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.
Selecting Allscripts for the ambulatory setting — “They’ve been one of the most responsive vendors I’ve ever dealt with”
Working with the specialties
Measuring up to Meaningful Use
The art of physician engagement
Prepping for ICD-10, ACOs
I’ve been in the industry longer than I like to remember… and they definitely have been one of the top vendors I’ve ever had to deal with in terms of customer responsiveness and attention to the client.
We’re probably not looking to apply for Meaningful Use until 2012 because of what we have to do with PatientKeeper… so we anticipate by that timeframe we’ll have gone through all of the reporting structures and be able to report on all of their requirements.
If we actually had done demos of the MEDITECH client server environment to the physician community, we would have probably had a reading on what their thoughts we’re going to be about that version… and we may or may not have done the same process. I think we learned from that, and historically, I’ve tried to work whenever possible with the physicians.
A couple of the physicians have actually gotten involved to the point where they were doing a lot of the content development. So we’ve got a great commitment from a very strong core group of physicians in this community—much more so than I’ve ever run across before.
Guerra: Going back to the Allscripts selection, to quote the release, you said, “We were impressed by the pervasive culture of integrity, respect and service reflected by every one of the Allscripts people we’ve met. That stood out to me; you don’t see statements like that being thrown around. Tell me a little bit more about that.
Sandifer: They’ve been a very cooperative vendor. I mean, if you go all the way back to when we initially set-up demos and then started doing site visits, they were very responsive all the way through the reference portion of our research and the contracting. I’ve been in the industry longer than I like to remember and have dealt with a number of vendors, and they definitely have been one of the top vendors I’ve ever had to deal with in terms of customer responsiveness and attention to the client. It’s been a very positive experience from the beginning.
Guerra: Have you seen any change—positive or negative—in customer service since the acquisition of Eclipsys?
Sandifer: No, we really haven’t. I think maybe because they’re still bringing the companies together. I’m not sure how much overlap there is and we’re really focused with the ambulatory side of the shop still, but we have not seen any really impact from our perspective.
Guerra: Regarding your work with the clinics versus the independents, is there a big difference that you’ve seen as a CIO in working with those two groups of individuals?
Sandifer: Well, the clinics have a cross-section of different specialties. We’re scheduled to go live with our first clinic on the EHR on May 1; there are 18 physicians in that clinic, and of those, there are seven specialties.
As we’ve gone live with our pilot group with the community physicians, we’re finding that the majority have been in family practice. We’ve gone live with an OB-GYN practice and a gastro practice, but from what we’re looking at in the community right now with the backlog that we have, there are more family practice physicians in our queue that are approaching us than there are specialties right now. And when you look at their work effort, it’s probably beneficial to us, but I think that the clinics having just about a cross section of all specialties is somewhat different.
Guerra: When you talk about specialties, that makes me think of Meaningful Use. One of the issues they’re working through is how to handle quality measures so that the specialties have something to report and everything that they see isn’t irrelevant to what they’re doing. Overall in terms of positioning for stage one, tell me how you are looking—how are you moving toward that, and how does that relate to the specialty issue.
Sandifer: We’re going to take the latest version of the Allscripts, which has all of the reporting and requirements to meet stage one. In fact, we’re scheduled to go live with that sometime in the August time frame. We’re probably not looking to apply for Meaningful Use until 2012 because of what we have to do with PatientKeeper and everything, so we anticipate by that timeframe we’ll have gone through all of the reporting structures and be able to report on all of their requirements.
Guerra: So in terms of CPOE, I don’t even know if electronic documentation is really required; I think you have to put one electronic note per patient stay day, something like that. But how are you doing with CPOE?
Sandifer: We’ve started the implementation of the PatientKeeper EMR, which should be pretty much complete in the May-June timeframe. What we’re doing with PatientKeeper is having the project as two phases, starting the CPOE implementation probably in the June timeframe. They’ve approached us about moving that implementation up sooner, so we’re looking at that and seeing not only how we could staff it and handle the concurrent projects, but we’ve also got to make sure that everything we’ve promised to the physicians that are entailed in the EMR is still delivered on a timely fashion. So we certainly feel that we’ll have both the EMR and the PatientKeeper CPOE up well in advance of the end of the year.
Guerra: You talk about Allscripts having some nice reporting functionality. How are you doing on the inpatient side as far as reporting?
Sandifer: Well again, Meditech is 5.6 certified and that’s another area that we’re going to have to look into in the reporting. We have some reporting tools that we’ve acquired through the advisory board that we think might help us in meeting the reporting requirements in addition to what we’ll get with the Meditech and the Allscripts environment.
Guerra: You mentioned physician engagement, having six physicians engaged at one point and two at another. When we talked about an elongated selection cycle, you said you’d had trouble keeping their attention. Talk to me in terms of the best practices you’ve found for engaging physicians, because everyone says that if you don’t, they’re never going to use the product if they weren’t part of selecting it.
Sandifer: Looking back on the process with this organization—and I wasn’t here at the time, but I think if we actually had done demos of the MEDITECH client server environment to the physician community, we would have probably had a reading on what their thoughts we’re going to be about that version of the MEDITECH environment, and we may or may not have done the same process. I think we learned from that, and historically, I’ve tried to work whenever possible with the physicians. So we didn’t even think about trying to do something in the ambulatory setting without bringing physicians in. I think we got very lucky while we opened it up to all of our clinic physicians—there are 74 of them—and the community physicians. It was sporadic in attendance depending on the demo and the time, so we got very lucky in that we had these six physicians that made it to all of the demos and took an interest. Some of them are family practice, and again, we had a gastroenterologist and an OB physician, so we really had a couple of good specialists in our family practice that took the interest and have dedicated a lot of their time and effort to being our pilot physicians and developing content with my staff. And a couple of the physicians have actually gotten involved to the point where they were doing a lot of the content development. So we’ve got a great commitment from a very strong core group of physicians in this community—much more so than I’ve ever run across before.
Guerra: Now we’ll talk about your career a little bit, which you said has been long and interesting, but I’d like your thoughts on the overall job that CNS and ONC have done with laying out the program as it was outlined in the law.
Sandifer: Well, I think we were a little concerned when it was first announced about what requirements we could meet, and after they came out with the file rulings they backed off some of it, so they’ve made it easier for us to meet stage one in a more timely fashion. I think we’re still seeing some issues with CMS; we have some physicians who have outpatient surgery centers and ambulatory centers that we can’t share EMR data with, and it doesn’t seem like it meets what the government is trying to have us do. So while we’re seeing the direction and the rules, it’s pretty clear that there just seem to be a time some conflicts between what the government is trying to do and some of their agencies, specifically CMS, are doing.
Guerra: Is ICD-10 on your radar?
Sandifer: It is. Like many organizations, I think we probably have not given it the attention that we should. A group of us that attended HIMSS, which included a couple of physicians, went to some of the presentations and came and said, “We have to give this more attention.” But while we do rely on both of our major vendors—Allscripts and Meditech—to get the code available to us, we’re going to have to probably scale up our attention to it and start working with some of our partners and move a little bit quicker than we have to this point. It’s just that, like a lot of organizations, we’ve got our plate full.
Guerra: And at HIMSS, everyone was talking about accountable care organizations. Does that mean anything to you today in terms of practically budgeting or planning a project—does that translate into any concrete action other than the Meaningful Use measures, which may dovetail into what’s required? What are your thoughts on ACOs?
Sandifer: We’ve got a parallel project that’s going on with accountable care in our clinics. We are getting some outside help in setting it up; they’re working with us as we’re rolling out the Allscripts environment. When we brought them onboard in the organization, we made the determination that they were going to move toward the accountable care model while finished with most of the implementation work with the office management product. And we’re into the EHR development stage now, so while we haven’t completed areas in the scheduling environment, we are modeling the Allscripts rollout to meet accountable care, and that certainly is something that we’re heading toward.