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.
- Effects of the Eclipsys acquisition
- What it means to truly “partner” with a vendor
- iSirona for device connectivity
- Integrating with physician offices for HIE
- Tackling quality measures
- Thoughts on Meaningful Use
We know them, they know us. They keep track of what it is we’re doing and really work with us to implement new components and put in new upgrades. It’s a good relationship.
I can go in the vital signs flow sheet and right click ‘Auto Enter,’ and they’re there. So I think one of the big things about it is that it allowed us to get a lot tighter integration, and that’s something that we really strive to do.
Right now we’re just kind of going through and picking up the pieces, but I think the biggest thing, besides Meaningful Use obviously, is really connecting the community around us and then focusing on quality measures.
There’s really two different thought processes: do I go best-of-breed or do I go single platform. And where I feel we have an advantage is that data comes from all of these areas throughout this hospital and they feed into one repository, whereas if you have these single systems, you’ve got to find a certified quality reporting tool if you’re going to do things like report on your Meaningful Use measures.
We work hard to integrate and bring new technology, and when we look for vendors, we look for partners. We look for a partnership where this isn’t just another contract and this isn’t just another hospital. We want them to engage and work side by side with us to always have a successful implementation.
Guerra: Let’s talk about the acquisition of Eclipsys by Allscripts. What was your first reaction to that, and how has it gone since then—has it been a positive overall?
Neece: It’s been a positive overall. We have a great relationship with Allscripts. We are a true partner of theirs, and they are a true partner with us. I think they’ve got a great product—one of the industry’s top products in my mind, and it gets better every day. The merger to me really hasn’t had much of an affect at all other than that we have a larger team and we have now a larger tool kit to pull from.
Guerra: When you say they are a ‘true partner’, can you tell me what that means to you?
Neece: Well, I don’t look at them as just a vendor. They really work with us. I don’t just call support just being another client. We know them, they know us. They keep track of what it is we’re doing and really work with us to implement new components and put in new upgrades. It’s a good relationship. And their support staff is great. We work with their services folks, and we’ve had the privilege of being able to work with some of their developers as well. They really engage with the client. They have a lot of work groups and they have a lot senior level discussions that the CIOs and CMIOs get to participate in. So it’s just a lot of open forum discussions and involvement.
Guerra: Let’s talk a little bit more about device connectivity. You mentioned that you’re working with the company called iSirona on that. What were the issues that you needed help with, and what were the challenges you were facing with devices?
Neece: Back in the day when we were looking at device connectivity, and we’re talking probably 2004, initially we utilized the GE product because of the bedside devices here and the monitors were GE. And then we started looking at expanding that into other areas like the Dynamaps and one of the biggest things was cost. I don’t know if you’ve priced some of these other vendors, but it’s very expensive to do. This device needed this piece of equipment, and that device needed this other piece of equipment. There were a lot of complexities to it. And then also how do we integrate this product into our workflow and into Sunrise Clinical Manager. Then after doing some research, our director of IT found this company called iSirona and we partnered with them to integrate their device connect software, their system into the actual workflow inside Eclipsys.
To show you how that works in Eclipsys, I’m on my patient in the system, and I can actually go and click a tab inside Eclipsys without getting out of it. And I’ve got my device with me, my Dynamap with me on a card. I’ve got my laptop on that same card, so that association with the device and the patient is made at that point, and I’m in the tab inside Eclipsys. Basically I take the vital signs and then I can go in the vital signs flow sheet and right click ‘Auto Enter,’ and they’re there. So I think one of the big things about it is that it allowed us to get a lot tighter integration, and that’s something that we really strive to do.
Guerra: We talked about how advanced your shop is. What would you say is the most pressing issue on your plate right now? What’s the number one thing on your mind that you want to move forward?
Neece: We’re really connecting the community—creating interoperable exchanges with the physician offices and with other hospitals within the state, so that we can do things like health information exchange. We’re working a lot with the physicians in the community so that they can do cool things like pre-register a patient from their office and send their admission orders across electronically. Or create a situation where the office note becomes the HMP in the hospital and they can exchange discharge information back to their office.
We’re just trying to make it more fluid and make that transition of care more seamless. So that’s a focus, and then just going and picking up these one-off areas inside the hospital, like surgery. We’re starting to deploy down in those areas. Right now we’re just kind of going through and picking up the pieces, but I think the biggest thing, besides Meaningful Use obviously, is really connecting the community around us and then focusing on quality measures. Those are really driving reimbursement, and every day they grow. And so we’ve got a big focus on things like value-based purchasing, IQI, and of course the quality measures they came with Meaningful Use.
A huge tool that we use today, especially with Meaningful Use, is the Allscripts Analytics product. It’s integrated with Sunrise ED, Sunrise Critical Care, Sunrise Clinical Manager, and Sunrise Ambulatory. The data feeds into it, and then we have the ability to produce those needed quality measures. So those are probably the top topics on my mind right now.
Guerra: So you mentioned that the Allscripts Analytics product is the key to being able to produce the quality measures that are being asked for by countless government entities. What if you don’t have that? What if a shop is not as far along as you are? Are they going to be in trouble soon?
Neece: I would say it would be challenging, especially if you’re having to basically write ad-hoc reports or query across multiple vendors or multiple systems. It’s always been a challenge and there’s really two different thought processes: do I go best-of-breed or do I go single platform. And where I feel we have an advantage is that data comes from all of these areas throughout this hospital and they feed into one repository, whereas if you have these single systems, you’ve got to find a certified quality reporting tool if you’re going to do things like report on your Meaningful Use measures.
Guerra: So you think the best-of-breed shops out there could have some difficulty?
Neece: I would say they have a challenge. That’s something that I’ve been fortunate with here. We actually have a strategy where we’ve had to focus on taking Sunrise Clinical Manager and putting it in all the areas that we have so that we have not only the front-end integration, but that seamless transition from the ED to the critical care area, to the med-surgical unit, and out to rehab. They’re all using the same system with the same data, sharing the same patient information down to the same observations. And then you look at shops that have separate ED systems, separate inpatient systems, and separate labor and delivery systems. Any time you have to integrate, I believe you create more challenges.
Guerra: Right. So when you say you’re trying to integrate with the independents, you must be facing physicians that have no system and physicians that have a system that works well with what you’ve got on the inpatient side, and everything else under the sun. So are you looking at sort of HIE-type cloud model or are you doing point-to-point?
Neece: Well I think it’s going to be a combination, depending on the system that they’re using at their location, or even looking further to the critical access hospitals in the south that work with us on a daily basis as well. I don’t think there is one solution.
Guerra: I noticed when I was doing research for the interview that you’re quoted in the number of press releases for vendors. So I wonder is that part of your philosophy about partnering—if they do a good job for you, you’re willing to go out there for them.
Neece: That’s right. That is one thing that we do. We work hard to integrate and bring new technology, and when we look for vendors, we look for partners. We look for a partnership where this isn’t just another contract and this isn’t just another hospital. We want them to engage and work side by side with us to always have a successful implementation.
Guerra: Have you ever been asked by a vendor to participate in a press release or some type of event where you didn’t feel comfortable doing that?
Guerra: They wouldn’t ask probably. They would know better.
Neece: No, I haven’t been in that situation.
Guerra: Alright, well I know we’ve got a tight time frame. Is there anything else that you wanted to add before we could conclude?
Neece: One thing that we didn’t really discuss was Meaningful Use. I think that’s a major topic on everybody’s mind, and just another key kind of partnership where we worked side by side with our Allscripts colleagues. JRMC was the first hospital in the state to successfully attest to Meaningful Use, and one of the first in the United States, and I think that’s a major accomplishment. It speaks to the hospital, to our clinicians and their dedication, and to the realization of the need for a system like this and the need to use it. And I think it speaks for the product as well, and the Eclipsys team and the iSirona team providing us the integration and the real-time vital signs in the system. It’s a major accomplishment and I just wanted to make sure that we did discuss that.
Guerra: Before I let you go, how do you feel about what we’re seeing for Stage 2?
Neece: I think we’ll be in good position for it. When we did our attestation or when we put together our Meaningful Use toolkit, we did so to achieve not only the minimum but to reach the higher thresholds—90 or 95 percent—as well as meet all of the main requirements. So I think that has put us in a position that depending on what Stage 2 is—and nobody really knows for sure what those are going to be, I think we’ll be in pretty good position for it.
Guerra: Overall you think the program has been positive?
Neece: Yes, I think the program has been positive. I think it’s given us a launching board, something that we can leverage to help push the system further and push the integration further into areas that it may not have been before.
Guerra: All right, Patrick, with that I’m going to let you go. Thank you very much for your time today, and I hope to talk to you again soon.
Neece: All right, thank you.