Of all the tools and resources available to him as CIO, perhaps the most useful for Tom Stride is his clinical background. As vice president and CIO of Aria Health, a Philadelphia-based system that includes three community hospitals and a network of outpatient centers and physicians, Stride faces a challenge many CIOs can relate to in integrating independent and owned physician practices with the acute setting. But where he has an advantage is in understanding firsthand the extent to which upgrades impact workflow, and how important it is that clinicians are on board with any initiative. In this interview, Stride discusses how he has benefited from his experience, how his organization has achieved 96 percent CPOE, the importance of optimally prioritizing projects, and best practices in vendor relationship management.
- About Aria
- Allscripts (Eclipsys) Version 5.5 Shop
- 96 percent CPOE
- Hospital/physician practice integration with dbMotion
- Since the merger …
- Integrating the independents
- Measuring up to Meaningful Use
- Fostering CPOE adoption
One of our challenges with every vendor we deal with is that when they’re growing, it’s harder to get resources assigned when you need them. So we’ve been dealing with that, but as a whole, it’s been a very good relationship.
We’re hosting the system, but we get a lot of requests from people to connect to us. They want important information like radiology results and lab results, and our way to do that is to utilize dbMotion integration with our enterprise manager patient index to secure that connection with each private or employed physician.
Something to me that’s very difficult and non-practical is giving discharge instructions on thumb drives and CD-ROMs. That’s a difficult situation within a hospital, especially at discharge. That’s been one of our struggles.
We did a lot of upfront training. We have a physician that works as a liaison that just did endless training with all of the physicians, and we had senior leadership backing and support to get this accomplished.
Order sets is one piece of it, but I also think the GUI interface and how to utilize that for the physicians—less clicks, ease of workflow, and ease of getting things done—is critical. So when we say CPOE, these were some of the things we evaluated—how quickly you can do certain tasks and how many steps it takes.
Guerra: Good morning, Tom. Thanks for joining me today to talk about your work at Aria Health.
Stride: Good morning.
Guerra: To start, please tell us a little bit about your organization so we get the lay of the land. I know you’re in northeast Philadelphia, but why don’t you give us some of the highpoints of your health system, and we’ll go from there.
Stride: Sure. We’re in northeast Philadelphia, we have three acute hospitals, we have around 488 beds, and we have three to four outpatient clinics.
Guerra: And the hospitals employ a community model with the independent physicians referring in?
Guerra: Do you have any employed physicians?
Stride: We do. We have around 37 practices that are employed physicians.
Guerra: Okay. I know you’re on Allscripts, which was Eclipses now. So you’re using Sunrise Clinical Manager. Tell me about when you went on that and just bring me up to date with your general clinical application environment.
Stride: We are on Sunrise Clinical Manager. We’ve been with Eclipsys, now Allscripts, and before TDS, probably since the 1980s. We’ve been doing CPOE for a good 10 years or so, and we’re probably running about 96% on CPOE. That is our main clinical application. We just went to version 5.5 with all the different modules; we have Rx-writer, we log in immunizations, education log, and exit care integration for the patients. That’s pretty much been our model and what we’ve done recently.
Guerra: Do you have the same system at all three hospitals?
Stride: We do. We have the same system across the entire enterprise.
Guerra: And the clinics, right?
Guerra: So what’s going on in the clinics? There are different products there, right? Eclipsys is the inpatient product and Allscripts has a strong ambulatory product and ED product. Tell me about that.
Stride: Right now our strategy, and what we currently have in place, is on the acute side, we have Sunrise Clinical Manager which I just described, and we have all the modules that are related to that. Then on the ambulatory side, we have the enterprise system, which we also integrate with the practice management system for private or employed physicians.
Guerra: And how do you integrate those two?
Stride: We are in the middle of doing an integration with an aggregation software company right now. We actually started that project probably about a month ago. So what we’re doing is we’re going to have something like a data warehouse that integrates both the acute and ambulatory side.
Guerra: Do you want to name that company?
Stride: Oh yeah, it’s dbMotion.
Guerra: How has your experience been with the merger?
Stride: We have not many issues. As far as support, it’s fine. Doing the project has been fine. One of our challenges with every vendor we deal with is that when they’re growing, it’s harder to get resources assigned when you need them. So we’ve been dealing with that, but as a whole, it’s been a very good relationship.
Guerra: Ideally they were talking about integrating the Eclipsys acute care product with the Allscripts ambulatory product and really becoming an Epic-like or Cerner-like company. Do you know if there’s been much progress in that work?
Stride: What I know is that their going to that spec, if you will, so they are going to integrate as much as they can between the two systems at the database level. There hasn’t been much on that at this point, but I know from going to the technology meetings, that is one of the things they’re discussing.
Guerra: Okay, so you’ve got your dbMotion solution to get the integration you need between the hospital and the physician practice environments.
Stride: Right, but more importantly with what I’m doing is our exchange strategy to get out to all physicians. So whether it’s an employed physician or a private physician, we’re using the dbMotion solution to do that, with integration to all ancillary electronic health records.
Guerra: And you said it’s going to be a cloud-type model?
Stride: No, not a Cloud type model. We’re hosting the system, but we get a lot of requests from people to connect to us. They want important information like radiology results and lab results, and our way to do that is to utilize dbMotion integration with our enterprise manager patient index to secure that connection with each private or employed physician.
Guerra: So for the independent, private physicians, you probably have a number that are on different products, and you can use dbMotion to plug them in so they can exchange data with the hospital?
Stride: Yes, that’s what we’re doing currently.
Guerra: What about the independents that don’t have anything? Are they asking you for help in choosing a system or to help them to come up with a strategy?
Stride: Yes, all of the above. They’re asking us for help in choosing a system and they’re asking us what our strategy is. And we also offer them what we would do. For example, we offer the Allscripts practice management and/or the Allscripts product suite for the ambulatory side. So we partnered with Allscripts to do that.
Guerra: Is it easier for you to integrate with an All Scripts Practice than with a Next Gen practice, or because you’re using dbMotion, does it not really matter?
Stride: Right now I would say that Allscripts is easier because it’s a known integration. I would say that with dbMotion we’re not at that level yet, so I can’t really answer that at this point.
Guerra: How do you feel about your timeline with this? Does this impact your Meaningful Use efforts—do you have to get this done to qualify for Meaningful Use?
Stride: No, it does not. This is separate from Meaningful Use. It doesn’t really impact what we’re doing for Meaningful Use.
Guerra: And how are you doing on Meaningful Use?
Stride: We’re doing very well. We’re actually in our reporting period now.
Guerra: So you’re going to get stage 1? You’re looking good for that?
Stride: We’re looking good for stage 1, yes. One of our difficulties was working with the state but I believe we’re getting through that, so I think we’ll be okay.
Guerra: And how do you feel about what you’re seeing? Have you paid much attention to what’s coming together for stage 2?
Stride: We have, but our main focus has been on stage 1. And I know that’s been delayed a little bit, so we want to really get the base infrastructure set up so we’re prepared to handle stage 2.
Guerra: Do you feel like they did a good job putting stage 1 together? Do you feel like those things were appropriate for improving care?
Stride: I do, but I think that it could have been more extensive. What I mean by that is to achieve Meaningful Use, you have to use it in a Meaningful way. And I think that’s their first step to get there. So for example, something to me that’s very difficult and non-practical is giving discharge instructions on thumb drives and CD-ROMs. That’s a difficult situation within a hospital, especially at discharge. That’s been one of our struggles.
Guerra: When you say it’s not practical, tell me what you mean.
Stride: The reason I say that is because it’s one thing to give it through medical records or health information management, and it’s a whole other thing to have the nurse download it to a PC. I don’t think it’s a hard thing to do; I just think it’s a big workflow change for the whole process.
Guerra: You’ve mentioned that you have the 96% CPOE. Have you been there a long time? Were you there when the organization went up on CPOE?
Stride: Yeah, I’ve been here since 1999. I was here when they went up on it.
Guerra: So achieving 96% with a lot of independent physicians—what’s the secret there that your colleagues might benefit from?
Stride: I would say that we did a lot of upfront training. We have a physician that works as a liaison that just did endless training with all of the physicians, and we had senior leadership backing and support to get this accomplished. They’re the two key components, I would say.
Guerra: Would you say you were able to do this at your own pace, and in your own timeline? You probably did this before HITECH came out, right?
Guerra: So my question is, for your colleagues that are late to this dance and responding more to the government programs, do you think there’s ample time to ramp up CPOE in the way that you did?
Stride: I think it’s difficult. It took us over a year or so, and again I wasn’t directly involved with that at the time, but it was at least a year or so to get that accomplished. So like I said, you need to ramp it up. You need to have endless training and you need to focus a lot of your resources on CPOE. So if you just do that one piece of it and then you get all the other pieces Meaningful Use, I would say it’s a difficult task, from my point of view.
Guerra: From everyone I hear who’s been successful at this, it just sounds like most of them did it before HITECH and it took a number of years and a lot of meetings and a lot of time. I wonder what’s going to happen with organizations that are rushing this in, just to get to check—how that’s going to play out.
Stride: I agree. I think that it’s a very tight timeframe, and I do think you need a lot of time to accomplish CPOE.
Guerra: Is the development of order sets a huge part of it?
Stride: That was one of the pieces of it, yes. We have an ongoing committee that works with order sets and that’s a multi-discipline community that deals with that. But again, whatever you could do to make the order easy for the physician is what you have to do to get the adoption where you want it.
Guerra: When we talk about customizing these systems, are we talking mostly about order sets or is there another level of customization you can tell me about that helps you make the systems user-friendly?
Stride: I would say that order sets is one piece of it, but I also think the GUI interface and how to utilize that for the physicians—less clicks, ease of workflow, and ease of getting things done—is critical. So when we say CPOE, these were some of the things we evaluated—how quickly you can do certain tasks and how many steps it takes. As you know, everybody’s busy in health care, so we want to make sure it is the most efficient thing possible.
Guerra: And was that a process of picking the right system, or does it have more to do with customizing it once you get it?
Stride: Well, I think it’s both. I think you have to pick the right system, and I also think that whatever customization that you can do, I believe you have to optimize that.
Guerra: Right, so again, we’re talking about things that take time.
Stride: Absolutely, everything within the CPOE process takes time. Like I said, it took us well over a year to get that accomplished.
Guerra: Did you have some physicians that just wanted no part of this that you had to bring around to your way of thinking? Is that maybe where your physician champions really came in handy?
Stride: Yes, we did. And the key for our success there was having the physician liaison and the training process, and making sure we met their needs as far as that’s concerned.