Heath Bell, CIO, KishHealth System
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.
Chapter 2
- Developing an HIE strategy, Medicity at the core
- Dealing with the specialists (the oncology exception)
- Measuring up to Meaningful Use (going for S1 in 2012)
- “I think some of the timelines for the smaller facilities are going to be a challenge … ultimately, it should shift a little bit”
- Meditech comes through
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Bold Statements
We have a pretty well-adapted community here, and they were all coming back to us and saying, ‘We need to find a way to start having the data flow back and forth between the clinics and the hospitals, etc. What can you do for us?’
We’re looking at the platform as a way to be able to get that data exchange in our local community so that we can enhance the care as a whole. And then as we transfer out, that we’ll be able to easily move the data out to other places, whether the HIEs are up and running or not.
We’re finding that a number of the major practice management vendors on the ambulatory side don’t do a good job with radiation oncology, or even medical oncology as solution sets. So we will look at each individual practice to see if there’s a need to specialize, but for most part, we’re going to standardize.
I think that ultimately the timelines should shift a little bit. I think that they’re going to be too tight for a number of people to hit, but we’re taking a wait-and-see approach right now to see where we’re going to end up.
In working with individual vendors, I’ve found that as long as you build a good relationship with some of the key people there, you end up finding a way to navigate the problems that you have. And that’s not to say that we don’t ever have a difficult conversation with them, because we absolutely do. But I think there’s a mutual respect.
Guerra: You’re not going to have inpatient and outpatient on a single database. You’re going to wind up with a situation where you have Meditech inpatient and one of these other outpatient ambulatory systems, so you’re going to have to integrating between those two. Is that just the reality of it?
Bell: It is the reality of it, but at the same time, because we’re not in a fully owned market with our physician practices and we had a number of physicians in our community that are running almost every flavor of the EMR that is out there, so we were going to have the integration challenges to begin with. We started planning for that last year. We’ve actually purchased the Medicity platform here to run and integrate with our community. So we’re going to be using that to help us with that inpatient versus ambulatory integration.
Guerra: And we will definitely get into that discussion. Before you purchased Medicity, had you had much interaction or data flow going between Meditech and any of the ambulatory systems?
Bell: Other than LSS, no.
Guerra: Okay, so Medicity comes in to solve this issue, correct?
Bell: Correct.
Guerra: All right. Now tell me about that; I guess a point-to-point is not going to work unless you have all of your owned practices, and so you have one ambulatory system and one inpatient system, then maybe an interface engine could do it. But it’s not going to do it with a situation where you’re dealing with many points to many points. Does that make sense?
Bell: Yeah exactly. And that was actually exactly where we found ourselves. So we actually started the journey that let us down to Medicity about two years ago. We were having a number of physician offices that had come up on their EMRs; like I said earlier, we have a pretty well-adapted community here, and they were all coming back to us and saying, ‘We need to find a way to start having the data flow back and forth between the clinics and the hospitals, etc. What can you do for us?’ And we started doing the standard investigation associated with the point-to-points. And as I did the investigation about the number EMRs that were out there running in our communities, the many-to-many was just going to be an insane number of interfaces to try and help manage and get up and running.
So once we realized that, we started to look for some kind of integration partners that could help us with that. We took our time with the process because we also were trying to see where things were going to go with our state initiatives in the realm of HIE. And so we’ve started our internal processes looking at a way to make this data flow and it ultimately let us down to where we selected Medicity. We actually had finalized our selection in August of last year, and we were still going through some of the negotiation points at the time of the announcement that they were being purchased by Aetna—that was before we reached contract signing. And so it delayed us a little bit beyond where we wanted to be, but in the end we feel that’s it’s going to be a good solution for us.
Guerra: And how did you feel about the Aetna purchase?
Bell: It was a little concerning. I had a lot of conversations with the upper management associated with Medicity, and they were able to bring us some comfort. It’s one of those things where as you start to look around the market, you see that United Healthcare and Blue Cross Blue Shield have entered the market. So you’re seeing the movement anyway. I think ultimately, this is just a strategy by the payers to find a foothold into the ACO models that were promised, at least at the time that these acquisitions started. I will say that so far with our process with Medicity since that happened and since we’ve been going forward, I haven’t seen a hiccup with it at all. We’ve become comfortable with it.
Guerra: So it looks like you bought everything—Novo Grid, ProAccess, Community, MediTrust, PHR Gateway, HIE. Is there anything you didn’t buy?
Bell: I think there was one little piece out there that we decided against just to begin with, but now I think we got it all.
Guerra: And just tell me—what is this going to do for you? Or the better question is, what kind of relationship will this allow you to have with your owned and not owned ambulatory centers?
Bell: What we’re after is, we want to make sure that we have the communication flowing between our physicians and our hospitals—in all of our communities, and even beyond that. As I said earlier, we are a community-based hospital, so we’re not providing tertiary care. We’re not one of the academic centers that’s out there, so we do have to refer patients out of our facilities occasionally. And we’re looking at the platform as a way to be able to get that data exchange in our local community so that we can enhance the care as a whole. And then as we transfer out, that we’ll be able to easily move the data out to other places, whether the HIEs are up and running or not.
We’re starting the process with simply a data flow out of the facilities; shooting results out to the individual physicians’ EMRs, and then using the grid and/or ProAccess, even those physician practices that have chosen not to go with EMRs will still have online access in their office to all of this data through the Medicity products. So we’re seeing that as a great benefit.
As I mentioned before, we already have a joint venture with our local university here, and we’re looking to expand that to our community players. I actually have a meeting next week with one of our mental health facilities. We’ve already met with another long-term acute facility that is in our area, and we’re having early discussions with our local health departments about being able to have this as a full continuum of care through this process.
Guerra: We hear about specialists having some pushback on using what are generally thought of as primary care-centered EHRs. You mentioned the ophthalmology clinic—have you seen that pushback, do you think there’s going to be more of that, and how do you plan on dealing with it?
Bell: Yeah, I think there’s definitely some of that. Even when we did the initial purchase of the product for the ophthalmology clinic, that was a big driver for them—what were the specifics that were brought forward to meet the needs of that specialty within that product line. And for them it worked out, because at the time, they were our only owned clinic that we were running.
As we go forward, I absolutely think that will be one of the problems that we’re going to run into. And that’s one of the reasons that we’re being, I believe, diligent in our selection process—we want to find the vendor that has the most flexibility. But we need to understand that there’s no perfect solution out there, and that regardless of the vendor that we end up with, there’s going to be somebody that’s not going to get all of their needs met, but we’re going to try and get the most rounded solution that we can.
Guerra: Now you have the Medicity solution coming in to help with data exchange, but you still want to get from those three EMRs down to one. Why do you still want to do that even though Medicity is coming in? I guess there are still limitations when you’re not acting off a single database, is that correct?
Bell: There are, and we also have the maintenance issues associated with the hardware. With three different solutions, we’re running multiple databases, we’re running multiple bits of hardware, and we’ve got different configuration requirements for each one, and so the support long-term also becomes a little more difficult for us. So solidifying that into a single solution at least puts all of that into one set of hardware and one set of maintenance pieces that we have to deal with on that.
If there were other pieces of that so that we could make an exception for some of the specialties, etc., we may do that. For example, we run a cancer center at both of our facilities at this point, and we are looking at a potential product that would be outside of the standard EMR set we roll out that would be specific to just them, because we’re finding that a number of the major practice management vendors on the ambulatory side don’t do a good job with radiation oncology, or even medical oncology as solution sets. So we will look at each individual practice to see if there’s a need to specialize, but for most part, we’re going to standardize.
Guerra: Alright, let’s talk a little bit about Meaningful Use. How you set up for that program?
Bell: Kishwaukee Community Hospital is doing very well; we actually contemplated filkng for Meaningful Use this year at Kish. We had most of the pieces in place; we needed the Meditech topoff and we got that. And we believe that we meet the requirements associated with all of things at this point here. We’ve made the decision to hold off one year, though. We were a little nervous in relation to what’s was going to happen with Stage 2 and Stage 3 requirements, and we wanted to make sure that we heard a little bit more about that before we jumped into the river with that one. And so we held off there.
Valley West, our second hospital, is a little bit further behind on their adoption. We needed to get a few more modules in place from Meditech at that facility to be ready to go. We are working with Meditech on that to get those deployed now, but we think that if things go well, we’ll still be almost in shape to take them for Stage 1 next year as well. So we’re doing well in relation to that, and I think we’ll be in good shape.
Guerra: What do you think about how they’ve developed the program and the requirements? Do you think they’re about right or too hard or too easy?
Bell: As a whole, I like the direction that it’s going. I think it’s something the industry has needed to move toward for a long time. But at the same time, I think some of the timelines, especially for the smaller facilities, are going to be a challenge. Even in our case, we’ve been running an EMR here for almost 11 or 12 years, and it’s still had us spinning our wheels a little bit to get the final requirements for Stage 1 ready to go.
And some of the smaller facilities like our critical access hospital will find themselves behind the gun, and I think trying to catch up is going to be very, very difficult. And that’s not to take anything away from some of the larger facilities; even CPOE implementation in some places is difficult for people to get through, and some of these requirements are just going to be a bear. I think that ultimately the timelines should shift a little bit. I think that they’re going to be too tight for a number of people to hit, but we’re taking a wait-and-see approach right now to see where we’re going to end up.
Guerra: And how has Meditech been in terms of being responsive, getting what you need, and those types of things?
Bell: I actually want to give Meditech some credit there. It may be that we were just staged better than so many others, but initially I was very concerned, and I approached them right after the regs came out. And actually, we were already starting our approach even before the regs were finalized for Stage 1 and were having conversations about what we were going to need to finalize everything. And the initial responses that I was getting sounded like it was going to be very problematic for us to get everything that we were going to need at a timely manner. To their credit though, I think they’ve listened to a number of their customers, and I think that they have tried their best to deliver to those that they felt were very close to meeting the requirements to begin with. So in my case, they have been very responsive to me and my specific needs, and I appreciate that from them.
Guerra: Do you go with the honey rather than vinegar approach with that?
Bell: I try to. Over the years in working with individual vendors, I’ve found that as long as you build a good relationship with some of the key people there, you end up finding a way to navigate the problems that you have. And that’s not to say that we don’t ever have a difficult conversation with them, because we absolutely do. But I think there’s a mutual respect between the two institutions. And ultimately, we try to explain that this is where we need to be, and ultimately, if we get there, then that also looks good for them to be able to show that they have others in that place. And it’s worked for us so far.
Guerra: So you try to stay away from saying things like, ‘If we don’t get to this point, here’s what we going to do to you.’
Bell: Yeah. Generally, I don’t like to have that approach taken with me on anything, and so I tried to take the same approach with my vendors that I would like taken with me.
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