A 242-bed acute care facility based in the beach town of Cape May, N.J., Cape Regional Medical Center serves a patient population that hovers under 100,000 during the off-season before swelling to more than one million during the summer. But for CIO Rich Wheatley, the operational challenges associated with a fluctuating patient base pale in comparison to the complexity of New Jersey’s HIE environment, which is about as “clear as mud.” Throw in Cape Regional’s plans to bring on physician practices, the challenges of juggling different systems, and the Meaningful Use timelines, and it’s safe to say that Wheatley’s job is no vacation. In this interview, he discusses his plans to integrate physician practices with the inpatient Siemens Soarian system, the use of Allscripts in the ED, his thoughts on the merits and weaknesses of Meaningful Use, and how he docked in Cape May.
- The Soarian implementation
- Measuring up to Meaningful Use
- “My concern is can the industry as a whole support the change being forced on it?”
- The art of vendor disengagement
- “ACO is not on my front burner right now”
- “ICD-10 is nagging at me”
- The importance of getting staff up to managerial speed
It’s necessary for us to ensure that we go live far enough in advance to have the system settle in prior to hitting our summertime volumes. The March-April timeframe is really the window of opportunity for us. So if we miss that, we’re going to be looking at a fall implementation, which will not allow us to achieve Meaningful Use.
We’re introducing a new system and new workflows, but it’s not as if we’re bringing users onto something like med administration—we’re already doing that today. So I’m fairly confident that the transition is not going to be as painful as it would if we were introducing completely new technology to them.
ICD-10 is one of those things that is nagging at me. From an organizational perspective, we’re probably not as far along as we should be. And I think one of our biggest challenges—and I have to believe most other people are in the same boat—is that we’re trying to figure out who’s the owner. It’s a hot potato.
We have some considerations about reporting—how do you span report periods from ICD-9’s and ICD-10’s, and how do you do this comparison. But those are all things that we can figure out. My biggest concern is really the education of the physicians and how the physicians are going to be impacted.
The IT leads now are being challenged with managing multiple resources, and hindsight being 20/20, I should have spent the time leading up to implementation providing better education from a project management standpoint in terms of preparing them for those leadership roles.
Guerra: Tell me about the project. What are some timelines for the Soarian project going forward? And with the background of Meaningful Use stage 1, do you think you’re going to make that?
Wheatley: That’s our plan. We have split the project into two phases. The first phase is scheduled to go live on March 20 of next year, and that phase will basically be everything that is currently electronic today in our Meditech system. We expect to be electronic on March 20. And that includes clinical documentation, assessments, care plans, orders, pharmacy, med administration, charting, etc. So we expect to basically be brought up to the same level that we are today with Siemens Soarian in March.
Again, our seasonal volumes have a big impact on our planning because nothing big happens here on the summertime, and it’s necessary for us to ensure that we go live far enough in advance to have the system settle in prior to hitting our summertime volumes. The March-April timeframe is really the window of opportunity for us. So if we miss that, we’re going to be looking at a fall implementation, which will not allow us to achieve Meaningful Use.
One of the benefits that we have is that we’re doing CPOE in our ED today. So that allows us the flexibility and opportunity to go ahead and apply for Meaningful Use before June of next year, since we have our CPOE covered. From a Siemens perspective, phase 2 would then be the rollout of our CPOE initiative and physician documentation which is currently scheduled for the fall of 2012. Once we get through the craziness of our summertime, people can settle down and we can start planning that CPOE rollout within the SIEMEN world itself.
Guerra: So you had to disengage, on some level, with some applications—the main ones right now on the clinical side. You’re disengaging with Meditech. Tell me how you handled that. Was that difficult? Did you actually make a call or send a formal e-mail which notified them of your plans?
Wheatley: Yes, absolutely. They were one of the two finalists in terms of our decision and our direction, and at that time that we did formalize our agreement with Siemens, they were notified.
Guerra: Was that at all difficult for you on any level? How long have you been at the organization, and how long did you have a close relationship with your Meditech contacts there? Was that difficult in any way?
Wheatley: Actually it was not, because I’ve been with the organization just a little less than two years. And I don’t have a lot invested in Meditech, to be quite honest with you. But on the other hand, we will still have many Meditech Magic applications here, and we will be continuing that relationship with Meditech well into the future. So I expect that Meditech will continue to supports us as they have in the past.
Guerra: In the manner you’ve become accustomed?
Guerra: We have Meaningful Use, and right now, to a certain degree, you’re essentially going to have to do both. A lot of organizations are going to have to do what you’re doing, which is install and ramp up use almost at the same time, which is very hard. And there is a lot of danger in there with patient safety issues when you don’t have time to really refine things and tweak things. Are you concerned about the speed that you’re going to have to do this?
Wheatley: I’m not terribly concerned because we’re not necessarily introducing new workflows. We’re introducing a new system and new workflows, but it’s not as if we’re bringing users on to something like med administration—we’re already doing that today. We’re replacing technology, but we’re already providing that barcode checking at the bedside today. So I’m fairly confident that the transition is not going to be as painful as it would if we were introducing completely new technology to them.
Guerra: What are your thoughts overall on the program the government has put together?
Wheatley: Boy, that’s a good question. I think my biggest concern all along is that I certainly understand what the government is doing—I applaud them for their carrot-and-stick approach in trying to incentivize health care organizations and physicians with dollars to move them into the electronic world as well as understanding that penalizing those laggards that don’t adapt. My concern, and one of my challenges today, is can the industry as a whole support the change that we’re forcing on it?
One of our biggest challenges today in terms of our implementation is getting resources; getting vendors, not necessarily Siemens, to commit. We have a lot of players. We have Allscripts at the table. We have integration partners at the table, and they’re not necessarily as invested in our successful Siemens implementation as we are. And they’re stretched in terms of their resources, because everybody’s busy. It is a big challenge for us.
Guerra: I can imagine. You talk about getting everybody at the table who needs to be there at the same time, because that’s your table but they’re at a whole bunch of other tables at the same time.
Wheatley: Absolutely, yes.
Guerra: You’re just coordinating. It must be difficult when you have to get two or three or more vendors on a conference call, which I would imagine you have to do to really efficiently resolve an issue. That’s got to be difficult in and of itself.
Wheatley: And I’ll just use my ED inauguration as an example. The players at the table are Allscripts; our integration partner, Iatrix, which has the Allscripts to Meditech integration in place; we have a third party consultant, OpenLink, helping us; we have Siemens; and we have ourselves. So we have five parties at the table, and like you said, just trying to coordinate conference calls to get the right people on those calls and the time involved in getting those scheduled and getting the feedback is a painful process.
Guerra: And then somebody can’t make the call who is key to the discussion and you have to reschedule.
Guerra: Wow, that’s frustrating.
Wheatley: Welcome to my world.
Guerra: And the clock keeps ticking on Meaningful Use, right?
Guerra: All right. Let’s talk about more fun stuff. Give us your thoughts on moving toward becoming an ACO or on the ICD-10 transition.
Wheatley: ACO is not on my front burner right now. The organization is kind of taking a ‘wait and see’ approach, as I imagine many community hospitals of our size are doing. Certainly the bigger organizations that have lots of integrated services, whether it is home health, visiting nurses, etc., will probably be more aggressive in looking at that. ICD-10 is one of those things that is nagging at me. From an organizational perspective, we’re probably not as far along as we should be. And I think one of our biggest challenges—and I have to believe most other people are in the same boat—is that we’re trying to figure out who’s the owner. It’s a hot potato. Nobody wants to own it. And I’ll be honest with you, I would own it, except I have a Siemens implementation going on. So to have the two of them running simultaneously is certainly a challenge.
But from an IT perspective, it doesn’t scare me. It’s fairly finite. There are systems out there. We can identify them. We know those that have ICD-9’s today that are going to have to move to ICD-10. Yes, we have some considerations about reporting—how do you span report periods from ICD-9’s and ICD-10’s, and how do you do this comparison. But those are all things that we can figure out. My biggest concern is really the education of the physicians and how the physicians are going to be impacted. And those referring physicians that aren’t necessarily well-aligned with the hospital that are sending those outpatients in for their lab work and whether or not those scripts are going to be coded properly so we can be billing appropriately for those services. That’s really my big concern in terms of making sure that our physician community is educated and will allow us to continue to receive the level of reimbursement that we are currently enjoying.
Guerra: So it’s really a governance question in terms of just looking at it as a project and having somebody develop the proper governance to get it done?
Guerra: I guess most things can boil down to proper governance. You put the proper governance in place and then it will move forward.
Guerra: Interesting. So let me ask you an open question. Do you have any other main projects on your plate or issues that you want to bring up before we talk a little about your career?
Wheatley: The only thing that I would like to bring up is one of my current challenges and just a heads up to others that may be listening. And that is, one of the things that I underestimated coming to an organization this size is the skill of my IT staff in terms of project management. One of the mistakes that I made is that we have what we call IT leads. Historically, the IT lead meant that you are responsible for a project that you didn’t have anybody to manage. You pretty much had all of the responsibility of getting something done. As we transition into the Soarian implementation, it’s a much bigger deal. The IT leads now are being challenged with managing multiple resources, and hindsight being 20/20, I should have spent the time leading up to implementation providing better education from a project management standpoint in terms of preparing them for those leadership roles.
Guerra: How do you think you would have gone about that—just one-on-one discussions of what it takes to do a project, or maybe involving them more as you move forward with projects? How do you think you would have done that?
Wheatley: I think just some basic project management education; sending them to classes and changing their mind set in terms of the fact that they’re not responsible for everything. They don’t have to take the world on their shoulders—they now have resources available to them and they need to share those responsibilities and delegate some of those responsibilities to others.
Guerra: That’s a great point. So if you’re giving people managerial responsibility, make sure that they’re equipped to know how to wield it?
Wheatley: That’s correct, yes.
Guerra: That’s a very good point, and a very good lesson for others to hear.