One-on-One w/Frederick Memorial CIO David Quirke (III)

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.

(Part I, Part II)

BOLD STATEMENTS

… this wonderful technology pulls data from all the different systems we have in the hospital and presents it to the physician in a format that they want to see, rather than a rigid structure that many HIE systems force us to use.

Yes, we want to get our stimulus dollars, but if we take our eye off the core of what many of us got into this industry for, we may end up in the worst spot — we may end up losing ourselves to chase dollars, and then spending more dollars to get back to our core.

… positioning these initiatives as CIO initiatives only positions you for failure.

GUERRA: So you’re got a preferred ambulatory EHR that you’re underwriting for the independent practices — which is it?

QUIRKE: We selected NextGen.

GUERRA: Are you doing a direct NextGen to Meditech (the hospital CIS) integration or is it NextGen to the cloud to Meditech so you’re able to tie any ambulatory product into the cloud, which ultimately taps back into Meditech?

QUIRKE: Yes to all. Actually, you’re exactly right. If you imagine an equilateral triangle where we have Meditech in one corner, NextGen EMR in another and other ambulatory systems out there in the third, and with the HIE in the center, there will be direct connections from Meditech to the cloud. So the cloud, if you like, will contain a master patient index. We will feed in information such as our available patient beds, problem lists, allergies, and more advanced data as we progress. The physician practice system will also feed their MPI, their patients, with the same information. We’ll match those patients in the cloud and have those form a link with the other ambulatory systems. They will have the ability to connect to the cloud and match their patients with the cloud patients. So the cloud will be the whole. The systems in the hospital — not just the Meditech system — will contain hospital-based data, the ambulatory EMRs, each practice will have their data and, within the cloud, we’ll have a shared data exchange.

For example, when I present in the ED, there’ll be a CCD, CCR document sent from Meditech out to the cloud. The cloud will determine who my primary care is, who else needs to know if there’s a consult, make sure that if I need to go see a cardiologist for a consult afterwards, they will all get updates directly into their EMR systems, irrespective of whether they’re on NextGen, Allscripts, eClinicalWorks or whoever. So we’ll have those kinds of direct links to and from systems.

We’re looking at order entry right now — whether order entry will go through the cloud or a direct connection. We’re looking at getting  support from third-party integration vendors, like Iatrics, which will help us manage that interaction.

GUERRA: Tell me about the core vendors that are supporting the cloud environment.

QUIRKE: The players we’re using, ultimately, are Meditech at our core, NextGen which made a product called CHS (Community Health System) — that contains some basic EMPI functionality — and another very exciting element from a company called Medseek that we’ve had a phenomenally successful relationship with over the last several years. They’re a health Web integration vendor. We’ve developed a physician portal with them where we tie all, I should say most, of our core hospital systems together and give our physicians a patient-centric view of all data we have, whether it’s a monitoring strip, EKG, MRI, x-ray, or bedside telemetry, they can get on the Web from anywhere and see all of that. They can see bedside telemetry for ICU patients, their allergies, their differences. So this wonderful technology pulls data from all the different systems we have in the hospital and presents it to the physician in a format that they want to see, rather than a rigid structure that many HIE systems force us to use. And we’re looking at integrating that solution into it so our physicians will not only see just hospital-based data, but they also will have the ability to see cloud data and ultimately, drill into their own practice data and those of their partners and trusted friends.

So we’re excited and we see this kind of portal or vestibule technology as maybe one of the great wins in trying to provide our caregivers a single look at all the complex patient data out there in their EMRs, in the different hospital systems and then, ultimately, we’ll give our patients that same access, empower our patients to participate and use the data filter in a secure way, allow them to participate in their care by reporting on how they reacted to a medication,

“It made me itchy … it made me drowsy,” and then we could convert that to a stated allergy. So we could possibly code it — it could be a coded allergy later on — but the goal is to get a single look and view for all our patient data in our community. And then, as we interact and talk about our local solar system, as we participate in the universe that is Maryland, and then the cosmos which is the nation, we really want to develop systems that will be very open to sharing data to the state, on the federal level, and even with partner hospitals in the area.

A lot of hospitals in our area are looking at the same kind of challenges. I met with another CIO in Baltimore and she’s got exact the same challenge that we have. We’re looking at some shared development opportunities around this kind of Web-based portal technology.

GUERRA: There are so many projects coming at the CIO today, so many pressures. Do you agree with that, and do you have any advice for dealing with it all?

QUIRKE: I certainly agree with the assessment. My advice to my peers is let’s just focus on the basics, the reason why we got into healthcare, the reason why health IT is still the pioneering frontier that it is. We’ve come so far, and we have so far to go, but let’s focus on the basics. Let’s focus on improving the quality of care and supporting the providers to take care of our patients, and help build solutions that do those things. That’s got to be fundamental. Yes, we want to get our stimulus dollars, but if we take our eye off the core of what many of us got into this industry for, we may end up in the worst spot — we may end up losing ourselves to chase dollars, and then spending more dollars to get back to our core.

The other advice is that these initiatives are not CIO initiatives. Getting the dollars is not a CIO role; it’s the role of every provider in the organization, every vice president, every C-level person in the organization. You can’t present a CPOE initiative, for example, as purely a technology initiative. CPOE is an organizational reengineering process; it’s a change management initiative, and some of the other requirements that get us to Meaningful Use are just like that also.

The CIO cannot go out there and force 80 percent of ambulatory physicians to use CPOE. The CIO cannot go out there and force the use of barcode scanning and medication reconciliation. There have got to be partnerships with our physician leadership and nursing leadership to achieve these goals. So positioning these initiatives as CIO initiatives only positions you for failure.