In 2011, Licking Memorial had an opportunity to go the early adopter route and attest to Meaningful Use stage 1 — which would’ve been a coup for a community hospital. But Sallie Arnett wasn’t confident the software was ready, and decided the risk to patient care wasn’t worth the reward. Four years later, Arnett feels it was “definitely the right move,” and is proud to be with an organization that is willing to wait. In this interview, she talks about the benefits of being a small organization, the three-year strategy to become a fully-integrated Meditech shop, and her team’s strategy to increase patient engagement. Arnett also discusses the myriad benefits of breaking down silos between IS and clinical, the “drive toward best practices” at LMSH, and why she’s stayed there so long.
- About Licking Memorial
- “We’re really driving away from the interface model.”
- Structural changes to IS
- 3-year integration project with “staged out” clinical projects
- Meditech since 1985 — “Our team is very entrenched in it.”
- Being small — “We don’t have to get 100 committees together to turn the ship.”
- Focus on MU 3: “I’m a strong advocate of patient engagement.”
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Like everybody right now, we’re very project-heavy. It always seems like there’s something new going live every week, if not every day.
Every time we do clinical decision support, we’ve got to do it in three places. So as we start to unify those applications, that will make things simpler. It’ll make training much easier for the physicians, it’ll make it more consistent, and it should help us improve our quality metrics as well.
For a long time, that departmental workflow was king for us, and we bought products based upon that, but now that we’re kind of looking at the patient across the entire continuum of care, it just makes more sense to integrate.
I have the responsibility for health information as well as the EMR products, so it’s a little bit easier than at some larger facilities to have a shared vision, sit down with our peers, and drive change quickly.
I think as the technology matures, we’re going to see our numbers increase, but yes, it is a little bit hard not knowing if this is going to be our stage 2 attestation year or not, and when does it stop and when does it start. I think there’s a little bit of frustration there.
Gamble: Hi Sallie, thank you so much for taking some time to speak with us today.
Arnett: Thank you for inviting me to participate, Gamble.
Gamble: Sure. So to give our readers and listeners some background, can you just talk a little bit about Licking Memorial Health System?
Arnett: Certainly. We’re a small community health system comprised of a 227-bed community hospital. We have a level 2 nursery, of course an emergency department. We have a very wonderful interventional cardiology program. We also have two urgent cares, an inpatient rehabilitation unit, and a separate hospital for chemical dependency.
We also have about 100 employed physicians located throughout the country in various practices. Along with that same group, we have a hospitalist program, interventional cardiology as I mentioned, and then of course, family practice, internal medicine and quite a few specialties. So right now we have about 1,900 employees and IS staff of about 35, serving all the folks throughout the community, and we’re planning to grow the IS department actually to 50 employees within the next year.
Gamble: That’s exciting. I can certainly see why, talking about everything going on. And geographically, where are you located?
Arnett: We are in Central Ohio, about 30 minutes east of Columbus, home of the Ohio State Buckeyes — I think it’s mandatory for us to say that. So it’s a very close drive. It’s a beautiful, kind of almost a bedroom community for Columbus at this point. We have rolling hills, beautiful countryside. The hospital is actually the biggest employer in the county. We do serve the entire Licking County area, so it’s a fairly good coverage area that we have. And we’re the only hospital in the community, which is wonderful, so we try and serve the community here and we’re very community-based and we’re very focused on serving the community here.
Gamble: Right. You mentioned you have physicians — are those both part of the system and also affiliated with the system?
Arnett: We have a hundred that are employed by us; our medical staff is right around 200. So for the 100 employed, we support their EMR and provide them with full services just as we would any other physician here in the hospital.
Gamble: Okay, so in terms of the clinical application environment, what type of EHR system are you using in the hospital?
Arnett: We use Meditech as our primary EMR and it’s our legal medical record as well. So we’re a Meditech MAGIC hospital, but we do have quite a few interfaced products as well. We use a product called PulseCheck — which used to be Picis and is now owned by Optum — for our emergency department. We use Picis OR Manager for our surgery suites, GE Centricity Perinatal for the maternal-child unit, and then GE RIS, PACS and MUSE, so we have quite a bit of GE mixed with Meditech, which is, I think, pretty common for hospitals our size.
Gamble: Right. I imagine that makes for some challenges though in having, like you said, all the interfaces to contend with?
Arnett: With Meaningful Use, we’re really starting to drive away from the interface model. We’re really finding that the workflow integration of a single vendor really is superior in many aspects, so we are in the process of replacing our OR right now with Meditech’s module, and we’ll follow suit with some of our other products over time.
Gamble: Okay, so is that part of the rationale behind the expansion of the IS staff, just as far as some of those plans?
Arnett: A lot of our expansion has been due obviously to projects, like everybody right now, we’re very project-heavy. It always seems like there’s something new going live every week, if not every day, so we are adding four staff members to do project management. We have a very small project management staff right now, so we’re expanding out the project management staff and we’re expanding out our security staff. We decided to do a dedicated information security program about a year ago and staff that in-house, so we’re adding a whole entire team for that. And we’re also adding more clinical applications staff, which is of course to be expected as we grow.
And then we’re actually doing a change within our server staff. We’re adding a team of clinical server folks, so they’ll be the experts for things like our PACS system, our MUSE system, and our CVIS, and they’ll have a little bit of a closer interface with the clinical staff as well as our clinical project managers so that we have kind of a consistent team managing the servers for those groups as well.
Gamble: Right, a lot to talk about there. When you talk about driving away from the interfaces, can you just talk a little bit about what are some of the challenges there and how you’re making it part of the strategy?
Arnett: As we went through the Meaningful Use process, we were very fortunate that we had already done things like bedside medication verification and we well into the CPOE process. We actually started doing bedside med verification back in 2004 with a non-Meditech product, and one of the things that we identified at that time were the challenges associated with having a separate system for ordering, having a separate system for lab results, having a separate system for pharmacy, and so we actually made a decision not long after we installed the first product to go with the Meditech product for bedside medication verification.
What that allowed us to do was have a single system where physicians were ordering, and as people were taking off the orders, they could see the orders very clearly, especially for the meds, and also they were seeing lab results as they administered meds. We felt when we had a patient that maybe had, for example, a sliding scale insulin and they needed the latest values before they gave it, that it was really wonderful to have that tool as the nurse administer the meds.
So that was our first foray into starting down the path of that integration, but it really got reinforced as we went into Meaningful Use. As we try to do better quality metrics across the board and as we try and do clinical decision support, right now with having a separate ED system and a separate OR system and a separate system for the rest of the hospital, every time we do clinical decision support, we’ve got to do it in three places. So as we start to unify those applications, that will make things simpler. It’ll make training much easier for the physicians, it’ll make it more consistent, and it should help us improve our quality metrics as well.
Gamble: Is there are a timeline you’re looking at for that?
Arnett: Right now, we’re sort of phasing it across three budget years. Obviously MU is tying up a lot of our resources, so we’re trying to kind of stage out our larger clinical projects. Right now we’re in the middle of doing a RIS/PACS replacement, along with taking 100 percent of our cardiology images electronic as well.
We already had our RIS and PACS and we’re 100 percent electronic in PACS, but we’re doing that with cardiology now, as well as replacing our PACS and putting in a vendor neutral archive. So we’re going to move on after that and do the ORs, which we hope to have it by about mid June or July of next year, and then the ORs will go on Meditech. And then we’ll probably take a look at oncology and moving that onto Meditech, and then move down into the emergency department and consider swapping that to Meditech as well, so it’ll be a pretty big retrofit. And actually, we just retrofitted our home care system into Meditech as well. That was six months ago, so that seems like a million years.
Gamble: Yeah, definitely. Obviously there are so many challenges when you’re having to retrofit, but that’s just the reality of how things are now. And was it a challenge just as far as making the case for going on to Meditech, from your angle?
Arnett: Our folks have been entrenched in Meditech. I’ve been here since 2001, and actually the health system went live in 1985, so the facility’s very, very comfortable in Meditech. Our team’s very entrenched in it and very skilled. We have a good team of IS staff as well as a great team of clinical coordinators, so they’re all used to the environment.
When I came on board, we did a lot of looking at workflow and we picked a lot of best-of-breed products. I had come from a McKesson hospital, so we were very well-versed there in doing interfacing, so I sort of brought that with me when I came. We were very comfortable doing interfaces here as well, but we started to really look at not only the departmental workflow, but the integration across the entire health system. For a long time, that departmental workflow was king for us, and we bought products based upon that, but now that we’re kind of looking at the patient across the entire continuum of care, it just makes more sense to integrate.
I don’t think it was really a hard sell here. Across the clinical spectrum, we work very closely with VP of Nursing and assistant VPs over the clinical areas and the radiology directors and the cardiology directors. I think we have a shared vision of where we want to go with the EMR and we see the benefits that it brings, so I think we got a shared vision. It was definitely not a tough sell to go down this road.
Gamble: It seems like having the different department heads working more closely together is also maybe one of the overarching goals of expanding the IT staff and getting people to work together more closely?
Arnett: Well, we’re fortunate. We’re a great size; being right around 200-bed facility, we’re not so massive that it’s impossible to turn the ship, and we talk to each other frequently, if not many times daily. So we don’t have to get a hundred committees together to turn the ship. We sit down, we talk through processes, and we look at our workflows. The IS and the clinical people work hand-in-hand here, as do the HI staff. I actually have the responsibility for health information as well as the EMR products, so it’s a little bit easier, I think, than at some larger facilities to have a shared vision, sit down with our peers, and drive change quickly, which is really great.
Gamble: Yeah. You talked about Meaningful Use being behind a lot of this push because of having to have all the quality metrics. So now how are you positioned for that?
Arnett: We actually attested to MU 2 last year, so we’re sort of obviously just kind of waiting with everybody else for what happens in MU 2, year two, but we went ahead and attested as scheduled. We could have actually attested for stage 1 in 2011, but we made some decisions to wait until some of the Meditech software was a little bit more fully developed. So we attested in the first full year; we didn’t attest in the early year. But we feel really good about where we are. We actually just recently put in the MU stage 3 code, so we anticipate there will be some changes to that, but we feel pretty confident that we’ll be well-positioned going forward.
Gamble: I can imagine that there is some frustration with all the waiting and the ‘hurry up and wait’ that comes with Meaningful Use?
Arnett: I have a strong belief in the underlying philosophy behind it. I think a lot of times where we have difficulties putting some new things into practice, and I think all of us are struggling with the patient engagement piece and the increase in the thresholds between stage 2 and stage 3. I’m really excited about patient engagement and I am a strong advocate. But I think part of the difficulty we’re having is moving the patient population along that realm. When you have people who are sick and they’re in the hospital, they just want to get to feeling better, so they’re not really thinking about how do I get my information until they’re home and kind of back on the mend, and then sometimes that doesn’t stay a priority as people get to feeling better.
So there are some of those metrics that aren’t so clear-cut, and I don’t think that feeling is much different than a lot of other people have. And I think as the technology in that realm matures, we’re going to see our numbers increase, but yes, it is a little bit hard not knowing if this is going to be our stage 2 attestation year or not, and when does it stop and when does it start. I think there’s a little bit of frustration there.