As CIO of CentraState Health System, Neal Ganguly is in a unique position. Although the organization offers ambulatory services, it is still considered a stand-alone community hospital, and is located in the most densely populated state in the country, among a sea of large multi-hospital systems. For Ganguly, the challenge is to forge ahead and continue build the organization by finding new ways to connect with physicians, aligning with the state’s largest HIE, and leveraging initiatives like CHIME StateNet — a forum in which CIOs can share best practices. In this interview, Ganguly talks about why strategic planning should focus on meeting immediate needs — and not on achieving Stage 7; dealing with the growing demands of sophisticated users; and the challenges of maintaining a healthy work-life balance.
Chapter 1
- Being a standalone facility in a competitive marketplace
- Looking for ways to partner with community docs
- Setting up a portal for EMR-resistant docs
- Stage 1 attestation: the devil is in the details
- Connecting with NJ’s largest HIE
- Giving clinicians a complete view of the patient
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Bold Statements
We’re not part of a larger health system, and we’re in an area where we’re surrounded by multi-hospital systems. So we’re in a very competitive marketplace.
We’ve taken two models: for those physicians who have an EMR, we’ve gone ahead and built interfaces between MobileMD and the EMR and we’re pushing our lab results, transcribed reports, and radiology into their EMR. For those who don’t have an EMR, they can go through the portal to view that information and also to leverage some of the communication tools.
The question from our perspective is, can we help them capitalize on the investment and make it the right way — implement the system in a way so that they’re not losing productivity dramatically and are getting some benefits from technology?
Overall I would say we were fortunate, because we had put a strategic plan into place six years ago that had a big clinical focus, and so a lot of the infrastructure we needed had already been put in place. We weren’t starting from zero.
We’re focusing on making sure we’re keeping our numbers consistent and growing things like our CPOE utilization just to make sure that we’re going to continue to qualify for the next two years’ worth of payments.
Gamble: Hi, Neal, thanks so much for taking the time to speak with me today.
Ganguly: My pleasure.
Gamble: We have a lot of things we want to talk about but why don’t we get started with a quick overview of CentraState?
Ganguly: Sure. CentraState is a mid-sized community hospital. We’re at 282 beds. We offer a full range of acute care services and some specialty areas in oncology, cardiology and women’s health. We also have a full range of senior care services that are affiliated with the acute care hospital, including a skilled nursing facility, an assisted living facility, and a continuous care retirement community. Otherwise, we’re a stand-alone facility. We’re not part of a larger health system, and we’re in an area where we’re surrounded by multi-hospital systems. So we’re in a very competitive marketplace. We have been fortunate to be profitable; we have a good demographic and a good mix of physicians and a good staff here. So I think that we’re well-positioned to remain independent and to serve our community.
Gamble: And you have both employed and affiliated physicians as part of the system?
Ganguly: We have very few employed physicians today — under 20, but that number is growing. We have resisted employing physicians and instead are looking for more creative partnering opportunities where we may joint-venture partner with the physicians in different ways to avoid actually entering into a full staff model.
Gamble: Okay and I want to get into that more in a little bit, but as far as the clinical application environment in the hospital, you use Soarian, correct?
Ganguly: We, unfortunately, are a best-of-breed shop in a lot of ways. Siemens and Soarian are a key component of our clinical system infrastructure and that covers inpatient, nursing, physician order entry, results viewing, etc., and on the backend, we have the Siemens pharmacy module as well as medical records and other key modules. But we also have different products in our emergency department, OR, and our LDRP (labor and delivery) areas, so we’ve actually got quite a few other feeder systems that are part of the inpatient process, and then in the ambulatory side, of course, we have a wide range of products that are out there.
Gamble: As far as the affiliated physicians, how does that work in terms of integrating with them when they’re using different systems?
Ganguly: We’ve got a little over 500 physicians on staff, and as I said, somewhere between 15 and 20 are employed. The employed physicians are on the NextGen EMR platform and are integrated partially by virtue of our relationship between NextGen and Siemens, but we’ve also decided to support our community docs by putting an HIE platform in place. A year or so ago, we opted to go with the MobileMD product, which subsequently was acquired by Siemens, so that actually we hope will work out in our favor. But even before that acquisition, Mobile MD looked like a good partner to help us tie our community docs together and to the hospital.
Gamble: Is that the EMR-lite that they’re using?
Ganguly: Well they have an EMR-lite; we have actually deployed that. We’ve taken two models: for those physicians who have an EMR, we’ve gone ahead and built interfaces between MobileMD and the EMR and we’re pushing our lab results, transcribed reports, radiology, and those types of things into their EMR. For those doctors who don’t have an EMR, they can go through the portal to view that information and also to leverage some of the communication tools that are there. If they want to do referrals between physicians, they can do that kind of stuff through the portal.
Gamble: With the portal, is that something that’s more of a temporary solution or can it have some kind of a long-term sustainability?
Ganguly: I think it has long-term sustainability. If you look at the mix of physicians from sort of an aging of the population, we’ve got a number of doctors who are probably in the last ten years of practice. They’re somewhat reluctant to make major investments in technology, and the portal seems to be a pretty good solution for those folks. There is an EMR-lite component that Mobile MD has built. We haven’t rolled it out yet but we’re interested in doing that. That may help fill the gap or augment the portal, but for the younger doctors, most of them are making the investments in the EMR — those who have 10-plus years in practice, I’d say, have seen the writing on the wall and are really making the investment. But the question from our perspective is, can we help them capitalize on the investment and make it the right way — implement the system in the right way so that they’re not losing productivity dramatically and are getting some benefits from technology?
Gamble: Now as far as Meaningful Use, which is everybody’s favorite topic, I see that CentraState qualified late last year.
Ganguly: We actually attested on September 24, so just before the end of fiscal year 2011, and we’re pretty excited about that. We actually got our check in late November.
Gamble: So just in time for the end of the year.
Ganguly: Yeah, finance was about that.
Gamble: I’m sure. So what would you say was the biggest challenge in attesting to Stage 1?
Ganguly: I think it’s the detail — being able to understand where you’re getting your data to assemble your evidence of attestation; whether you have the right feeder systems. Because we’re in a best-of-breed kind of environment, we did utilize a Siemens tool called SQM which Siemens had certified as their reporting module, so we had to feel all the source systems into that to make sure we could generate the statistics and numbers necessary to attest, and that process was challenging.
Then on top of that, of course, understanding where we have gaps — where we’re not collecting information that we need to, how do we change some of the culture around that. There were some challenges there, but overall I would say we were fortunate, because we had put a strategic plan into place six years ago that had a big clinical focus, and so a lot of the infrastructure we needed had already been put in place. We weren’t starting from zero. So we were able to focus a lot more on process than we were on pure implementation.
Gamble: Okay, so it was a part of a larger strategy that you already had in place before all of this came down.
Ganguly: Yeah, that was just luck.
Gamble: Or good planning, maybe.
Ganguly: Well, yeah.
Gamble: So is Stage 2 on your radar now?
Ganguly: It is, and we’re hoping at HIMSS we’ll see the release of the rules, if I understand correctly, so we’re all kind of waiting with bated breath to really dive in and begin to understand what that’s going to look like. But right now, since Stage 2 has been delayed, we really can qualify for our first three payments under Stage 1. So we’re focusing on making sure we’re keeping our numbers consistent and growing things like our CPOE utilization just to make sure that we’re going to continue to qualify for the next two years’ worth of payments. And of course stage 2 is important to us, but we feel like we’ve got little time to get the numbers to that level.
Gamble: Right and that’s important — instead of jumping right to the next stage, to really focus on making sure everything’s in place the way you want it, and like you said, being able to qualify.
Ganguly: In the first year, we only had to show 90 days of compliance but in year two, we have to show a full year. So it’s incumbent upon us to make sure we’re tracking all of this and not going off the rails somewhere along the way.
Gamble: Okay, so one of the topics I really want to talk to you about is health information exchange, and I wanted to talk a little bit about the HIE picture in New Jersey. I know that it’s changed a bit recently. At one point, there were five funded HIEs, I believe, but now there are four, so I want to talk about that and whether CentraState has plans to connect with one of them, and what you’re seeing with that.
Ganguly: We actually are connected with one or we are a member of one—we haven’t gone through the actual technical process of connecting yet, but we’re a member of Jersey Health Connect, which is the largest HIO in the state. I understand that in New Jersey, we’ve decided to call the larger groups health information organizations, and as a result, we’re eager to get connected. I think our technical folks are working with the Jersey Health Connect folks as we speak to look at the first connection points over the next few weeks.
But yes, there are a number of funded HIEs in the state. I think there were four funded originally, and now that’s down to three. And then there were a couple of HIEs that are out there that weren’t publicly funded but had formed just as groups of hospitals getting together looking to leverage the HIE infrastructure. So I think we have, depending on how you look at it, somewhere between five and eight HIOs operating throughout the state.
Gamble: You were talking before about being at a disadvantage in that you’re a pretty much a stand-alone hospital in New Jersey, which, I know very well, is surrounded by large health systems. Is it something where being a part of an HIO just kind of helps a little bit with that as far as being stand-alone organization?
Ganguly: I don’t know. I don’t think it necessarily does. I look at participation in HIO primarily as a vehicle to make sure that our clinicians have as complete a picture of their patients as is reasonably possible. But in terms of advantage as compared to being a part of a multihospital system, I don’t know if that’s doing much for us there; at least not that I can see right now.
Gamble: It’s interesting that they call them health information organizations, is that something that’s pretty new?
Ganguly: In New Jersey — I don’t know how well it’s catching on in the rest of the country. I think the rationale was that health information exchange is an action; it’s a verb, and health information organization is more of an entity.
Gamble: Right.
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