The days of associating small hospitals with low-tech facilities are slowly fading in the past. One reason is that the small, including critical access, hospitals (CAHs) are not exempt from the HITECH programs carrots … or sticks. But sometimes being small does mean being resource constrained and, in that environment, doing any kind of rip and replace is often impractical. Washington County Hospital CIO Kim Larkin recently grappled with that challenge and, thanks to some timely vendor M&A, came out on top. To learn more about this fortuitous turn of events, and just how creative small-facility CIOs need to be, healthsystemCIO.com editor Anthony Guerra recently chatted with Larkin.
… that’s where we really ran in to problems with other vendors. They were unwilling to drop in just their inpatient product into my existing setup here. Now they’d sell me a whole new billing system and clinicals, but they wouldn’t just give me their clinical component and interface it …
We get to keep what we’ve got and now we’ve got someone who has a vested interest in working with the entire product line to convert it into, basically a single database, a single login, a single system that looks and feels the same.
With the whole Meaningful Use regulation coming down the pipeline and all the other things that we needed to be able to do here at Washington County, throwing a whole new financial system on top of everything else … we couldn’t do it, couldn’t do it.
GUERRA: Hi, Kim. Thanks for being with me this afternoon. I appreciate your time. I’m looking forward to having a little chat with you about some of the work you’re doing over at Washington County Hospital in Nashville, Ill., not the Nashville we mostly think of, right?
LARKIN: That’s right. It’s Nashville with about 3,400 people.
GUERRA: Alright, a little different, but I know you’re doing some work with NextGen so we probably could talk about that and then expand the conversation a little bit. Now, I see that you started with the Inpatient Financials and the HIE technology and then you brought in the Inpatient Clinicals. First of all, is that correct?
LARKIN: It is correct. We’ve had the Financials since ’98 and we’ve had the CHS (Community Health Solution) product for two years now. We are in the midst of the implementation for the Inpatient Clinicals, and we have had ambulatory NextGen Clinicals up and running for over two years as well.
GUERRA: I know that NextGen acquired Opus — is any of this Opus technology?
LARKIN: It is. The Inpatient Clinicals is actually the Opus product and the financial component that NextGen has now was previously known as Sphere Healthcare System. We’ve had Sphere since ’98. NextGen acquired them last summer and then acquired Opus this winter. I think in February they made the announcement. Right now they still look like separate systems, but NextGen’s intent is to integrate the systems seamlessly into one single product, so we will be one of the first three or four hospitals in the country running all of their systems.
GUERRA: So it still feels like you’re running three systems.
LARKIN: Oh yes, it’s three separate systems right now. There’s interfaces in place — they’re all HL7 interfaces, and there are more of those to come — but they’ll be rewriting different functions or different sections out of the financials into more of a Web-based version and, over the course of a couple of years, they’ll be morphing the product into a single product where it looks the same, where there’s a single login to get into everything. That’s their goal, and with putting it in Nashville, because we are a small hospital, we’re better able in a lot of ways to handle that change. Every time they rewrite something or want to try something out, they’ll try it out on us, and we’ll be able to help guide that development and have some say and some input into what works.
GUERRA: Are you using a third-party integration engine to move data between the systems?
LARKIN: We’re not. The vendors, NextGen, which is now one vendor, are doing the interfaces for us, and I’m really not sure of what they’re doing on their end to write those interfaces. Right now, the interfaces between the Sphere product, Opus, and NextGen, they’re all the responsibility of NextGen to get those systems talking to each other, so I don’t even have to get really involved in that very much. They pretty much are handling all of that internally. Then for the interfaces with other software — like we have a pharmacy system from Mediware — we’re working with NextGen and Mediware to do those kinds of interfaces.
GUERRA: You said NextGen was willing to work with your vendors and integrate with your existing systems more than others. Can you tell me more about that?
LARKIN: Sure. We are very small. We are a critical access hospital. We don’t have a lot of money. We had Sphere Financials since ’98 and we are very comfortable with them, we liked it very much because it has a lot of flexibility. We were not at all interested in getting rid of that, but we are willing to put in electronic health records in our rural health clinic. We ultimately selected NextGen for that product — or for that project — which left us needing the inpatient system, and that’s where we really ran into problems with other vendors. They were unwilling to drop in just their inpatient product into my existing setup here. Now they’d sell me a whole new billing system and clinicals, but they wouldn’t just give me their clinical component and interface it with my existing systems.
I didn’t have the money or the staffing or the time or the energy to totally switch out my financial system, so we were looking for a vendor that was willing to work with us, that had an inpatient system or a hospital system that we could drop in and not have to throw away our Sphere Financials or our NextGen Ambulatory Clinicals.
We’ve been working with NextGen quite awhile with CHS and with the ambulatory clinicals, and they were well aware of what we’re trying to do and the need for hospitals like ours that didn’t have the resources to just start all over. We needed a product they could drop in and Opus was their solution for that. We jumped right onboard when we knew they were looking at Opus because we didn’t have to give up anything or spend money on redoing things or try something out. We get to keep what we’ve got and now we’ve got someone who has a vested interest in working with the entire product line to convert it into, basically, a single database, a single login, a single system that looks and feels the same.
GUERRA: You must have been excited by the Opus acquisition.
LARKIN: Yes, we were waiting for something like that.
GUERRA: And the responsibility is all on NextGen to do the integration?
LARKIN: Sure. They’ve got more skin in the game than even I have to make this work, to make it into a successful single product line, and this hospital is wide open to them. They know they can come in and try anything they want, they can load it up on the test site and we’ll give it a run and see how it works. They’ve kind of got a test tube, if you will, here for them to work in, so it’s a win-win for all of us.
GUERRA: It sounds like it. Switching out financial systems is no joke.
LARKIN: Absolutely. It’s enormously risky switching billing systems. It’s one thing if you have to do it if your vendor is going out of business or your systems can’t be supported anymore or whatever. It’s not something you want to do lightly. With the whole Meaningful Use regulation coming down the pipeline and all the other things that we needed to be able to do here at Washington County, throwing a whole new financial system on top of everything else … we couldn’t do it, couldn’t do it. Then the added risk there of your AR days going up, your cash stops coming in, all that puts you deeper in the hole. It just wasn’t an option for us to get rid of Sphere.
GUERRA: So it worked out. Tell me a little bit about the NextGen HIE product and what you’re doing with that — I saw that you’re doing some work with Salem Township Hospital. Just give me the background on that relationship and what you’re trying to do there.
LARKIN: Well, I think it was in ’06 or ’07 that Nashville and Salem hospitals received the benefit of a grant, the Federal IT grant that was actually awarded to the State of Illinois, and with that grant money we were able to put in the NextGen ambulatory product at Nashville and Salem, and we were also able to purchase the community health solution of NextGen. It’s not licensed to Nashville or Salem, it’s licensed to the Illinois Critical Access Hospital Network, which is a network of 50 critical access hospitals here at Illinois. ICAHN has full license for the CHS product and the plan, the whole idea was we needed to be able to give these 50 hospitals a vehicle or a mechanism to get their data out there into an electronic format for an information exchange.
Our intent has never been that we will be exchanging information between the critical access hospitals. We are spread all over the state. There’s a few instances where we actually compete with each other, but most of the time we don’t. Our service areas are separate. This was a different way of doing an HIE and most of them were geography centered or sharing, but what it did for us is it allows us to get our data on our ambulatory EHR right now into the CHS system, and we can give access to that portal now to providers at other hospitals when we transfer patients over. We can let them login and get our information.
Currently we’re actually hosting that CHS server here at Washington County. I’m able to do it right now, but it’s going to shortly move off to a hosting site. We have 11 other practices from Gibson City, Ill., currently feeding data from their EHR into a test database. What we’re really excited about is we’ve got a list of other NextGen ambulatory users that are willing to start contributing into the CHS. That will be a tool for all those 50 hospitals that ICAHN can administer and help keep the cost down so they’re not having to pay a whole lot of money to join other information exchanges. That part is really exciting. We’ve been working with NextGen asking for some modifications and some tweaking of the screens. We’re moving right along on that, and it’s looking good.