The regulatory requirements that CIOs are grappling with are overwhelming enough—throw in a major leadership change, and it can feel like being caught in a whirlwind. It’s how Kim Ligon felt when DCH Health System had a new CFO take the helm just as Meaningful Use was coming down the pike. But rather than panic, Ligon, who serves as CIO for the West Alabama-based system, reached out to her colleagues for help. What she found is that there is no better source than CIOs for issues like dealing with steering committees, prioritizing projects, and balancing the budget. In this interview, Ligon also talks about having to interface with physician offices that use different EMR systems, her role in developing a statewide HIE, when a project needs to be delayed, and why she believes nurses bear the biggest brunt of CPOE.
- About DCH Health System
- Running a Meditech Magic 5.64/LSS shop
- Hospital/physician practice integration, HIE
- Looking to the states to facilitate integration
- The final frontier — inpatient CPOE
- Going 6.0 someday?
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They selected LSS because they wanted to have the integration with the hospital. And those practices also happen to use our lab services as their reference lab, so they saw it as a kind of a win-win to be able to have all that information in one place.
I’ve already had to expand the resources for interfaces. Historically that’s been something we were able to do on the side and we didn’t really have to have carved out resources for it. And now I’m someone whose whole job is whole job is primarily supporting those ambulatory practices.
The state of Alabama is actively working to develop a statewide HIE. I’ve been participating in one of the committees that are helping to build the rules for participation. And I think that initially we’ll probably be looking at what the opportunity is there, as much as anything else, rather than trying to reinvent the wheel somewhere.
Even though rehab doesn’t count for Meaningful Use, it’s kind of a microcosm of what you would actually see in a mixed environment on the floors. Our administration doesn’t want to have to mandate that the physicians are going to do this. And so we’re working through this pilot to see if a mixed environment is even sustainable.
We actually delayed our ED implementation at the regional medical center for a full year because we wanted to make sure that we had time for building all the pharmacy strings and the things that had to happen to make that as elegant a solution as possible.
Guerra: Good morning, Kim. Thanks for joining me to talk about your work at DCH Health System and your recent CHIME survey.
Ligon: Thank you.
Guerra: Let’s start off by talking about the organization to give everyone the lay of the land. I know you have a number of facilities, but why don’t you go through the highlights for the readers and the listeners?
Ligon: The DCH Health System is in west central Alabama and Tuscaloosa is where the flagship hospital regional medical center is. We have four hospitals, two of them are small rural hospitals and two of them are here locally in the Tuscaloosa-Northport area. We have about 935 beds and support around 4,800 employees and about 400 physicians. We have several specialty areas, a cancer center, a spine care clinic, and occupational medicine. We have full services for women, including two neonatal units, and we support a nursing home and a home health agency. So we’ve got a broad footprint in this area. We are the primary source of healthcare for about an eight-county area in Alabama.
Guerra: You mentioned 400 doctors—are they employees?
Ligon: No, they are not. We have a very few physicians who are actually employees. We have some contracted hospitalists and we have one group of three hospitalists who are actually direct employees, but virtually every other physician is a community-based physician who simply does business at our facilities.
Guerra: So you don’t have to support a lot of small physician practices or even moderate physician practices, correct?
Ligon: We are supporting some. We use LSS. We’re primarily a Meditech shop, and so use LSS and we have it currently installed in two practices that are community physicians, and we’re in the process of installing it for a group of surgeons right now and have four other practices on the drawing board to do next.
Guerra: Those are independent practices, not ones you own, correct?
Ligon: Independent practices.
Guerra: Right. But you don’t have a lot of owned practices and ambulatory sites?
Ligon: No, we do not.
Ligon: The spine care center and the cancer center are the biggest concentration of physicians that we would have. And between all those areas, there are about eight physicians.
Guerra: So, did you give them a choice? Did you underwrite it using Stark? How did they go—did they pick LSS?
Ligon: Basically, they selected LSS because they wanted to have the integration with the hospital. And those practices also happen to use our lab services as their reference lab, so they saw it as a kind of a win-win to be able to have all that information in one place.
We haven’t heavily marketed it, we just did some demos and invited people to come and see it. But some of the practices that we’ll be going up are incubator projects where the hospital is assisting and recruiting some physicians and helping getting them started. And then they’ll become independent practitioners after that.
Guerra: Right. Did you underwrite this at all?
Ligon: Not really.
Guerra: Okay, so they paid for it themselves.
Ligon: That’s right.
Guerra: If they had not selected LSS, would that have represented more headaches to you from the integration point of view?
Ligon: Not really. We have about 150 offices that actually have access directly to our Meditech system, and we have about 25 offices that we’re currently interfacing data with at least one way but not by directionally, and we’re working on a bidirectional with another vendor.
Guerra: Are those one-offs? I mean, within those 25, are there a whole bunch of different ambulatory EMRs?
Ligon: It’s probably split between about four or five primary ones.
Guerra: Do you see that as sustainable as that 25 moves up and up and you get more and more EMRs, or do you need to move to some kind of cloud HIE type of thing?
Ligon: Well, I’ve already had to expand the resources for interfaces. Historically that’s been something we were able to do on the side and we didn’t really have to have carved out resources for it. And now I’m someone whose whole job is whole job is primarily supporting those ambulatory practices. I think that’s going to continue to grow and I think we are going to have to look at some other alternatives probably in the long term.
Guerra: Right, because then you’d be getting a call every other day from a small practice using an obscure system that asks you to write an interface. That’s not sustainable long-term.
Guerra: Does it make sense? I mean, do you think of HIE solutions— Axolotl or Medicity-type solutions—could they have a role to play in some sort of larger ambulatory integration solution?
Ligon: Well, I think right now the state of Alabama is actively working with Thompson Reuters to develop a statewide HIE. I’ve been participating in one of the committees that are helping to build the rules for participation. And I think that initially we’ll probably be looking at what the opportunity is there, as much as anything else, rather than trying to reinvent the wheel somewhere.
Guerra: Right. So that maybe something that’s going on in many places where hospital CIOs are working to have the integration going between the physician practice and the hospital with an eye toward what the regional or state organizations are doing around HIE to see if maybe they’ll take the problem off your plate and give you a turnkey kind of solution to make this go away. Does it make sense?
Ligon: Yes, it does. And I’m hopeful that’s exactly what’s going to happen.
Guerra: That would be nice, wouldn’t it? Your tax dollars at work.
Ligon: Yeah, every once in a while. Well, the state of Alabama got about 10 million dollars from one of the grants that went out about a year and a half ago to do all that kind of connectivity, so I’m hoping they use it well.
Guerra: Right. So let’s talk a little bit more about Meditech. What version are you on?
Ligon: We’re a Magic 5.6.4 site.
Guerra: And that’s the Meaningful Use version?
Ligon: Yes, it is.
Guerra: Did you have to take an upgrade to get there within the last year?
Ligon: We took the upgrade in July.
Guerra: And how did that go?
Ligon: It was okay—a little bumpy, but it was okay. The biggest issues we’ve had really have been with the LSS practices and with some of the things for physician care manager. We were pretty well-positioned before that. We had most of the clinical apps up and we’ve had physicians up on documentation on kind of a voluntary basis for about two years. We had not broached the CPOE bridge yet, but two of our emergency rooms are up on EDM. And actually, for CPOE phase 1, we’re going to be able to meet that just from the volumes that are going through the emergency room with our physicians using the systems there.
Guerra: Right, and when they up that, then it’s time go in-patient?
Ligon: And we’re starting an in-patient pilot right now. We’re starting it on our rehab unit—even though rehab doesn’t count for Meaningful Use, it’s kind of a microcosm of what you would actually see in a mixed environment on the floors. Our administration doesn’t want to have to mandate that the physicians are going to do this. And so we’re working through this pilot to see if a mixed environment is even sustainable.
Guerra: Right. So, at this point, you don’t know if 5.6.4 if the CPOE and documentation interface is going to work for the physicians, because I think it’s suppose to be better than 6.0—I don’t know if you’ve looked at that and if that was a consideration when you took the 5.6.4 upgrade. Did you look at 6.0?
Ligon: Yeah. We’ve been looking at 6.0 for a couple of years, but when we stepped back, we didn’t think that we could actually do a two or three-year implementation on 6.0 and meet Meaningful Use. So we made the decision to meet Meaningful Use with what we have and then go to 6.0 at a point after that.
Guerra: It’s interesting. I speak to a lot of people who are in your position and looking at these upgrades with Meditech especially. Do you wonder in the back of your head if 5.6.4 is going to work with the physicians for CPOE?
Ligon: Not really, because we’ve have such good success in the emergency rooms that I really feel like we can get there from here with ordering. For the documentation I’ve got about 60 doctors right now, including some physicians from our university residency program who are using the documentation portion, and we’re using Dragon Naturally Speaking in those things and they like those things. So to me, the ordering piece is as much about the comfort and a good build as it is anything else. We actually delayed our ED implementation at the regional medical center for a full year because we wanted to make sure that we had time for building all the pharmacy strings and the things that had to happen to make that as elegant a solution as possible. And I think that was a good decision because it really meant that was a very usable system whenever we rolled it out.
Guerra: And how are you looking for Stage 1? Did you attest yet?
Ligon: We have not attested yet. What we are planning is to go ahead and complete the pieces that we have to. The biggest issues right now would be probably the capture of the quality measures from the system and getting that the rest of the way rolled out. We’re making some changes to nursing documentation to help with that capture and we’re planning to start our data collection by July of next year so that we’ll attest in October.