As one of only 240 hospitals to have achieved HIMSS Analytics Stage 6 status, 471-bed Jefferson Regional Medical Center is in good company. For Patrick Neece, CIO of the Pine Bluff, Ark.-based facility, one of the keys to success has been working closely with physicians to deploy systems that accommodate their workflows — instead of putting in systems and then asking the users to change the way they practice. In this interview, Neece talks about Jefferson Regional’s progress in implementing advanced clinicals, why it was beneficial to get physicians on CPOE before HITECH forced their hands, and what it means to truly partner with a vendor.
- About Jefferson Regional
- An Allscripts (Eclipsys) shop
- McKesson Series on the financial side
- Stage 6 HIMSS Analytics
- What it takes to gain traction with advanced clinicals
- The key to CPOE (and electronic documentation)
- The importance of application flexibility/customizability
I was lucky enough to have someone here who had a plan looking across the next 10 years of what the hospital should do in order to stay competitive and really be ahead of the game.
Our physicians really migrated to the structured notes in Eclipsys more so or faster than they did the order entry components, and that’s kind of a unique thing—something you don’t see typically.
And as more and more physicians come on, they speak to their other colleagues, and that’s how the interest builds and they get involved. What we’ve done is just made sure that we were there with the physicians providing training and one-on-one discussions.
What’s nice—and this has been great about Sunrise—is that we can customize it. We can introduce workflows on the fly and individualize those workflows for the docs, and so it’s really flexible. And I think what really makes it a big win for the doctors is that they can come to us and say, ‘This is something new I need,’ and we can turn that right around for them.
Each time you do an upgrade, there’s some nuance that comes along with that. So you have to always be with your physicians, listening to them, asking the right questions and then communicating back to them. It’s not, ‘I got them here. They’re at 75 percent now, so I can just coast along.’ There’s still quite a bit of work and monitoring to keep it where it is.
Guerra: Good morning, Patrick. Thank you for joining me to talk about some of the things you’re doing at Jefferson Regional Medical Center.
Neece: Good morning.
Guerra: Let’s start with an overview. I have down that Jefferson Regional is a 471-bed, acute care hospital in Pine Bluff, Ark., but maybe you can give us some more details.
Neece: That’s correct. We’re a licensed 471-bed, acute care community-based hospital. We were founded in 1908. We’re the fourth largest hospital in the state of Arkansas, and the second largest employer in the county. We employ about 1,800 people and we service approximately 280,000 residents in 11 counties. To give you an idea of some of the statistics as far as volume, we run about 12,000 admissions and 55,080 visits per year, and our total admission is about 13,000. We are the second busiest ED in the state as well.
Guerra: Is it a standalone? So there are no owned clinics or practices, that type of thing.
Neece: It is a standalone, but we do have some owned clinics. We do have managed clinics as well. Within hospital itself, we also have a rehab unit, a psych unit, a transitional care unit, and of course a full maternal ward. We do have probably six owned clinics which we’re expanding pretty much every month.
Guerra: What about employed physicians? Is it mostly independents that are admitting in?
Neece: Yes. The majority of the physicians in this community are private practice physicians. We do have some employed physicians. We have a hospitalist, and our ED doctors are contracted. I would not be able to tell you an exact number but it’s maybe around a dozen.
Guerra: So it’s small—maybe a dozen employed physicians?
Neece: That would be my guess.
Guerra: Okay so it’s mostly the independents that are coming in that you’re working with.
Neece: That’s correct.
Guerra: Let’s get the basics on the application environment. My research shown here says you use Sunrise Clinical Manager, which was Eclipsys and now is Allscripts. Tell us a little bit about your current application environment.
Neece: That’s correct. So just to give you a little background, I’ve been here at the hospital since 1999. I started with the then-Eclipsys product in 2002. We had, since 2002, implemented pretty much the entire product line of Sunrise Clinical Manager in this hospital. And that includes Sunrise Acute Care 5.5, Sunrise Emergency Care, the critical care product, Sunrise Pharmacy, and Sunrise Ambulatory. We have Sunrise Ambulatory up and running in roughly 20 clinics. So not only do we have ambulatory in the owned physician clinics, but the private practice doctors who have worked with us also have it installed in their clinics.
We use Sunrise Analytics. We have knowledge-based medication administration house-wide, so basically that is the bar coding of medications at the bedside for five rights. Our clinical documentation package includes knowledge-based charting, and just a few other Sunrise pieces that we are using, including Sunrise Enterprise Scheduling. We also have Sunrise integrated with our devices throughout the hospital, such as our bedside monitors, our portable vital sign monitors, as well as vents and a few other pieces of equipment. We do that through iSirona, which is integrated into Sunrise.
We’ve also deployed the Sunrise Patient Portal, and we use the facility boards from Sunrise throughout the hospital. Each unit uses an electronic facility board—we’ve gotten away from the white boards. We also use the third-party product from Allscripts, ExitCare. A couple other nonclinical products that we’re running include EPSi. We’ve also deployed the Allscripts EPI, and we’re in the process of now deploying the Allscripts Enterprise EHR and PM in one of our orthopedic clinics. Outside of Allscripts, we also utilize McKesson Series today as our main financial system HIS. We also deploy McKesson HMI PACS. That’s pretty much the core products that we run from a clinical prospective.
Guerra: You’re a very advanced hospital, obviously. I believe you’re a Stage 6 in HIMSS Analytics.
Neece: That’s correct. So since 2008, we’ve been a Stage 6 hospital. We are the only Stage 6 hospital in the state, and when we made Stage 6, we were one of 51 or 52 hospitals in the nation.
Guerra: What makes that happen? You started there in 1999—was it your presence that got this all moving, or was it the hospital leadership?
Neece: No, we’ve had a very active and proactive board and administrative team. I was lucky enough to have someone here who had a plan looking across the next 10 years of what the hospital should do in order to stay competitive and really be ahead of the game—thinking about quality and those types of things. So really it has been driven from the top. Of course I worked and contributed to that as we’ve gone along, but it’s not something where I came in and just said, ‘Here it is.’
Guerra: And when you look at other facilities of comparable size and composition that are just nowhere and look at where you are, do you think that it’s just a question of leadership and seeing value in IT that makes the difference between your shop and one who’s barely Stage 1, for example?
Neece: Well, it’s hard for me to talk about another facility, because I just don’t know the different priorities that they may have or the circumstances that they are in. So I really can only speak to who we are and where we are. A lot of times it’s difficult to get the ball rolling and to get the kind of commitment or support that you need, because it is a major commitment that has to be taken in order to do something like this. And that, I think, happens a lot. But I really can’t speak of the other facilities and where they are.
Guerra: How are your CPOE rates?
Neece: They’re high. We have probably 70 to 75 percent physician order entry. All of our medications and all of our orders are entered electronically by an authorized provider, whether that’s a registered nurse or a physician, and we also have a very high rate of adoption of clinical documentation. Our physicians really migrated to the structured notes in Eclipsys more so or faster than they did the order entry components, and that’s kind of a unique thing—something you don’t see typically. And I think something that we stand out in is the amount of clinical documentation that we do at this hospital. Take our ED, for example. They’re really close to 99 percent on a monthly basis from a clinical documentation prospective, entering all that into Sunrise, same thing with our labor and delivery unit. There are other specialists throughout the hospital that have a real high rate of adoption, and there are very few physicians in the hospital that aren’t doing some level of clinical documentation.
Guerra: When did you say you really started your CPOE push to the physicians?
Neece: I would say probably somewhere around 2006 or 2007. Our main focus when we came up on this product starting in 2003 was really to get our nursing staff and the support staff and ancillary staff into the system, and get a lot of the things vetted out and workflows completed. And then have that staff so that they could support the doctors as they came on board.
Guerra: And how was it received? You said you’ve got a largely independent physician community there, and especially back then in 2006 or 2007, there was no HITECH that forced everyone to do this. So did you have an issue where some of your physicians said, ‘We’re just going to go down the street if you make us do this’?
Neece: Oh yeah. It wasn’t a case where we wanted to mandate anything, that’s for sure. What we’ve got to concentrate on is showing the value of it. And as more and more physicians come on, they speak to their other colleagues, and that’s how the interest builds and they get involved. What we’ve done is just made sure that we were there with the physicians providing training and one-on-one discussions. We’ve gone around throughout the years and basically called upon each doctor and asked if they were interested in it and if we could get them involved.
I would say that the big pull in getting doctors into the system for us was not only having real-time information available for them, but having the patient’s chart—wherever that patient may be—available anywhere throughout the hospital. That was another big key. And as they started seeing that information and how quickly they can get to it—they can get to it from their home, they can get to it from their office, and they can get to it from here—I think a lot of that brought on the adoption. One another thing that really helped was being able to have all of the medical records that they had to sign inside the system so they didn’t have to come back and forth to the hospital. So it’s not been one thing; it’s been many things across the years that I believe have really contributed to where we are from adoption prospective.
Guerra: And the Sunrise product is known to have a pretty attractive interface for the physicians. Have you found that to be true?
Neece: Each product has its own good qualities. They all kind of do the same. What’s nice—and this has been great about Sunrise—is that we can customize it. We can introduce workflows on the fly and individualize those workflows for the docs, and so it’s really flexible. And I think what really makes it a big win for the doctors is that they can come to us and say, ‘This is something new I need,’ and we can turn that right around for them. It’s usable, it’s got a good usability to it, but it’s also really flexible for these guys. We have the ability to pull a lot of information to them quickly so they don’t have to search throughout the place to pull all of this information together. So yes, there are a lot of pulls for the physicians to get into the system, for sure.
Guerra: And you can usually handle most of that customization in your shop? Or you have to go back to Allscripts?
Neece: We handle 99 percent of that customization here in the shop.
Guerra: Would you say there’s a tipping point at which the physician community gets easier—is that the process that CPOE takes in getting those adoption rates up? Is there like a point at which you kind of get over the hump?
Neece: I have to think about that one a bit. I mean, it’s always a challenge—not only getting physician adoption, but really retaining that adoption. There are bumps in the road. Each time you do an upgrade, there’s some nuance that comes along with that, and somebody has a bad experience with something. There just things throughout that will come up. So you have to always be with your physicians, listening to them, asking the right questions and then communicating back to them. It’s not, ‘I got them here. They’re at 75 percent now, so I can just coast along.’ There’s still quite a bit of work and monitoring to keep it where it is.
Guerra: I was wondering if you find that you dread every upgrade that you have to do, because even if the changes are positive, people just hate change. If something isn’t where it used to be in the application and the field is over here now, they’re annoyed, even if in the long run you can eventually convince them that it’s better. Does that make sense?
Neece: It does, but I wouldn’t say that we dread upgrades. I’ve done two this year—we did another major one probably 12 months ago. And what we try and do is focus on what are we doing for you that’s going to make your workflow better—is it going to improve certain things throughout the application or just have better application functions.
What we do is we try to stay on top of the technology. We don’t want to get behind because the next thing you know, there’s something new that comes out, and we’re going to have wished we were on that new platform or at that new level. So that’s why it’s not just about the now, it’s about preparing ourselves for 12 months, 18 months down the road when this new piece comes out. That’s why we don’t really look at those. We’re really first on spot in line to get to the upgrade.