With nearly two dozen years of CIO experience under her belt, Michele Zeigler knows full well that when it comes to physicians, no two are alike. The needs and preferences of a specialist can differ drastically from those of a primary care physician, and affiliated physicians and employed doctors often present with a completely different set of concerns. So how does Zeigler handle this delicate situation? By steering clear of the cookie cutter approach when deploying new systems, and by getting physicians involved in the selection process. In this interview, she talks about the importance of being flexible, the challenges of dealing with many interfaces at once, what she looks for in a vendor, and what her organization is doing around wireless device management.
- About Summit Health
- Embracing the affiliated physicians
- Running a Meditech C/S 5.6.4 shop — no plans for 6.0
- Implementing service packs
- Meditech’s service — “Their ability to open a ticket and track its progress is probably the best that I’ve seen”
- Physician engagement strategies
- Bringing up Medent in the owned practice, affiliates selecting LSS
- CCD limitations
I think that’s what’s attractive to some of our affiliated physicians—the fact that they’re not pigeon-holed into any one way. It can make things a little challenging for us, but if you get into that mindset of really providing the best service to that customer, you can’t go in there with a cookie cutter approach.
We have a lot of different vendors that we work with, and I must say that their ability to open a ticket and track the progress of that ticket is probably the best I’ve seen. As a matter of fact, I have asked some of my vendors if they could implement something similar to that.
I certainly think it’s easier when a group decides on a standard, and then they work with us on some standard templates. We customize those where appropriate. But it’s good when you have a group swell, and you don’t have two people doing this thing and two people doing that.
Since the physicians in the gastroenterology practice have a lot of their procedures done in their office, they thought it was very important that the procedure information goes back into the EMR. So some of them have a very, a pretty solid strategy about integration.
Although the CCD is a great start, it’s not discreet data, and it also doesn’t have lab data. And that is very important for an ambulatory EHR if you’re going to write rules or if you want to prescribe certain medications and you have to check that against a lab value.
Guerra: Good morning Michele, thanks for joining me. I look forward to chatting with you about your work at Summit Health.
Zeigler: Good morning, Anthony. I look forward to chatting with you too.
Guerra: Thank you. Let’s get a little overview of Summit Health so that people have some background, and we’ll go from there.
Zeigler: Sure. Summit Health is an integrated care delivery system in a semi-rural area in south central Pennsylvania. We’re about an hour south of Harrisburg, right near the Maryland-Pennsylvania border. We’re about 45 minutes west of Gettysburg, Md., to give you just some anchor points. We have two hospitals; one is a small, 64-bed hospital, and the other is a 248-bed facility with some different services. We have a large employed provider organization that’s part of our system. We have cancer treatments, both radiation and oncology, which is another corporation. And we also have, from an IS perspective, what’s called IS contracted services where we provide cafeteria-style menu of IS services to our affiliated but non-owned physicians.
Guerra: So with the affiliated and non-owned providers, we’re talking about the Stark relaxation there?
Zeigler: Yes. But we provide, like I said, a cafeteria-style menu. So if they only want us to come in and do their networking, wireless, and desktop and host their server in our data center, we will do that. We do not require them to select any one of our EMRs or ambulatory EMRs if they don’t want to; but if they want to choose that, it’s very flexible. And I think that’s what’s attractive to some of our affiliated physicians—the fact that they’re not pigeon-holed into any one way. It can make things a little challenging for us, but if you get into that mindset of really providing the best service to that customer, you can’t go in there with a cookie cutter approach, because that may not meet their business need.
Zeigler: We’ve found that that has been very successful.
Guerra: What’s your core clinical vendor on the inpatient side?
Zeigler: Meditech Client Server.
Guerra: And which version is that?
Guerra: Okay. Are you good with that or are you looking at 6.0?
Zeigler: No, we’re good with it. I think with everything else on our plate, both the regulatory requirements and just what we have to do to continue to be productive, I don’t think that we’ll be doing 6.0 for quite some time. Plus, based on my discussions, I’m not sure Meditech is ready to really go gung-ho rolling out 6.0. We’re a well-established Meditech current customer—we use about 30-plus Meditech modules—and I’m not sure that if we go to 6.0, we won’t be taking a bit of a step back.
Guerra: I’ve heard other people in your position say that they have to take some sort of a service pack update. Are you doing that?
Zeigler: Yes, we’re actually doing that right now.
Guerra: What does that entail? Is it a lot of work?
Zeigler: It has a lot of changes. A good portion of it is some of the meaningful use compliance reports that you could run, so of course you have to test that out. But there are a lot of programmatic changes in almost all of the modules. So we’ve probably done three parallels already, and we just had that delivered at the end of May.
This is probably the most condensed timeframe that we’ve chosen to test our Priority Packs, because actually were taking six or seven Priority Packs at once. We’re going from, I think, Priority Pack 14 to Priority Pack 22. So it’s quite a lot of code change, and with us having our advanced clinical live, we’re pretty particular about testing those things, like most facilities are, so that we make sure we don’t disrupt the current functionality.
Guerra: How has the Meditech been as a partner?
Zeigler: I think that Meditech is a fair partner. I think they’re really trying to beef up some of their staffing and their support. I do believe that when we escalate issues and make the case that the issue is a problem for patient care or a problem from a fiscal or a revenue cycle viewpoint, they do pay attention to those things. We have a lot of different vendors that we work with, and I must say that their ability to open a ticket and track the progress of that ticket is probably the best I’ve seen. As a matter of fact, I have asked some of my vendors if they could implement something similar to that. With some of the vendors, you call tech support and it’s like your ticket goes into like la-la land and sometimes you don’t even get the number to track. And especially if you’ve got like a user committee waiting on that—you certainly don’t want to discredit the vendor, but sometimes when you’re in the middle and you can’t give an update, it just puts you in between a rock and a hard place.
The nice thing is that you can open a ticket and anybody else that you have associated with that module gets copied on the ticket. And then as tickets are updated, you get prompted. Now you don’t get the body of the ticket because sometimes there’s confidential information, so you have to click on the link and then go look at the body of the ticket. But at least you know anytime that there’s activity or an update or they’ve done something and now they’re asking you to test. So it does move the solution along and give good communication to all involved all throughout the resolution process.
Guerra: You don’t want to be sitting there between the users and the vendor being asked what’s going on with this and have to say, ‘You know what, I really don’t know.’
Guerra: That doesn’t make you too popular.
Guerra: So they do a good job with that. Now you mentioned a large employed practice of physicians, how many doctors does that include?
Zeigler: We have about 110-115 providers. And we call them providers because we have physician assistants (PAs), nurse practitioners, and physicians.
Guerra: Are they mostly primary care physicians or do they run the mix of specialties?
Zeigler: They run the mix. We have quite a lot of primary care physicians, and we also have internal medicine physicians, cardiologists, urologists, surgeons, orthopedic surgeons, and anesthesiologists. So it’s an eclectic mix of primary care and specialties.
Guerra: Do you also have hospitalists?
Guerra: About how many?
Zeigler: We have one combined group that covers both hospitals, and they have about 18 full-time providers. They have some PAs and nurse practitioners in there as well.
Guerra: So you have 18 hospitalists and about 110 providers in the group. Approximately how many independents are credentialed to refer in?
Zeigler: Actively probably about 100 or 150.
Guerra: So, you’ve the whole mix.
Zeigler: Oh yeah.
Guerra: Have you seen a big difference between the levels of engagement you can get with the employed docs versus the independents? Is there a big difference there in how you need to go about getting them to use the systems?
Zeigler: We see some of that in pockets as we start to roll out, for example CPOE, which is really something that’s hitting the physicians. Our hospitalists are the first inpatient area that is going live. So certainly the engagement is there, I think because we’ve associated some performance goals with that. But we do get volunteers and input from the non-employed physicians, so I’m really pleased to see that it’s not one-sided.
Our hospitalists were the early adopters of our electronic progress notes, and they 100 percent use that, because they as a group decided that’s going to be their method of documentation. So I certainly think it’s easier like when a group decides on a standard, and then they work with us on some standard templates. We customize those where appropriate. But it’s good when you have a group swell, and you don’t have two people doing this thing and two people doing that. So it’s been really effective because we’ve gotten good feedback and I think we’ve been really able to fine-tune those tools to be more effective—certainly more effective than the one we originally wrote them out.
But we feel that a lot of non-employed physicians are gravitating because they see other providers use those tools; they like the output. We have some surgeons that are using it for pre-surgical history and physical examination, and we’re also doing voice recognition, because not everybody has good keyboarding skills.
Zeigler: We try to be really flexible with what we provide, taking into consideration peoples’ skill sets. If you don’t have good keyboarding skills, doing templates and going to a keyboard is going to slow you down.
Guerra: Let’s talk first about the physician practice that’s owned. What do you have there for an ambulatory EMR?
Zeigler: We’re bringing up the Medent system; it’s an ambulatory EHR. We’re going live with the administrative portion at the beginning of next month, and then we have a rollout scheduled of the clinical EHR portion of that for the next 18 months.
Guerra: And that’s Medent?
Guerra: I’m not too familiar with them. Can you tell me a little bit about how you arrived at selecting that product?
Zeigler: That was something that was really led by our employed physicians. We had one physician who did a pilot with that tool in his office. He was a solo provider in his office and had implemented that. For the contracted services physicians that were looking for an ambulatory EHR, most of them—as a matter of fact, all of them that we’re looking—selected the Meditech LSS solution, so we’ve implemented that for those practices.
But our employed practices decided to go in a bit of a different direction, so we are learning with this vendor. I can tell you that we’re probably the largest install this vendor has done, so we’re learning some things. From an IS infrastructure perspective, we’re a little bit more sophisticated than what they’re used to, so we’re asking for things that they’re not ready for yet. But I have faith that we’ll gravitate to those things.
Zeigler: One of the things, and I say this with the utmost respect because I know that we’ll gravitate to a different backup infrastructure, but for us to have to go back to tape backup, especially for an EHR, was kind of mindboggling. I know that they don’t get that request from small practices, or even 10-provider practices that they’ve implemented their system into, but we’ve had a SAN here for eight or nine years. And we’ve been doing tapeless backup, backup to disk, certainly for a system that is going to expand and have critical clinical data. We put in a more sophisticated backup infrastructure where we can snap copies and do redundancy between sites so that we can really protect that data, because if you only do a tape back-up once a day, you’ve got to host of data for a period of time that potentially is at risk if anything goes awry.
So it’s an initial hurdle that we’ll eventually overcome but you can tell sometimes that some of these smaller EHRs have very good tool sets, but when you try to put them in a very large install base, you have some growing pains. I’m sure we’ll live through those and come out on the other side and at a better place—both of us.
Guerra: Very interesting, so you have Medent in the owned practice rolling that out and you said that the independents—how did you describe that again? Who actually selected LSS?
Zeigler: The independent practices that didn’t have an EHR—most of them are using an administrative system that includes scheduling, billing, those types of things. I always call that the administrative side of an EHR. You have to usually have that in first to determine how you identify the patient, etc. Most of them had the administrative side, but most of those vendors didn’t have an EHR solution, or they were going to have to do a major upgrade anyway.
Zeigler: With all of our physicians, we have rolled out direct EMR access. So a lot of them like the fact that their information is right there; when their patients present to the ED, they can see their allergies, problem lists, etc. All of that is right there and then they get that information back into their record, and so a lot of them really gravitated toward that. They thought that it was very important. For example, since the physicians in the gastroenterology practice have a lot of their procedures done in their office, they thought it was very important that the procedure information goes back into the EMR. So some of them have a very, a pretty solid strategy about integration.
And then other practices that are IS contracted services have the Sage system where you can buy that module, and so therefore you expand your tools. What that practice has done is asked us to integrate the lab and the dictated reports and things of that nature. So we do that as well. We’ve been doing that for a couple of years; we’ll take an extract out of the Meditech system, and then we’ll populate their EMR.
We are working with one practice to extract some of their core information and populate it back into the Meditech system. It happens to be our rural health clinic, which has a provider base of about 40 physicians and a lot of patients that come into our ED. So ahead of the CCD, what we’re trying to do is pull the progress notes, pull the key clinical data, and populate that back into Meditech. We’ve done the Meditech to NextGen side, now we’re working on the NextGen to the Meditech side. Because although the CCD is a great start—I don’t mean any disrespect to the folks that are trying to help develop standards—it’s not discreet data, and it also doesn’t have lab data. And that is very important for an ambulatory EHR if you’re going to write rules or if you want to prescribe certain medications and you have to check that against a lab value. Or you want to grasp someone’s blood glucose over a period of time. You have to have those discreet data elements in order to be able to do that and to get that functionality out of your EHR.