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.
… our whole unique plan of modifying the ambulatory EHR — the single solution for our hospital — went out the window, because the piece we would have created for the inpatient side would never have been able to meet any kind of certification standard.
When I started talking licenses, I would get the glazed eyes and they’d tell me, “No, we can’t do that.”
GUERRA: During vendor selection, did you show different products to the clinicians and see which one they liked, or was it your role to just make sure that everything worked well together?
LARKIN: It was really kind of a strange role. Several years ago, probably ’05, I had started looking at EHR products. We already decided that we had to have something for our little health clinic, but we didn’t have enough money, and we really are so small that 85%, 90% of our volume is outpatient. We just don’t have a lot of inpatient. I had gone to HIMSS looking at the vendors, talking, and I was trying to find someone who had an ambulatory product, but I wanted a product where they would let me modify the screens. I said that if I can find a vendor with an ambulatory product that will allow me to build out the screens I need for the rest of the hospital site, maybe we can do this with a single product.
At that time, Misys (which was still Misys) and NextGen were the only two vendors I could really find that could do what I wanted and that were willing to work with me. Then we just waited for the money. Later, the grant came in, and we ultimately selected NextGen. We made that selection after doing demonstrations with the medical staff — we had both vendors came in, we reviewed the pricing, and that’s how we ultimately went with NextGen.
Then, about eight months later, the stimulus package came out along with everything about CCHIT certification, or certification by somebody, and our whole unique plan of modifying the ambulatory EHR — the single solution for our hospital — went out the window, because the piece we would have created for the inpatient side would never have been able to meet any kind of certification standard. That’s what left us really in a bind because now we had ambulatory NextGen, we had Sphere over here for financials, and I had to find something that I could put in the middle on the inpatient side without tearing out either end of what I already had.
We talk to NextGen almost every day. We asked if there was something out there they were working on regarding an inpatient solution. I don’t really know how much influence we had on them, but I could not have been happier when they came out with Opus, because that’s exactly what we needed. Had they not done that, I’m really not sure what we would do for an inpatient solution. You know, I could get MEDITECH, I could get any number of vendors to come in and take out my Sphere and replace everything with their product, but again, I don’t have the time, the money, the energy or the interest in doing that, so this is just perfect for us. It just fits with everything. The only thing that could be better is if I still could have modified my ambulatory EHR and not even had to buy anything, but that went by the wayside.
GUERRA: Your facility is certainly small and rural, correct?
LARKIN: Yes. We are a 23-bed critical access hospital.
GUERRA: Any advice you could offer to people in your position with similar facilities and resource constraints?
LARKIN: There’s the usual, “It’s always going to take more time and money than you think.” We were surprised by how much harder it was than we thought it would be. You know, you can have everybody saying they want something, but the workflow analysis, what’s going to change when we go electronic versus how we’re doing things manually, that’s a different story. I was actually surprised how much more difficult that was.
From a vendor standpoint, talk to your vendors, just talk to as many as you can, get as much knowledge as you can of what’s out there. I go to NextGen and say, “Hey, Epic can do this. Can you do it?” You can go back and forth — they’re listening. You need to go talk to everyone you possibly can and get as much information as you possibly can and then bring it back and figure out what’s going to work for you, for your hospital. It’s not one size fits all. It’s not always really obvious. You need to be creative about how you’re going to do things sometimes.
GUERRA: You said shopping the floor at HIMSS was a good way of getting information, so I guess there really are potential buyers at that show.
LARKIN: I literally walked that floor. I think I talked to everyone and it was kind of funny because there were a couple of things I had to have. One, they had to be willing to drop their product in the middle of my system without me throwing things away, and then when I was looking at the hospital side of things, when I was looking to modify an ambulatory product for the hospital, there had to be some way to handle the licensing. In an ambulatory product, you license it per provider, so if you have three docs in the office, you get three licenses. In a hospital, my doctor in town who’s not employed by me comes by everyday, he’s there for an hour, he makes rounds, and then he goes back to his office. I don’t want to pay a full license for a hospital doc like that. When I started talking licenses, I would get the glazed eyes and they’d tell me, “No, we can’t do that.”
So yes, I shopped the floor, I talked to more vendors, and some of them wouldn’t even talk to me, I’m too small. Well, some of the big vendors, you know the Epics and the Cerners, they’re looking for larger facilities than mine — it’s just not a good fit and that’s okay. I crossed them off, they’re not going to work for me, but yes, I shop the floor. I bring about five pairs of shoes with me when I’m working. I talk to everybody and it’s surprising how many times throughout the year something will come up when I want to contact someone I met at the show.
GUERRA: Are you a member of CHIME?
LARKIN: No but I would like to be. It becomes an expense part of my budget. Right now, I get to HIMSS and I’m trying to get to the NextGen user group meeting in November. Travel expense money here is pretty tight, and CHIME is just one more thing — I’m not willing to give up HIMSS for it, and I haven’t found a way to squeeze them both into my budget. I’ve seen a lot of what CHIME puts out and it looks like really good stuff, but I just can’t do it.
GUERRA: Maybe when the HITECH money comes in …
LARKIN: I’m waiting for that, but I’m not going to hold my breath.