Sometimes, a quick glace is all you need. And then other times, it only gives part of the story. That’s precisely the case with Citizens Memorial, which appears to be an 86-bed rural facility, but in reality is an integrated health network that includes 650 long-term beds and a growing base of clinics. It was also the first rural health system to achieve HIMSS Stage 7, and one of the first small systems to achieve MU Stage 2. So when Denni McColm says her organization has been “ahead of the curve in many areas,” she’s actually being modest. In this interview, she talks about what it takes to foster innovation (particularly on a small budget), the organization’s journey with Meditech (and why they aren’t rushing to implement 6.1), what it’s meant to have the same CEO throughout her long tenure, and why Citizens feels like home.
- About Citizens Memorial
- Bringing in practices — “We meet them wherever they want to be met.”
- Remaining independent
- Meditech since 2003 — “We’ve been ahead of the curve.”
- Waiting on 6.1 (for now)
- EHR conversion at a large — “It was a huge project”
- An infrastructure that “provides a foundation for growth.”
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We have had an approach where we would meet the physicians wherever they wanted to be met — whether they wanted to be independent or they wanted to be employed, and over time, it has ended up that almost every provider is employed.
It’s very efficient — reduced clicks, it’s mobile friendly, and our docs are anxious to move to it whenever the time is right. But for us, it’s not quite as pressing as it is for some, because we already have that integration where patient history and everything is at the fingertips of the providers already. So we can afford to wait and make sure that matures a little bit.
We thought that with the CCD, you’re just going to generate a bunch of CCDs on one side and plug them in on the other side, but the format of the CCD is so horrible, and we really had to strip out so much of what was in it because it was just hundreds of pages per patient.
One of the nice things about the infrastructure that we’ve built is that it provides a foundation for growth. And so, when we brought in a dermatologist a few months ago, we just stood up dermatology as a new clinic and voilà, trained him on the system and moved forward.
Gamble: Hi Denni, can you please give a little bit of information about Citizens Memorial to kind of get us started off?
McColm: Citizens Memorial is what I would call a rural healthcare system. We’re located in southwest Missouri, and we started actually before I worked here in 1982 — the hospital opened with just 52 beds and had three doctors at that time, and was the only game in town for healthcare.
We have since grown to become an integrated health network, including the hospital and emergency services. We operate ambulance services, we have home care services including skilled nursing, rehab, hospice, home medical equipment, homemaker chore services, and health transit. We’ve also expanded into long-term care, we started doing that in the late 80s, and we now have 650 long-term care beds at six different long-term care facilities. We have some independent living, some residential care and then we also have physician practices. We have some certified rural health clinics and walk-in clinics, and we have been able to grow our specialty base very nicely. We really have a broad variety of services for the community. Even in some areas where we didn’t have the expertise to do it ourselves, like cancer care or dialysis, we partnered with others to come in and bring those services to the community.
It’s quite a story. We’ve had the same CEO, Donald J. Babb, since before the hospital opened and he’s still with us. So it’s really been his visionary leadership for the organization that’s made the big difference.
Gamble: So it’s one of those things that that’s a bit deceiving because it’s not a huge hospital, but then you talk about all the other things you have, and it’s really running the full gamut of care across the continuum.
McColm: I think that’s what unusual about CMH. We really try to focus on not just providing the health care that we knew how to do, but providing the health care that the community really needed to be able to stay independent for as long as possible. Everybody want to stay home as long as they can, and then when they do have to come in for longer term care, we want to make it a good experience.
Gamble: Are the physician practices owned by the system or affiliated or both?
McColm: Mostly owned. We have had an approach where we would meet the physicians wherever they wanted to be met — whether they wanted to be independent or they wanted to be employed, and over time, it has ended up that almost every provider is employed.
There are a couple of small practices in town that are still independent, but even the larger practices over time have said, ‘you know what? I want to work for you and not worry about the landscaping and the hiring and firing and the payroll taxes, you take care of that.’ So it’s worked out well for us and for them. We employ somewhere around 80 providers, and then we have a few visiting specialists that come to us from Springfield, Mo., and some independent, so we have licenses for around 100 providers at this point.
Gamble: And as far as affiliations, do you have anything in place with other hospitals or health systems at this point?
McColm: We actually are not formally affiliated with any other system. There are two systems in Springfield and we partner with both of them on different projects. The air ambulance that we host right in front of the hospital is with the Mercy System and we have specialists from the Cox Medical Center who come down and visit. So we try to be a good partner for everybody, but we’re still very independent.
Gamble: Now, a lot of people are familiar with Citizens Memorial because of some of the achievements, achieving HIMSS stage 7 a while ago now, which is something that I’m sure is a really nice accomplishment to have.
McColm: Yes. When we started our implementation of our electronic health record back in 2002, of course we’ve never heard of any of those — I’m not even sure stage 7 was around. So it was all a nice surprise for us that for what we’ve done that we knew was the right thing to do for the organization, we were recognized for that. We won the Davies Award from HIMSS, HIMSS Stage 7, we’ve been Most Wired, and also the organization has won the Missouri Quality Award a couple of times now, so those are nice accolades that we’re proud of.
Gamble: And like you said, certainly something you weren’t striving for, that it just didn’t come around until a few years later.
McColm: Yes, we’ve been ahead of the curve in a few different areas and that’s one of them, I think.
Gamble: Yeah. So in terms of the EHR environment, the hospital is on Meditech?
McColm: We are. We’re on Meditech’s Client/Server version, which is not their older version and not their newest version, kind of in-between, and we have it implemented really everywhere that Meditech serves. So we have the hospital systems, home care, long-term care, emergency services, surgical center — all the way across the continuum. We plan to go to their latest version sometime in the next few years. We’re just waiting so that we weren’t on bleeding edge. So at this point, our plan is to eventually move to what they call Meditech 6.1 right now.
Gamble: Because in terms of the functionality of 6.1 versus the client server that there’s not like a necessarily a huge pressing need to go on it right away?
McColm: What a lot of people are moving to Meditech 6.1 for is to get the integration between particularly the physician component in the hospital, I think people all of a sudden were thinking, ‘I’m maintaining two medication lists, two problem lists, two allergy lists, and I don’t have continuity.’ We actually did that in the version that we’re on of Meditech — we implemented their ambulatory product in 2004 or 2005 and so we have that integration already. And so, what they do have in 6.1 is beautiful with ambulatory interface for the providers. It’s very efficient — reduced clicks, it’s mobile friendly, and our docs are anxious to move to it whenever the time is right. But for us, it’s not quite as pressing as it is for some, because we already have that integration where patient history and everything is at the fingertips of the providers already. So we can afford to wait and make sure that matures a little bit, and then get in line for the upgrade. It’s a pretty major upgrade when we do take it.
Gamble: Right. And in terms of having that integrated record across the system, that’s something that’s been in place for quite a while?
McColm: Yes, and it will be even better with 6.1. I think that there’ll be better integration with long-term care. We have one shared EMR now, but there are some pieces that are separate for billing reasons, and even those become one database in 6.1, so it will be nice. But it’s not quite as pressing as it would be if we were on Allscripts or NextGen or athenahealth and trying to move all our providers to one platform, because we’ve done that part of it already.
Gamble: So you didn’t have to really deal with having several different EHRs out there and moving to a different strategy?
McColm: Well, we had one case. Our largest acquisition was a rural health clinic with 13 providers, and they had gone on Allscripts a few years ago, I think in 2006 or 2007. About the time that we finished up our clinics and they did, they were like, ‘this is a great idea,’ and they went out and bought Allscripts and went paperless. They had seven or eight years of data when we acquired them a year and a half ago, all electronic. So we did do a conversion. It was quite an experience. We converted because we wanted them to be able to move directly into our Meditech ambulatory system and be able to operate from there without having to refer back to their old system all the time, and to have continuity. So we did convert all their lab results that they had electronic for all those years. We used the CCD or CDA document in order to bring over meds, allergies, and problems, and we brought all of their progress notes, all of their office notes, and most all of their scanned documents (except for the ones that we sent to them in the first place) into Meditech so that when they first started using Meditech, they’d have this history already there. It was a huge project to do a conversion from one system to another. I don’t envy anybody the process that they have to go through.
Gamble: Yeah, sure. But largely, it’s not something you’ve had to undergo?
McColm: No, that’s the only time. That was 40,000 patients though, so it was pretty big. And almost all of the patients matched our patients. We had a lot 97 percent overlap so we only had to create a few thousand patients, but just converting that large amount of data, over 250,000 scanned documents, was a big job. Thankfully we did it and we were able to convert it so that we can even do release of records out of the Meditech side, and we don’t have to maintain the old system going forward, which is the ultimate thing to have.
Gamble: Yeah, I’m sure that was quite a project. Did you have an idea of much of an undertaking it was going to be beforehand?
McColm: No. We thought like everyone thinks that with the CCD, you’re just going to generate a bunch of CCDs on one side and plug them in on the other side, but the format of the CCD is so horrible, and we really had to strip out so much of what was in the CCD because it was just hundreds of pages per patient. We had to have an external party help us reformat the meds because there was disagreement about whether or not they should include active or inactive and we only wanted active to cross, and so we had a third party help us with really a whole lot of it, and that was somebody who was expert on the Allscripts side, because we clearly lacked that expertise. So yes, much bigger than we thought.
Gamble: You mentioned that you own a pretty large percentage of the practices at this point. Do you anticipate there’s going to be more that come under the umbrella or is it hard to say at this point?
McColm: At this point right now it seems like everybody that we’re recruiting wants to be employed. One of the nice things about the infrastructure that we’ve built is that it provides a foundation for growth. And so, when we brought in a dermatologist a few months ago, we just stood up dermatology as a new clinic and voilà, trained him on the system and moved forward. So mostly they’re employed and mostly it’s a matter of growth for us just adding on to the system that we have.
Gamble: Do you think that that approach has been helpful of giving them that choice, or at least not try to force the hand right away and say, ‘we want you to be in employed by our system?’
McColm: I think it has been. Like I said, I think more and more they’re moving away from wanting to manage their own practices, but knowing that they have the option is key. If they want to buy in to the building, we will even let them have that. A few do that — some of them consider it a retirement. But for the most part, they want to be employed, have good benefits, and be able to do their thing and go home. But I do think being flexible has made a big difference for us over the years.