Charles (Chuck) Colander has been around the health IT game long enough to know that choosing the most sophisticated system doesn’t necessarily guarantee high adoption rates. Colander’s experience — which includes time spent as both a CTO and consultant — has taught him the best way to get physicians engaged is to build an implementation strategy that focuses on improving the patient experience. In this four-part interview, Colander shares his thoughts on how he manages a varied application environment, the vast difference between being a CIO and a consultant, why it’s critical for the IT department to embrace its role as a service organization, and how he hopes to steer a smooth transition into a new building.
- About Elmhurst Memorial
- Moving to a new building
- A Meditech C/S 5.6 shop (“6.0 is not on our horizon at this point”)
- NextGen in the owned practices (Phytel layered on top)
- eClinicalWorks in the mix
- No LSS? “I think the industry’s spoken on that one”
- Leveraging Stark for the independents
- Initiate for EMPI
- Emdeon as clearinghouse for lab, rad, information exchange
- Envious of enterprise shops?
Right now, we have all the tools that we need in order to make Meaningful Use happen. We’ve got some work to do and we’ve got to increase the adaption rate with the physicians in order to accomplish that, but we’re not in need of a major upgrade.
They program in some disease management characteristics into the EMR, and they’re able to discover patients who are dealing with chronic diseases and have not had the proper follow-up. And that prompts the whole process of getting the patients in.
We use Emdeon as clearing house to exchange lab radiology and other information with those practices. So we have three really options that we have for physicians depending on how close they are to us when it comes to electronic medical record.
I’ve been around this business long enough to know that there’s no magic bullet solution to any of these things with any of these vendors. I’ve worked in big Cerner shops and certainly been associated with large Epic implementations, and they all seem to be equally challenged. It’s not a matter of picking the right solution as much as it’s making the solution you pick right.
Guerra: Good morning, Charles. Thank you for joining me today to talk about your work at Elmhurst Memorial Healthcare.
Colander: You bet. You can call me Chuck.
Guerra: All right, Chuck, excellent. So it’s a 600-physician healthcare system based in Elmhurst, Ill. Why don’t you tell the readers and listeners what else they need to know to give us a baseline before going forward with the conversation.
Colander: Elmhurst Memorial Healthcare is located in the eastern end of Dupage County, which is directly west of the city of Chicago. It’s right between the Oak Brook area and the O’Hare Airport area. It was the first hospital established in Dupage County back in 1926. We do have about 600 staff physicians and we have some of what we call affiliated practices, which are as close as you can be to an owned practice model. We own the assets and the physicians are under contract. And that includes about 120 physicians. We are licensed at over 400 beds, although we operate closer to just over 300 beds. We are in the midst of building a replacement facility, so almost all of our hospital operations will be moving to our new campus this Saturday.
The new facility has 260 beds, and includes all the things you would find in a typical community hospital. And our existing campus will remain with some inpatient facilities, including a behavioral health unit and a rehab unit, which will stay on site there. We operate about 16 locations throughout the western suburbs of Chicago, including four major out-patient care centers, which typically include an immediate care/urgent care center, physician offices, diagnostic imaging, and other out-patient services such as rehab and therapy.
Guerra: So you have 600 employed physicians?
Colander: No, we have about 120 employed physicians under contract. Six hundred is much larger number that just have privileges here, and as many of the listeners or readers know, for many of those physicians, their use of our facility varies significantly.
Colander: Some admit very infrequently, and others are quite dedicated to our institution.
Guerra: So you have 120 employed physicians.
Colander: Yes. I never like to use the word employed physicians. I don’t think they actually feel employed, but they’re under contract.
Guerra: Okay, and then about 400 or 500 independent physicians that refer in.
Guerra: So you have a nice mix there.
Colander: Yeah. We are not an academic institution, so we don’t have any residents. There is no residents program here, which is pretty traditional, I think, in a community hospital model.
Guerra: Right. So with the new facility, you’re actually going to transfer patients. It’s not like you’re just adding the same type of beds where you’re going to put new patients; you’re actually transferring patients.
Colander: Correct. It’s a replacement facility.
Guerra: All right. And the existing facility, as you said, is going to be used for different purposes, but it’s going to remain part of the organization.
Colander: It will. Most of it will eventually be demolished—probably 75 percent or so of that series of buildings will be demolished. Again, we will keep just under 50 beds there for the behavioral health and the rehab services piece; the inpatient piece of those services. And then that site will be built out for extended purposes like assisted living. We plan to have assisted living site there as well as some additional physician offices and urgent care center for that portion of the geography that we support.
Guerra: So the new facility will have 260 beds, correct?
Guerra: And that is going to suit your needs? You said you were licensed for over 400 but you’re not using them all.
Colander: Yeah, correct. I mean, the license goes back many years, before the constant shift we’ve had over the last two decades toward less and less inpatient care and more and more things being handled on an outpatient basis. So our large census for us here is maybe 260 patients.
Guerra: Okay. And we’ll probably talk more about the move in a little bit. But let’s go over your application environment; what you’ve got for inpatient, what you’ve got on the out-patient side with some of the owned urgent care centers and ambulatory centers, and then if you’re doing anything under Stark with the independents.
Colander: We are Meditech shop on the inpatient site; we use Meditech Client/Server 5.6. We’ve consolidated many of our departmental systems on Meditech; it supports truly an electronic medical record for the institution. All of our documentation is electronic. The physicians are doing electronic documentation in the ED, and we have a pilot group doing electronic documentation and CPOE on the inpatient side. We’ve kind of taken a respite from some of our electronic medical record and CPOE activities while we prepare for this move, but our plan is by the end of the calendar year to be up significantly with CPOE and physician documentation, continuing those pilot programs.
On the ambulatory side, our owned practices run NextGen. We have a significant NextGen implementation. They’re fully electronic and are quite advanced, actually, with their use of the electronic medical record, and they’ve done some great things with quality tracking and disease management. They’re using the product called Phytel that they’ve layered on top of the NextGen implementation. So there’s a lot of significant activity there.
We make NextGen available for independent physicians to utilize as part of the Stark program. We also have an agreement with eClinicalWorks. So we have two options to provide support for independent physicians who are looking for some help in implementing an electronic medical record in their offices.
Guerra: All right. A lot of questions came to my mind. Let’s talk about Meditech first. Are you all set for Meaningful Use with Client/Server 5.6? Have you looked at 6.0? Is that something in your future?
Colander: Meditech 6.0 is not on our horizon at this point. We think that’s the direction eventually of Meditech, and they’ll help guide us toward a 6.0 implementation. But right now, we have all the tools that we need in order to make Meaningful Use happen. We’ve got some work to do and we’ve got to increase the adaption rate with the physicians in order to accomplish that, but we’re not in need of a major upgrade. I think we do have to take a service pack implementation to get us to the certified level of 5.6, but basically we’re in pretty good shape from a software side. Of course the more challenging piece is the adoption, especially for a community hospital like mine. So, we’re getting focused on that. We’re trying to get folks lined up. And again, we have some pilot activity going, which is going pretty well. But we still have our work cut out for us when it comes to Meaningful Use. Stage 1 looks quite attainable, but as we get into those further stages, I think, things will get much more challenging.
Guerra: Right. When did you go with NextGen? When did the organization make that decision?
Colander: Back in 2003 or 2004, I believe, is when the clinic decided to implement NextGen. At that time they were about a 50-doctor practice, and they’ve now expanded to be right around 100. So they’ve been at this for while. And again, they’ve overcome some of those initial hurdles that are necessary in order to get the physicians online. Really, they’re about as close to 100 percent electronic as you can get, and they’ve done some wonderful things with disease management piece using this product called Phytel, which actually scans the electronic medical record database. They program in some disease management characteristics into the EMR, and they’re able to discover patients who are dealing with chronic diseases and have not had the proper follow-up. And that prompts the whole process of getting the patients in.
A great example is that with diabetic patients, it monitors the management of their sugar levels. If they have trouble with that, it prompts them to schedule an appointment to see their physician. If they haven’t had their eye exam or foot exam, it helps to make sure those appointments are set up, and there is follow through to make sure those things happen. Disease management in that form is one of the things that everybody in the industry is trying to achieve when it comes to the benefits of the electronic medical record.
Guerra: All right. Do you have any integration or information flow between NextGen and Meditech?
Colander: Yes, we do. We’ve built point-to-point interfaces for orders, lab results, radiology reports, and the like, back and forth between NextGen and Meditech. We also have an initiative underway to implement the Initiate electronic master patient index product because we don’t have that synchronicity with patient identification between the two systems. That was not something that was thought about when the systems were implemented, so we are actively working to strengthen that link. But we are able right now to exchange things electronically between the two systems using point-to-point interfaces.
Our eClinicalWorks option that we’re providing the physicians also includes an interface to Meditech. And for those outliers—the physicians who have their own electronic medical record systems not supported through any of our options, we use Emdeon as clearing house to exchange lab radiology and other information with those practices. So we have three really options that we have for physicians depending on how close they are to us when it comes to electronic medical record. If we host it, we build the interfaces directly. And if we’re not involved in hosting it, we use the clearing house option with Emdeon.
Guerra: What about a scenario where you have one primary care physician on NextGen and then you have specialist on eClinicalWorks, and they want to exchange some data. Is that something you’ve thought about or are working on?
Colander: Absolutely. And again, that’s a feature of both of these tools. So for the folks who are going up on our hosted version of eClinicalWorks, we’ll have an interface to NextGen for their electronic referral process. That again will be a point-to-point interface that we’ll work with the vendors to develop. On the independent side, we’ll use Emdeon for that. Emdeon has a feature to handle a standard approach for exchanging. I can’t remember the acronym for the standard that’s used for moving that clinical information between those systems through an electronic referral process.
Guerra: Do you have any thoughts about LSS as an option?
Colander: The Meditech ambulatory option?
Guerra: Yeah. Any thoughts on that?
Colander: I think the development of that product is going to be interesting now that Meditech has acquired their product, and I think that’s a good move. When it was evaluated here back in 2003 or 2004 by the clinic, it was not chosen. They felt that NextGen was a better fit for where they were trying to go. I think the industry has kind of spoken on that one, and the integration folks really would like to have a fully integrated product. It’s just that their product didn’t seem to hold up to the functional requirements of many organizations. I think Meditech acquiring that product and now putting some rigor around how they can further integrate it and further develop the functionality will make it a very viable product going forward. It’s just not in that position for us right now.
Guerra: What about some of your colleagues who have Epic or Cerner solutions, and they’re able to have that single database for the inpatient and out-patient, and don’t have to do these point-to-point interfaces and worry about upgrades on one side and then retest the interface and all these types of things. Do you look at your colleagues who are in that situation and say, ‘I wish that was me?’
Colander: No, I don’t. I’ve been around this business long enough to know that there’s no magic bullet solution to any of these things with any of these vendors. I’ve worked in big Cerner shops and certainly been associated with large Epic implementations, and they all seem to be equally challenged. It’s not a matter of picking the right solution as much as it’s making the solution you pick right. I think you’re going to be challenged with any solution you come up with. And the idea that there are perfect systems out there that are fully integrated and work in those scenarios—I’ve given up on that long time ago.
Guerra: Right. So you make it work. You deal with the plumbing on the back end to make it work as best as you can, correct?
Colander: Yeah. Frankly, I look at something. The point-to-point interfaces, given today’s standards and some of the things you can do—as long as you can limit the number of them you’re dealing with—become manageable. I think for us, the breakthrough was with the independent physicians and the use of this clearinghouse approach with a vendor like Emdeon. We don’t get involved in the interface between Emdeon and the physician’s office; they handle that. All we have to do is get our data at Emdeon. They will take care of the integration and all the interfaces associated with Emdeon to the physician’s office system.
So there’s no way I would have the staff to be able to provide that level of service to the organization and to all those individual physician offices. There’s just no way. So that’s been a great win for us and for our independent physicians.