With more than 30 years in the industry, Ron Sandifer has seen it all. But even Sandifer is amazed at how demanding today’s healthcare IT world has become. With Meaningful Use, ICD-10 and ACOs all either on his plate or radar, there isn’t a minute to spare. To ready his organization for the brave new healthcare world, Community Memorial is upgrading its inpatient Meditech environment from Magic to Client/Server 5.6, slapping on a PatientKeeper front-end to increase physician satisfaction, and rolling out Allscripts in the ambulatory environment. To learn more about how Sandifer is managing it all, healthsystemCIO.com editor Anthony Guerra recently caught up with the California-based CIO.
Creating physician affinity in California, Stark in the community
LSS a no go, selecting Allscripts for the independents
Meditech 5.6 client/server in the hospitals, Going 6.0?
PatientKeeper laid on Meditech for the docs
Forward Advantage (Data Express) for interfacing
dbMotion melds Community Memorial’s Magic and client/server environments
We received a substantial amount of pushback from the physicians, and we just felt that with them not really accepting the EMR, that we probably would have some of the same issues with CPOE.
We’re at the point now where we’re live with a number of physicians, and it’s been very successful. So I don’t think there’s any thought that anything could have been or should have been done differently.
In thinking about what we were going to do, we kind of thought back to the dbMotion product and said, “Well, wait a minute. If they can bring dispirited systems into an HIE, I wonder if they can bring in the two Meditechs.”
Guerra: Welcome to chapter one of HealthSystemsCIO.com interview with Ron Sandifer, vice president and CIO Community Memorial Health System in Ventura, Calif. In this segment, Sandifer discusses his strategy for creating physician connectivity in California, why LSS was a no-go on the ambulatory side, and the system selection process that ultimately led Community Memorial to Allscripts.
Good morning, Ron. Thanks for being with me today. I’m looking forward to chatting with you about your work at Community Memorial Health System.
Sandifer: Good morning.
Guerra: All right, let’s get the lay of the land. Tell me a bit about the organization and then we’ll go from there.
Sandifer: We’re made up of two hospitals, Community Memorial and Ojai Valley. Community Memorial has 242 beds and Ojai Valley has 93; about 60 of those are actually skilled nursing facility beds. We serve the western area of Ventura County, with 10 clinics spread out through the community. And we service about half a million residents.
Guerra: Now, in California, you’re not allowed to employ physicians, so there are some foundation-type models. Tell me what you’re doing with the independents. I saw that you’re using Stark, and I know you’re working with Allscripts. We’ll get into all that. But do you use a foundation model or anything like that?
Sandifer: At this point, we don’t. Our clinics have been set up for a number of years, and basically, they are contracted independently with the health system.
Guerra: So the physicians working at the clinics—are they treated as employees or are they more like independents?
Sandifer: They’re independent.
Guerra: What about physicians that are not associated with the clinics but do refer into your hospitals?
Sandifer: Yeah, they would be on our staff or they would just be independent community physicians.
Guerra: And outside the clinics, are you using Stark in that situation to underwrite EMRs for them? Or are you just working with the clinics?
Sandifer: No, with the structure we have with the clinics, we can fund that entirely. But with the community physicians, we’re using Stark, and doing up to 85 percent. And I think we’re going to be a little bit below 85.
Guerra: So you don’t need to use Stark for the clinics. Because of the structure, you can 100 percent underwrite what they’re doing.
Guerra: Okay. For the 85 percent of the independents using Stark, are you giving them a choice or are you just offering them Allscripts?
Sandifer: No, we’re just offering Allscripts. We have a contract with Allscripts for the enterprise version and we’re hosting it here onsite.
Guerra: Alright. Let’s talk about your inpatient situation. First of all, are the two hospitals both on Meditech or are they on different systems?
Sandifer: They’re both on Meditech. We’ve converted to the Meditech 5.6 client server in April of 2008.
Guerra: Have you looked at 6.0, and do you have any plans to upgrade?
Sandifer: Not at this point. We had an option for a 6.0 when we went to 5.6 and it just wasn’t quite ready for us, so we’re probably set. We’re going to build a new hospital which should open in the 2014-2015 timeframe. At that point, we’ll probably look and see what we’re going to do.
Guerra: What was it about 6.0 that made you want to hold off?
Sandifer: Well, it was pretty new in the market place. I mean, we made the decision to upgrade in 2007.
Guerra: Right. So is 5.6 going to be certified?
Guerra: So you’ll be able to set with that.
Now, I understand that you’re working with PatientKeeper and that sort of puts a nice cover over the Meditech front-end. Tell me about the genesis of that and whether you were getting pushback from the physicians; for example if they said, “We’re not going to be able to do CPOE with this.” How did you deal with that?
Sandifer: Well, yeah. Our issues really started when we converted to Client Server with the Meditech environment. The physicians were not real receptive to the EMR in Client Server. They had been used to the Patient Care Inquiry and the Magic environment and really liked that.
They were not real happy with the layout of the EMR. We received a substantial amount of pushback from the physicians, and we just felt that with them not really accepting the EMR, that we probably would have some of the same issues with CPOE. The delivery schedule that we receive from Meditech for CPOE was not until actually August of 2012. So we felt that for physician satisfaction and for meeting meaningful use in a more timely fashion, we would look at the PatientKeeper product.
Guerra: So when we say client server, you mean 5.6—that’s the same thing?
Sandifer: Yes, it is. There are two versions of Meditech: MAGIC and Client Server. We’re on 5.6 of Client Server.
Guerra: So the August 2012 schedule would have cut you out of stage one?
Sandifer: Yes, it would have.
Guerra: So that wasn’t even accessible. Let’s talk about the ambulatory space. Take me through the decision to go with Allscripts. I know you’ve been there about three years that the organization. Did it precede you?
Sandifer: No, when we converted to Client Server from Magic, the plan with the organization that had been put in place in 2007 was to install the Meditech partner LSS in our clinics—both their office management product and their EMR.
Again, in the physician demos of the EMR, the LSS product wasn’t widely accepted. And we did have some issues during the conversion on the office management product (which we are still currently running) to the point that the organization said they felt that because of where LSS was in the development with their EMR, along with some of the issues we had, we needed to go out and look for an ambulatory system for our clinics.
We started that process well before ARRA even came about. We had our first demos in January of 2009. We looked at five of the most widely used EMRs and did demos of all five of them. We opened it up to not only our clinic physicians, but also physicians in the community, with the idea that maybe depending on the product and what we did, it might be something that we could offer to the community physicians.
During that process, we had six physicians who basically did all of the demos and really demonstrated an interest in helping us find a product. We reduced the number of potential vendors to two: Allscripts and NextGen. We then took those physicians to HIMSS and we had more focused demos for those physicians from each of the vendors.
When we came back, we scheduled site visits for the physicians as well as the office management staff that does the billing. Out of those site visits, there was a vote taken and it was unanimous from the physicians that Allscripts was the direction they wanted us to take.
Guerra: Do you feel like your selection process was the best it could be, or do you look back and say that you would have tweaked something.
Sandifer: No, we looked at it as having been a very successful process. I mean, we’re at the point now where we’re live with a number of physicians, and it’s been very successful. So I don’t think there’s any thought that anything could have been or should have been done differently.
Guerra: How long did the whole process take of evaluating the market and finally selecting a vendor?
Sandifer: Well, we started in January and we signed a contract with Allscripts in August.
Guerra: One CIO told me these things should never take more than a year. Do you agree with that?
Sandifer: Yeah, I can’t imagine being able to keep interest from the physicians or the vendors for much longer than that.
Guerra: Right. So once you determined that LSS was not going to work for you, at any point did you look at your Meditech inpatient system and say, “Hey, there are some organizations going with the full big bang.” Did you think of perhaps going to a different vendor, one that could allow you to roll out inpatient and outpatient?
Sandifer: No, because we had just done the Magic to Client Server upgrade, which was a substantial financial commitment from the organization. And in truth, the Meditech system is a very cost-effective, stable environment, so there was no discussion about replacing that.
Guerra: In terms of integration, I know you’re working with dbMotion, tell me a little bit about that. Because now we have AllScripts, we have Meditech, we have PatientKeeper, and we have to tie all these things together—plus any ancillary departmental solutions you have that are outside of the Meditech suite.
Sandifer: Meditech has designated Forward Advantage and their Data Express product as the interface partner. And where Meditech in the past has not supported uploading into the Meditech environment and most of the companies out there that did interfacing were using screen scraper technology, Forward Advantage has an interface engine.
We basically outsourced that function to them since I did not want to hire interface engineers internally. And they, in turn, are writing the interfaces between Meditech, Allscripts, and dbMotion. They will look at all of our interfaces that have been done point-to-point in the past, and eventually rewrite all of those going through the Data Express interface engine.
Guerra: How did dbMotion come in to the picture?
Sandifer: Well, we signed the contract with Allscripts in August of 2009 and right after that, Allscripts said, “You know, we’ve got this product that you might be interested in.” And we did a short demo with a very limited audience. We actually only had two physicians, our CMO and one of the physicians that had been working really extensively with our department, along with my staff.
Understanding that we had just invested a lot in capital for our Meditech upgrade, and had just gotten the organization to commit to a substantial amount for the Allscripts, when we looked at the dbMotion product, we said, “You know, it looks like something we might eventually be interested in, but we just can’t address it at this point.”
In the Meditech space, their Client Server upgrade did not allow for conversion of the old Meditech data. So we’ve had to keep two Meditech environments running. When a physician wants to go back and look at a history, they have to click out of the Client Server and go into the old Magic to get that information. That has not been well received by our physicians.
So we brought a couple of companies and said, “Can you help us convert the data from Magic into Client Server?” And they both looked at it that we had a couple of starts and stops, and finally it was just determined that there was no way to convert that information.
So in thinking about what we were going to do, we kind of thought back to the dbMotion product and said, “Well, wait a minute. If they can bring dispirited systems into an HIE, I wonder if they can bring in the two Meditechs.” So I contacted them and discussed with them what our issue was about bringing both Meditech Client Server and Magic into the HIE so we would have a single seamless record for physicians to look at. And they went back and talked about it and said that they didn’t see any roadblock to doing it. So our initial thought was to utilize them to bring our two Meditechs into the HIE, which is being done right now.
But then as we negotiated the contract, we said, “You know, we do need to bring Allscripts into it.” And we do have other systems in our community, so we think we’ve got our contracts structured so that once we get the Allscripts and both of our Meditech environments into the dbMotion product, we’ll probably look at external systems that are not Allscripts in the community and address some of the requests we’ve had about interfacing into Meditech and look at that.
Guerra: Is this a unique problem that Meditech customers have where you upgrade from one version to the next and then your data can’t come along?
Sandifer: Well, we’ve done a lot of upgrades in Meditech over the years, but the technology and the infrastructure of the Client Server versus Magic in their first release, or in the 5.0 or 5.5, 5.6 environments, did not allow for conversion of that Magic data.
In the 6.0 version, they have been able to write conversion programs. So if you go to 6.0, you are able to bring your Magic data into the 6.0 Client Server world, which those of us that went before 6.0 were unable to do.
Guerra: How has Meditech been as a partner helping you through these issues?
Sandifer: Well, they were not thrilled that we went the Allscripts route. But they have not thrown up any roadblocks. In discussions I’ve had with them, I think they realize that they’re not going to be able to count on all of their client bases going to LSS. So I think that’s why they partnered with Forward Advantage, realizing that they needed to have a partner to be able to do interfaces, whether it’s Allscripts, NextGen, or any of the other EMRs out there for the ambulatory setting.
Guerra: So they understand that. And you saw that they just acquired LSS or announced plans to acquire it. But we have to assume it’s going to take some time to get the integration down.
Sandifer: Well, it’s been an integrated system for a number of years. It was a logical move for them. They’ve been marketing the LSS environment because it has been integrated with their platform. So it was not as a surprise, I don’t think, to any of us in the Meditech space.
Guerra: So the problem is not lack of integration with the inpatient environment?
Guerra: It’s a functionality issue.
Sandifer: Functionality, yes. And I think one of the things that we experienced when we demoed the product to some of the physicians is that they want to go on the Internet and they want to look at the product and consider whether we want to install it in the office before we’re ready to have it either in our clinics or offered to the community. And the LSS product really only works in the Meditech integration model. So it’s not something that a doctor would go out and buy to put in their office.
So I think that in looking at it, we were motivated as to say, “Well, you know, while there’s certainly benefits to have the integrated model, we felt that we would probably be more likely to run it to physicians in our community that were either on a NextGen or an Allscripts system.”