There is a growing sentiment that when the Meaningful Use criteria were established, small organizations—which are often short on resources—were not the top priority. Even forward-thinking organizations like KishHealth, an Illinois-based health system that has been running an EMR for more than a decade, are spinning their wheels to meet the requirements. But CIO Heath Bell hasn’t let that hamper his plans. In fact, he has big dreams for his (relatively) small organization that include consolidating from three EMR systems to one, facilitating data sharing both within and outside the health system, entering the realm of owned physician practices, and of course, meeting those Meaningful Use requirements.
- About KishHealth
- Getting into the practice ownership business
- Communicating why integrating EMRs isn’t plug and play
- No Stark … yet
- Developing an ambulatory EMR strategy
- Going from three (NextGen, GE Centricity, LSS) to one — “Long term, having three EMRs is not going to function well for us”
- Meditech C/S 5.6.4 on the acute side (Going 6.0?)
We’ve had the conversations around the alignment strategy as a whole, saying that it would be beneficial if we had all of our physicians on the same platform so that we would have some sharing of data as referrals start to go through. That’s the model that we’ve been pushing in the conversations with them.
We’re not taking the strategy at our health system that we want to be able to employ every physician that is in our backyard. But where it makes sense and where there’s an interest, we’ll explore that.
It also depends, at least in my case, on how many conversations those individuals have had with some of the vendors themselves; if the vendor has been in their office recently and thrown out all of the buzz words and terms that are out there. They certainly pick up on it.
We have noticed that a number of the new physicians coming out are still looking for a sponsored EMR model. And so as we go forward, once we select our final ambulatory strategy, we will also leverage that in a model that can be expanded on the Stark side.
It seems to be a solution that needs a lot of enhancements, and to Meditech’s credit, they’ve recently purchased that outright and have started some development work on that. And so I think there’s a lot of promise associated with it. But for now, it’s not functioning to meet all of our needs.
Guerra: Good morning, Heath. I look forward to chatting with you about your work at KishHealth System.
Bell: Good morning.
Guerra: I think a good place to start is to give us a little background on KishHealth. I think you have two hospitals; give us the lay of the land and tell us if you have any ambulatory clinics and owned practices—those types of things. Just describe the system for us.
Bell: Sure. We are a two-hospital health system. We are located in DeKalb, Ill.; we run our main operations at Kish Community Hospital, which is running about 94 beds right now. And then we have a second hospital—Valley West Community Hospital in Sandwich, Ill., which operates as a critical access hospital with 25 beds. We’re located at about 65 miles west of Chicago. So we’re far enough out where we’re not really considered a suburb, but close enough that I can enjoy the city for a little while.
As far as operations, we do own a couple of clinics that were operating right now on the ambulatory side. We run a hospice unit as well, and we just entered the market into owned physician practices, so that is something that we seem to be gravitating toward over the next year as a strategic model.
Guerra: So you have two hospitals; one has 94 beds and one has 25?
Bell: That’s correct.
Guerra: Okay so they’re fairly small. And you say they are critical access—is that how you would describe them?
Bell: The 25-bed hospital is critical access; the other is a community based hospital.
Guerra: And you said you’re just getting into the owned physician practice realm. Tell me a little bit more about that from a business point of view, and how it is going to affect you as the CIO.
Bell: Sure. In relation to the owned practices, we’re starting to enter the market primarily out of a drive from the physicians. Our market has actually been somewhat isolated from a lot of competition just because of our geographical location. But as we started to recruit physicians, especially to our community access hospitals, it’s been a little more difficult to get some of the specialists and some of the primary care physicians that we would like to see in that area. So we’ve been out and talking with a few of them, and they would like to see if we would offer an employment model. And so we have entered in to that realm with one primary care physician as well as one specialist. Both of them will be coming on board this month.
As far as the impact on me as the CIO, that’s obviously going to mean that we’ve got to look at the realm of ambulatory EMR’s integration into the overall aspects of our corporate EMR as well. So we’ve been in the market looking for some selections of a long-term strategy with ambulatory EMRs to make sure that we’re going to meet those needs.
Guerra: Do either the primary care physician or specialist have an EMR currently?
Bell: The primary care does not have an EMR currently; they are running just a practice management system that they run as an outsourced model. The specialist has one, but we don’t believe that it’s going to be our long-term platform for him. And so we’re looking at a replacement for that.
Guerra: I wonder how those discussions go. So basically, you’re buying the practice and the physicians become employees, but they continue to run to their practices, correct?
Bell: Yes, that’s correct.
Guerra: Okay, so have you talked to the specialist about the EMR and had that discussion where you say, ‘This is not going to work going forward,’ and was there any desire on the specialist’s part to keep that because he was comfortable with it? I think your colleagues could benefit from hearing how these discussions go.
Bell: We actually got into a little bit of this about a year ago. We acquired a clinic—we did not acquire the physician with the purchase, but we acquired a cancer center that was operating on one of our markets. And one of the physicians there was going to remain on staff but just be a contracted employee. And we had those exact conversations. We had the conversation saying, ‘With the acquisition, we’ll take on that the EMR that you currently have, but in the long term, we’re going to be looking at replacing this.’ And with this newest acquisition, we’ve had the conversations around the alignment strategy as a whole, saying that it would be beneficial if we had all of our physicians on the same platform so that we can ease the communication, and so that we would have some sharing of data as referrals start to go through. That’s the model that we’ve been pushing in the conversations with them. And there is some resistance to that, because obviously, there’s the familiarity associated with the system they’re currently using. But for the most part, I think they’ve understood—or at least the ones we’ve entered this engagement with have understood that they’re becoming either an employee or an affiliate of a health system. And to a certain extent, they’re giving up a little bit of the freedom that they have historically enjoyed being that they owned their practice.
Guerra: That’s got to be a very interesting discussion.
Bell: I think it all depends on the personalities of the individual physicians. There are some of them who take it very well and understand it. As a matter of fact, the primary care physician that we were discussing this with didn’t have the EMR already running. So it’s going to be a little bit less painful in his case. But he was very clear upfront that he expected us just to walk in and tell him what it was going to use, so again, I think it goes back to the personalities of the individual providers.
Guerra: I bet you’re going to find that there as some who aren’t quite able to make that psychological transition to employee.
Bell: Actually, it’s interesting. In the market, we’ve talked to a number of our existing physicians about whether they would be interested in this type of model, and a lot of them are coming back and say, ‘No, right now I enjoy the freedoms and I don’t want that.’ And we’re fine with that. We’re not taking the strategy at our health system that we want to be able to employ every physician that is in our backyard. But where it makes sense and where there’s an interest, we’ll explore that.
Guerra: I’m guessing you would advise your colleagues that these discussions on possibly switching out a physician’s EMR—you want to have those during the acquisition talks, and not afterwards.
Bell: Absolutely. And actually in my particular case, it’s worked out very well. We have a vice president of business development that works on most of the deals with the physicians. And in this particular model, he is an adviser on our IT steering committee, so he understands what our global directions are in terms of EMRs and integration, etc. And he actually delivers the message more often than not, at least at the beginning of the discussion, just to let them know that this is the direction, and that begins to take a temperature of whether this is going to be a continued conversation. So it works pretty well in that regard, and as negotiations proceed, if it starts to look like we’re getting very close to a deal, then I do come in and have a more frank discussion about exactly what’s that going to mean with the physicians.
Guerra: Do you find that sometimes you have discussions to make them understand why things aren’t plug-and-play, and to make them understand why they can’t keep their current EMR?
Bell: Absolutely. And as a matter of fact, even without doing the employment model, I’ve been providing a lot of education to the physicians in relation to that in our community as a whole. We have CME department here, and they’ve asked me to come and speak about general topics like Meaningful Use and integration. At the same time, I’ve had individual physician offices and invite me over to meet with their administrative team within their practices, so that they can talk about exactly what this is going to mean for them in the long term. It’s a constant reiteration of exactly the difficulties associated with exchange of data and having everything integrated in a streamlined care process.
Guerra: Do they ever throw things out like, ‘What about the CCD?’
Bell: Of course. And it also depends, at least in my case, on how many conversations those individuals have had with some of the vendors themselves; if the vendor has been in their office recently and thrown out all of the buzz words and terms that are out there. They certainly pick up on it, and they have a conversation with me about it. But I’ll give a lot of credit to a number of my physicians here that do have advanced use of the EMR. They have a group usually within their practice, whether it would be one or two individuals or a large specialty practice, who gets it—a few of them do, and so I try to leverage those people to make sure that we get the message spread throughout the practices.
Guerra: That’s really funny. So you can go into a physician office, and if they use a few buzz words, all of a sudden you know what’s going on. Someone got to them.
Bell: Yes. That seems typically to be the case at least.
Guerra: Right, somebody didn’t know how to turn on the computer mentions HL7 or something like that.
Bell: Absolutely, yeah. I actually had one physician that has been a paper practice for a number of years call me one day and say, ‘Hey, I need to worry about this whole HL7 thing. Can you tell me a little bit about it?’ And so yeah, it’s always interesting when you seek those people out.
Guerra: Right. Let’s talk about Stark. For the physicians that do not want to be acquired, are you going down the road where you’re underwriting anything to get them integrated?
Bell: We haven’t, at least not up to this point. We looked at that a couple of years ago; we assessed our existing market, and we had a large population of physician practices in our area that were already either implementing at that time or had already implemented EMRs, and so our overall demand was kind of low. The only change that we’re starting to make to that is in recruitment. We have noticed that a number of the new physicians coming out are still looking for a sponsored EMR model. And so as we go forward, once we select our final ambulatory strategy, even for our internal clinics, we will also leverage that in a model that can be expanded on the Stark side.
Guerra: All right, let’s talk about applications. You mentioned that you’re in the process of deciding your ambulatory strategy, which I assume involves selecting a vendor. Do you have an acute EMR in place at the two hospitals, and is it the same EMR?
Bell: It is. And actually, going back to the ambulatory side, we’re running three different ambulatory systems today and so what we’re really pushing right now is trying to consolidate down to a single vendor.
Guerra: Which three are you on?
Bell: We run NextGen in one of our clinics, GE Centricity in one of our clinics, and LSS Data Systems in one of our clinics.
Guerra: So I’m assuming you’re a Meditech shop in the hospital?
Bell: We are a Meditech Client/Server shop. Kish Community Hospital was actually the beta site for the old Client/Server solution. So we’ve been running that since 1996 here. And Valley West came up a few years later, but yeah, we have a Client/Server running right now.
Guerra: What version of Client/Server are you on?
Bell: We’re on 5.6.4.
Guerra: Is the HITECH-certified version?
Bell: Yeah, we just took the topoff Priority Pack associated with Meaningful Use
Guerra: So that’s in both hospitals, correct?
Bell: That’s correct.
Guerra: Did you at any point looked at 6.0?
Bell: We did. At the time that we started going down that road, though, Meditech did not have a conversion routine tested for Client/Server to 6.0, and so we weren’t able to jump in that line and still meet some of the deadlines that we were trying to hit. So we backed off that and went to 5.6.4 for now, and let them get through some of the early adaptors on the 6.0 side, and then we’ll come back to that.
Guerra: So it could be in the future?
Bell: It could be, yes.
Guerra: All right, okay so you’ve got 5.6 and you’ve got LSS in ambulatory. Was LSS the first one? How did you end up with three—what was the evolution there?
Bell: Before I arrived at Kish so many years ago, they had chosen LSS to go in the ophthalmology clinic we own and the ambulatory surgery center associated with it. They bought LSS to go along with that clinic as for as the practice management system, and during the implementation there was some resistance. So they kind of pulled the plug on the implementation and held the system off for another year or two. And then once I arrived, we went in and selected a different solution to meet the needs of that clinic, and so LSS was kind of shelved for a little while. About a year into that, we also acquired our one of our ambulatory centers that we’re still running today. They needed a solution, and since we have LSS already purchased, we rolled it into that clinic to see how well it would operate for us as an integrated solution with Meditech.
So that’s how we ended up with the first two. With the third one that we picked up, we started a joint venture between ourselves, a physician group, and the local university here to set up what we call the Community Cares clinic. It’s an ambulatory clinic; it is not an urgent care center. It’s just a regular physician office, but with the intent of opening up additional access for the uninsured or underinsured patients in our community. And along with that, the physicians that were part of the joint venture were already running the GE Centricity system in their primary office, and they asked if we would extend that into the new clinic. And so we ended up with Centricity in that clinic. That’s kind of our evolution of getting to three different EMRs, and we’re starting to see that in the long term, that’s just not going to be a function that’s going to work well for us.
Guerra: So NextGen wound up going into the ophthalmology clinic?
Bell: It did.
Guerra: Okay, so they balked at LSS and you wound up giving them NextGen, and then you pulled the LSS license, which you already owned, off the shelf to try to get some value out of that
Guerra: How has LSS been functioning, and how was it received by the citizens that are using it?
Bell: Not as well as I would like. It seems to be a solution that needs a lot of enhancements, and to Meditech’s credit, they’ve recently purchased that outright and have started some development work on that. And so I think there’s a lot of promise associated with it. But for now, it’s not functioning to meet all of our needs at this time.
Guerra: So you have GE Centricity, NextGen, and LSS. It doesn’t sound like LSS is going to be the system going forward. Are you looking at NextGen or GE and are you trying to make one of those work, or could it be a totally different vendor that comes and takes over your whole ambulatory environment?
Bell: It is possibly going to be one of those, or it is possibly going to be one that takes over. We are evaluating both at this point. When we selected NextGen for our ophthalmology clinic, the primary reason for that was the EMR functionality associated with the ophthalmology practice. At that time, they had a very robust application for that that was going to work well. We are looking at the long-term strategy associated with us holding that clinic, and so we’ve decided that although NextGen is more than meeting our needs in that particular clinic, with us potentially spinning that division out, we may not hold that license anymore. And so we put on the table looking at other options out there as well. So we are back in the market for all EMRs right now.
Guerra: Any idea when you might make a decision?
Bell: Probably within the next 30 days. We’ve been doing selection, we’ve been doing evaluations, we’ve had some demos, and we’ve been checking on some references on the ones that are out there. So we’re hoping that it will be pretty soon.