While you might think a HIMSS Analytics Stage Six hospital sees the interim MU regulation as child’s play, think again. That’s because even though the hospital may be able to handle what’s being required, helping the local docs meet their criteria is looking to be a very tall order. The most troubling aspect of MU to Frederick Memorial Hospital CIO David Quirke — the 80 percent CPOE requirement for ambulatory practices. To learn more about how MU is playing on the street, healthsystemCIO.com editor Anthony Guerra caught up with the Maryland-based CIO.
So we feel like we don’t know where the puck is going to be, but we’re skating in the general direction of where we see it moving.
… there’s a lot of questions that we have in terms of how the basic governance of a system like this would be established when you’re dealing with over 150 practices that are independent businesses loosely connected with the hospital.
… we felt that supporting multiple systems would dilute our capability to deliver a quality product to our physician community …
GUERRA: Besides the ambulatory CPOE rate being required, what are your other concerns with the Meaningful Use definition?
QUIRKE: One of the single biggest problems that we’re dealing with right now is how to establish some of the partnership arrangements with our non-owned physicians as we try and support the creation of the Health Information Exchange. We’re also very closely connected with a wonderful initiative which is the Maryland statewide Health Information Exchange, called CRISP, and we’re ensuring that the standards we develop as we deploy our regional Health Information Exchange are complimentary to that of the statewide initiative.
So we’re working very, very closely with both the leadership of the CRISP organization and representatives from the state making sure that what we build here in our little laboratory — which is Frederick, Md., a single hospital with a single hospital organization with no other hospitals around — is a very stable master patient index, very stable physician population. How we build the interactions between the core hospital information system and the ambulatory systems, how we manage and exchange even some of the basic information through HIE standards, is going to be key to ensuring we can connect to the state and then ultimately beyond. So we feel like we don’t know where the puck is going to be, but we’re skating in the general direction of where we see it moving.
So it’s a very interesting time, and there’s a lot of questions that we have in terms of how the basic governance of a system like this would be established when you’re dealing with over 150 practices that are independent businesses loosely connected with the hospital. We’re in the position where we’re trying to create this exchange, trying to develop standards. For example, something as simple as a lab value — a potassium value that we would report as being abnormal or even critical would be something that a nephrologist dealing with dialysis patients would see every day, and would not particularly raise an eyebrow. Whereas if you deal with a GP or family practice, their perspective of what an abnormal or critical value on something as simple as a potassium value is varies greatly.
So to establish some of those standards among the community is going to be interesting, and we’ve established a core group of physician advisors that will help us determine a course and set the rules. So it won’t be the hospital or a bunch of IT folks saying what these things are, it’ll be a group of their peers governing the clinical direction of the Health Information Exchange.
GUERRA: Are you spending most of your time using Stark to underwrite independent EMRs or focusing on the HIE work?
QUIRKE: Both, really. We’re spent extensive time with the privacy folks with the Stark attorneys understanding how we can support our local physician groups as much as we possibly can. Like most hospitals, we are capital constrained, so we are limited as to what we can do. Our goal is to support our local physician groups to the maximum we can within the Stark guidelines and within our budgetary capabilities.
Along with that, we’re reaching out to some of the regional hospitals. I like to think of it as my solar system feeding into the total universe (our state), and then the cosmos, which will comprise the nation of interconnected regional units. We’re talking to Washington County Hospital, we’ve made overtures to Western Maryland Hospital, which is a small two-hospital chain, we’re seeing if we can coordinate and then funnel all our information up to the state and vice versa.
We’re working on a very exciting initiative with the state right now to look at some basic clinical exchange of information around EKGs, for example. We have a wonderful technology in play here where our EKGs are available to physicians on the Web through our physician portal. Our patients who might have a suspected MI heart attack can get their EKGs transmitted from the ambulance to the emergency room to our cardiologist’s home and they can call a code before the patient even arrives at the hospital. Our door-to-balloon times are some of the fastest in the country. And with that technology, we’re looking at how we could deploy it around the state using Frederick as an example. That will be phenomenally exciting if we could link the state together, even with something as relatively benign as EKG information. It’s exciting for us, in terms of how we could help directly save lives.
GUERRA: What’s your core inpatient system?
QUIRKE: We’re a Meditech Magic site.
GUERRA: We’ve all heard that Meditech’s ambulatory product, LLS, is not one of the featured products on the market, let’s put it that way. So I wanted to ask you around your Stark strategy, are you giving physicians a choice of one or two, are you offering them LLS, do any of them want it, how are you working that program?
QUIRKE: Again, as a capital constrained hospital like many, we went through a selection process, we looked at the option of supporting multiple vendors and actually that was a consideration at one point. As it stands today, we are supporting two but, based on our constraints, we felt that supporting multiple systems would dilute our capability to deliver a quality product to our physician community through our MSO. So we really focused on a single system.
The goal of the system that we selected, and the way we’re engineering and architecting our Health Information Exchange, will be agnostic, so even though we will have a core system and we will be supporting physicians in adopting that core system, should a physician or a practice choose to go in another direction — and we have physicians in our community who are currently using tools other than the vendor we’ve selected — we will be offering them an integration strategy into the cloud or Health Information Exchange and supporting their interoperability. So we remain committed to supporting interoperability, supporting the document exchange between physician practices with this ASP-model EMR system, or if they select their own.
Paul Roemer says
Great discussion. I am curious as to if Frederick Memorial is analyzing if it even makes sense to chase the MU incentive money, and if so for what year.
I recently worked on such an analysis for a provider who already implemented EHR. The ROI for them was upside down without even including (guessing) the costs for Stage 2 and 3.
I am curious to understand how another organization thinks this through.
Anthony Guerra says
I’ll send David the link and see if we can get him to comment here. Thanks Paul