Don’t be fooled by the appearance of Children’s Hospital of Central California. The brightly colored building may look more like a children’s castle than a hospital, but inside those walls, the IT team – led by VP and CIO Kirk Larson – is leading a transformation that will make it one of the most sophisticated pediatric hospitals in the country. Children’s Hospital, which is located in the San Joaquin Valley, is going live on advanced clinicals and CPOE this summer, and will soon deploy an application that enables clinicians and staff to view electronic records from anywhere in the building using an iPad. In this interview, Larson talks about the IT strategy that is driving Children’s Hospital, how his experience on the vendor side has helped shape his role, and what it’s like to work in a pediatric hospital.
Chapter 1
- About Children’s Hospital
- Running Meditech C/S 5.6.4, likely upgrading to 5.6.5
- No defined path, no 6.0
- Going live with CPOE this summer
- The ambulatory strategy — no LSS
- User-based system selection
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Bold Statements
They said it would probably be at least two years before it a path is defined for people in our situation, which was another reason for us to go ahead and make the move to 5.65, knowing that we’re not going to be on the 6.X platform probably for at least two years.
We are trying to move that along quickly, particularly with CPOE going live on the inpatient side this summer. Our expectation is that this will be exciting for the physician community, and people in the ambulatory setting will see that, and will want to have that type of technology.
When I last spoke with Meditech, they were upbeat with the acquisition. And they’re coming out with the new version where they’re really saying publicly that they believe that they are going to get past some of those interoperability issues. So I’m hoping that they’re right.
It’s not necessarily owned but instead facilitated by our project management office, and there is a selection committee that is quite diverse and really represents all the disciplines you’d expect… But certainly, physician participation and engagement and buy-in would really be essential to that process.
Guerra: Good morning, Kirk. Thanks for being with me today to chat about your work at Children’s Hospital at Central California.
Larson: Thank you. I’m very glad to be chatting with you today, Anthony.
Guerra: Why don’t you give us a little overview. I have down that it’s a 340-bed pediatric hospital, the second largest children’s hospital in the state, and the tenth largest of its type in the US. Please give us any additional overview you might have.
Larson: We’re very proud of our facility here. We sit on about a 50-acre campus, a very beautiful campus overlooking the San Joaquin River. As you said, we’re about a 350-bed pediatric facility, making us one of the 10 largest such facilities in the country. We have a medical staff of about 450 physicians who practice in over 40 sub-specialties, and we’re particularly proud of a couple recognitions that we’ve received.
We were the first pediatric hospital west of the Rocky Mountains to receive Magnet Nursing designation, which is a very prestigious designation awarded to fewer than two percent of the hospitals in the country, I believe. And we’ve also been recognized by the Leapfrog Group for excellent in patient safety and healthcare quality. So, that gives you kind of a sense for what we do here at Children’s.
Guerra: A 50-acre campus—is that just a lot of nice grounds, because the hospital is 350 beds; what else is on the campus?
Larson: It’s just the hospital. We do have some clinics on the site, as well as a medical office building. We’re adjacent to a Ronald McDonald House. If you see the hospital as you’re coming up the highway—I always remember the first time I saw it—you see that it’s very impressive, and it was designed with children in mind. Because normally, a hospital could be 10 stories high and very plain and a little intimidating. With our facility, there’s no place from the outside that appears to be taller than two stories. So it’s quite a bit more welcoming. It has very nice, kind of pastel colors. It’s kind of spread out and we have a lot of land. We’re technically in Madera but we can see Fresno from where we sit. So it’s a really beautiful campus and I think it’s welcoming to the children that come here for their treatment.
Guerra: That sounds very nice. I’m sure it’s very picturesque. So you have 450 docs in the medical staff—are they employed, independent? What’s the mix there?
Larson: We do work with a specialty medical group that’s closely affiliated with the hospital. I’m not sure exactly how many—I think there are 100-150 who are affiliated with that. And then the rest is a mix.
Guerra: So maybe 300 independent that are referring in. Is that the approximate number? I’m just trying to get an idea of the mix, because when you’re trying to implement advanced clinicals, sometimes you have a little more influence over even those physicians that are with that closely associated specialty practice, because there’s one person to go for discussions as opposed to trying to get 300 independent physicians all on the same page.
Larson: Well, I believe that’s probably about right. I don’t have those specific numbers though.
Guerra: No problem. What about the application environment—I see that you are a Meditech Shop. What version are you on?
Larson: We are presently on version 5.64, and we are in the client server environment.
Guerra: Do you need to upgrade to get on a certified version or are you all set?
Larson: We do need to upgrade. We basically have two choices—either to take Priority Pack 21 and remain with Version 5.64, or more likely what we anticipate doing is moving to version 5.65 late this year.
Guerra: Did you contemplate 6.0?
Larson: The thought crossed our mind. However, presently, Meditech does not have a defined path for folks who are on a client server environment to move to what I call 6.X, because by the time that the client server folks move to a 6.X platform, even right now, they said it would be 6.1, or more likely 6.2. And in fact, when I was in Boston meeting with Meditech folks, they said it would probably be at least two years before it a path is defined for people in our situation, which was another reason for us to go ahead and make the move to 5.65, knowing that we’re not going to be on the 6.X platform probably for at least two years to even begin that project work.
Guerra: Wow, two years. Do you feel that 5.65 or 5.64 have the CPOE functionality you need to get the physicians engaged?
Larson: I believe it does. We’re going to be going live this summer with the CPOE functionalities, so we’ve had physician engagement on that. And I believe that even the version that we’re on—5.64—I think physicians will find adequate and appealing for their needs.
Guerra: You said there are some clinics. Tell me about the ambulatory strategy—I know that there are no employed doctors in California, but you have that specialty practice. Are they on ambulatory EMRs? And for the independents, what are they on, and what is the strategy for community physicians to get more integrated to the hospital to some degree.
Larson: Our first step in that process is getting the clinics that are on campus here onto an ambulatory EMR. At present, there is not an ambulatory EMR. That project hasn’t been finalized, but we anticipate it will likely begin next year so we can get everyone on to the same platform. And then of course, the challenge will be how do we best integrate that with Meditech.
Guerra: So you, you haven’t sort of decided upon an ambulatory EMR that you’re going to recommend or endorse to the specialty on campus practice?
Larson: We have not yet. We are in the selection process, so RFPs have been sent out and vendors have responded and some have actually done demos already. We are trying to move that along quickly, particularly with CPOE going live on the inpatient side this summer. Our expectation is that this will be exciting for the physician community, and people in the ambulatory setting will see that, and will want to have that type of technology. So we are moving that along as quickly as we can.
Guerra: As I’m sure you know, Meditech had an association or interest in LSS and finally completed an acquisition. Recently, from what I’ve heard, the integration with the Meditech inpatient suite is not a problem, but the functionality of LSS leaves something to be desired by the physicians. Any thoughts on that?
Larson: Yeah, we will not be pursuing LSS as an ambulatory EMR.
Guerra: Is it because of those functionality issues, if you can tell me?
Larson: Among other reasons, yes. I’ve only be at Children’s about six months; there were some demos and some interactions that happened previous to my time. And it’s actually been kind of a standing strategy that we would not go in that direction due to functionality. And to be honest, as you indicated, even the integration with Meditech is something that gives us pause.
Guerra: I have heard that it was certainly functionality, but you’re saying even the integration leaves something be desired?
Larson: To some degree. I think in fairness, LSS is probably going to integrate the best of any potential ambulatory EMR, but in my experience, it’s still not going to be fully integrated. However, again, in fairness, when I last spoke with Meditech, they were upbeat with the acquisition. And they’re coming out with the new version where they’re really saying publicly that they believe that they are going to get past some of those interoperability issues. So I’m hoping that they’re right. But like I said, that’s not a direction that we’re looking to go at this time.
Guerra: You certainly are going to have an integration challenge. Have you narrowed it down to any sort of final list that you could share with us—top top three, top five ambulatory vendors that you’re looking at?
Larson: Probably not at this time. I think we’re getting close, and I’d certainly welcome continuing that conversation as we narrow it down. But I think that in fairness to folks who are still being scheduled for demos, I don’t want to kind of unduly tilt that playing field.
Guerra: Can you say anything about the methodology you’ve used in the selection process—the people that you’ve gotten involved and the constituencies to try and make it an accepted choice when you’re at the end of the process?
Larson: Sure, I’m happy to talk about that. It’s actually a very collaborative process that is being driven from our centralized project management office. So a couple of years ago at Children’s, the PMO function was actually moved from IT and established centrally so that projects such as this were not perceived—whether it was real or not—as being an IT initiative or an IT project, and were truly seen as an organization-wide project.
So it’s not necessarily owned but instead facilitated by our project management office, and there is a selection committee that is quite diverse and really represents all the disciplines you’d expect—the ambulatory executive director, physicians, nursing, the PMO itself, IT, and other folks as well. But certainly, physician participation and engagement and buy-in would really be essential to that process. So I’m excited about the level of participation that we have in that selection process.
Guerra: So when you make a final selection for the specialty practice, will you do a point-to-point integration between that EMR and Meditech’s inpatient system, but then have some sort of cloud solution to integrate with the dozens of ambulatory products that may be used by independent physicians? How will you work that?
Larson: It’s a good question, and we’re not quite sure how we will do that. And part of that reason is the fact that we have not yet landed on a vendor. And I think once we do land on that, we’ll be able to more fully flush out that strategy. Certainly in-house, the interfacing would be not easy necessarily, but a little bit more straightforward. But how we interact outside of our campus is a challenge that we have not fully flushed out.
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