as Sentara up in Norfolk and Duke LifePoint out of Tennessee. This week, our county commissioners — which is the ultimate governing body for the hospital — issued a letter of intent with Sentara. We’ll be spending the next six months or so, I would imagine, in a due diligence and transition planning process until we get to a final contract with Sentara.
Gamble: Wow, that’s pretty big. We’re seeing this a lot where hospitals are looking to align with bigger systems. Is that move about gearing up for all the changes in healthcare reform and wanting to be a part of a bigger system and have those financial advantages?
Clark: I would say yes to all those things. There is a lot going on in the national forefront. I have been very fortunate in the last seven years or so to get an infusion of capital into the IT organization to do some things that we needed to do to keep pace with compliance and a lot of the patient safety goals that have been set by CMS. We’ve done well that way, but we’re at a point where competing for primary care and other specialties in a small rural community has gotten almost to the point where we can’t afford to be able to do what we need to do to build that type of network in our community. So we’ve been looking for systems in our area that we can affiliate with that we already have relationships with to see if we can strengthen our primary care network, as well as some of the specialty care, and enjoy some of the things that we would get from being part of a larger system.
Gamble: I guess there’s a lot to determine as far as how that’s going to affect your role and how the reporting structures are going to change and things like that. Does a lot of that still need to be figured out?
Clark: Yeah, it’s yet to be determined. I know it probably sounds a little glib, but really my focus has been primarily on what’s best for our community. I am sensitive to the needs of the entire workforce, but especially for my staff, and typically when you affiliate with a larger system, it is a game changer from an IT perspective, because we’re considered to be one of those corporate functions, if you will. So it’s yet to be determined what’s going to happen, but I do know that with the proposals that we got in response to our RFP, all those systems are looking for IT people. There’s a shortage of staff out there, and I think that any organization would be happy to have the wonderful team that I have had here at Albemarle Health.
Gamble: That’s such a big issue — being able to attract and hold on to good people. I think that’s a common theme throughout the country.
Clark: The other thing too is that being in a rural community and being the size organization we are, it doesn’t really afford a lot of upper mobility from a career perspective for my team. I think through this affiliation with Sentara — or if it doesn’t materialize with Sentara and we end up staying with Vidant — there will be more career opportunities for them with a larger organization than they would ever get here.
Gamble: That’s critical. Now as you’ve gone through the process of putting out the RFP and as you continue down the road, have you been able to be fairly transparent with the staff just in terms of kind of keeping them abreast? I know it’s a tricky situation.
Clark: The board appointed a search committee — an RFP committee — which was accountable not only to our board, but also to the county commissioners, which have the ultimate say on what happens with the hospital. The board has been very transparent with the employees, although there are things that the taskforce was doing that were confidential and behind closed doors. A lot of the deliberation obviously was in closed session, so to speak. So some of that wasn’t as transparent, but as far as opening the RFP responses to the community and to our employees, and having open forums with our medical staff, with the board and the task force and so on, all those things have been very transparent in the community. And then of course when you do that, you get different camps of people out there so it’s been an interesting process. But yes, we’ve been very transparent with the staff, and we will continue to be transparent with them as we go through the due diligence process.
Gamble: I think that really does go a long way, because when there are mysteries as to what’s going on, you have speculation, and it can do more damage that way.
Clark: Well, there’s a lot of anxiety, obviously. The only thing we can do, based on all the organizational learning that I’ve done, is that you have to be able to name it. You need to embrace it and name it and say ‘Yes, there are unknowns. There are things we don’t know. The future is somewhat unknown, but we’re trying to create our future. We can either have it done to us, or we can create our own future.’ And that’s basically the posture we’ve been taking.
Gamble: You were talking a little before about the patient population that you have with the Outer Banks Beaches nearby, and like I had said to you before we started recording, I am one of the 7 million or so visitors you get each year. I can imagine that this presents a pretty big challenge in terms of staffing and things like that. How do you address that?
Clark: From an IT perspective, it’s fairly steady as far as the influx of visitors to our surrounding community. We do have facilities down at the Outer Banks. There is a small critical access hospital that’s a part of the Vidant System that’s located on the Outer Banks. We have an urgent care center as well as radiology and ambulatory surgery down at the beach. We do see spikes there during the summer when 7 million people come to visit the Outer Banks. Our census also spikes a lot higher in the summer time here at the hospital. It is difficult with nursing; being financially challenged, we have to flex our staff according to our volumes. That is probably not the most ideal situation, but it’s the reality of where we live, and our clinical teams understand that when surgeries are down, we’re not calling people in. When volumes go up and census goes up, we’re going to be calling people to come in to work. It’s just the reality of what we live in, and I think any organization that is trying to make a go of it and stay out of the red is dealing with the same issues.
Gamble: Let’s talk a little bit about the clinical application environment. At this point, you are on Meditech.
Clark: That’s correct, yes.
Gamble: What version of that are you on?
Clark: We’re on the Client Server version. We’ve been on Client Server since the late 90s. We are in the process of upgrading to 5.6.6. We’re on a certified version of 5.6.4. We’re going to 5.6.6, which will be Stage 2-certified in September. That’s our plan for going live.
Gamble: Okay. I’m not sure if I had cleared it up before, but when we’re talking about physician practices, are they owned by the system or are they affiliated? How is that set up?
Clark: We have a hospitalist group, which is contracted. They’re with the Vidant Medical Group. We also contract out our emergency department physicians with EmCare. We have an owned practice called Albemarle Physician Services. We have about 30-plus physicians, which is close to 30 percent of our medical staff that are employed. The rest are affiliated; basically they’re independent practices that have privileges here at the hospital.
We’ve standardized Allscripts Professional for our physician practices. Obviously, a lot of the independent practitioners have taken their own course on which practice EMRs they want to implement. We’ve been able to provide some electronic commerce with the hospital with our Medicity HIE engine. We do integrate labs, orders, and results as well as other type of reports. We use a NovoGrid for Dropbox and for being able to move reports and patient information back and forth with our physician practices — whether they are independent or employed.