Mike Rozmus, CIO, Rockingham Memorial Hospital, Chapter 1

The idea of being acquired by a health system — especially one as large as Sentara Health — can be daunting for a CIO. But Mike Rozmus viewed it as an opportunity to work closely with Sentara CIO Bert Reece and to try to emulate some of the success the 11-hospital organization has had in its advanced use of IT. In fact, since the merger last year, Rozmus has already incorporated one of Sentara’s best practices by leveraging physician advisory groups to get buy-in on projects. In this interview, Rozmus talks about other changes he has made since the acquisition, what he’s doing to bridge the inpatient and practice environments, the lessons he’s learned being a Meditech 5.6 beta site, and the challenges of dealing with a heavy workload.

Chapter 1

• About Rockingham
• Running a Meditech CS 5.65 shop
• Starting CPOE in the ED
• Keeping Picis (for now) in the OR
• The challenges of interfacing
• No 6.0

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Bold Statements

We realized that after we brought up Meditech in the rest of the organization that we had that disconnect between emergency department care and inpatient care because of being on two different systems. It was actually the ED physicians who came to myself and other members of administration and said, ‘We really need to get on a common platform.’

When the nurses on the floors in the med-surg setting started receiving the information from Meditech, they were probably the most pleased of all because for that patient that was being admitted to the unit, they had everything that they needed from the clinical documentation perspective.

As much as we’ve tried to interface systems, there’s always that one piece of critical information that doesn’t transfer. And when you start looking at allergies and problem lists and all of these data elements that aren’t necessarily strict HL7 results transfer, you really get into the nuances of where you need to have a common platform.

I don’t know if we will revisit that sometime in the near future to see if that integration capability with the Meditech application really outweighs our use of the current Picis tools. They’ve worked very well for us, so I think it’s one of those things where when we’re up to a major upgrade stage or we have a definite need for functionality that can only be achieved in a more tightly integrated system, that’s when we will make that decision.

Looking back I think we’d probably do it again, because one of the things that we were able to attain at that time was that common look and feel from the graphical user interface that the 5.6 application brought. And 6.0 brings that same user interface, but it provides some other functionality that can’t be delivered in the client server code set.

Guerra:  Good morning, Mike. Thanks for joining me talk about your work at Rockingham Memorial Hospital.

Rozmus:  Good morning, Anthony.

Guerra:  Can you tell us a little bit about the organization and give us an overview?

Rozmus:  Sure. We are a 238-bed community hospital. We’re located at Shenandoah Valley in the western part of Virginia. We see about 17,000 admissions per year. We have a fairly active emergency department; we’re treating about 72,000 patients per year. We built a new hospital that we moved into in June of 2010, and we also have a medical group that was formed in 2009. That medical group consists of about 65 employed physicians, both primary care and specialists, that serve around the seven-county market area for our hospital and our medical group. There are about a dozen locations that we have throughout that service area, most of them centralized in the Harrisonburg, Va. area.

Guerra:  And I see that you are a Meditech customer, is that correct?

Rozmus:  Correct.

Guerra:  And which version are you on?

Rozmus:  The version we are on is client server 5.65.

Guerra:  And that is the Meaningful Use version, correct?

Rozmus:  Yes, it is. We brought that version up last October.

Guerra:  So you are all set with that. Have you done CPOE yet?

Rozmus:  We are in the process. Actually in June, we were ready to bring up CPOE in our emergency department. We’re doing in a couple of different phases: the first phase is certainly the ED implementation, and then we’re going to work on the inpatient side of CPOE and we’re not planning on bringing that up until early 2013. Our Meaningful Use attestation will be in calendar year 2013.

Guerra:  So you are using Meditech in the ED?

Rozmus:  Correct.

Guerra:  How’s that looking? Do the physicians like the CPOE functionality in the ED?

Rozmus:  So far, so good. We have found that there is certainly a lot of workflow change that has to occur. Let me step back a little bit. When we implemented Meditech here, that was in 2007, and originally we did not implement the Meditech emergency department module. We were a long-term client of Picis, formerly the Ibex system, and we were using that in our emergency department quite successfully. The physicians liked it; they weren’t using it for orders, but they were using it for documentation, prescription writing, and communications. They were very pleased with that system.

And then we realized that after we brought up Meditech in the rest of the organization that we had that disconnect between emergency department care and inpatient care because of being on two different systems. It was actually the ED physicians who came to myself and other members of administration and said, ‘We really need to get on a common platform.’ They saw the value of integration working with the hospitalist group here, and realizing that the island of information that they had in the emergency department was great for emergency care. But when you’re looking at 60 percent of your inpatient admissions coming through the emergency room, it certainly elevates that need for integration and communication across those care settings. So they came to us and said, ‘we really want to look at this opportunity.’ And we did. We took that opportunity to implement Meditech EDM, which came up in 2009. And we’ve been on that product since 2009 working very successfully. Now we’re taking it to the next stage and bringing the CPOE functions with it.

Guerra:  It’s interesting that it came from the ED docs to get on one system because I would think it would be more likely for the inpatient physicians that are receiving those ED patients to want some information as opposed to the ED docs who are passing them off. But you said it came from the ED docs.

Rozmus:  Yes. They have a good working relationship with the inpatient physicians, and I think that they were realizing through their communications that there was really a gap. Certainly we had some limited communications between systems for ADT features, and we produced the report out of the Ibex system at the time and brought that into the EMR as a scanned document, but it really did not meet the need for that transition of care. In fact when the nurses on the floors in the med-surg setting started receiving the information from Meditech, they were probably the most pleased of all because for that patient that was being admitted to the unit, they had everything that they needed from the clinical documentation perspective that occurred in the emergency department — not just the physician’s notes and not just some of the lab results.

Guerra:  You mentioned they were doing documentation in the ED before putting in orders?

Rozmus:  Yes.

Guerra:  Because from what I hear, I think it’s usually the other way around, or I could be incorrect.

Rozmus:  Well, they were doing some documentation in Ibex — it wasn’t the full clinical documentation that you’re referring to. In fact, we haven’t achieved that stage yet; that’s another phase that we’re working toward because the emergency department module within Meditech uses the physician documentation — Meditech calls that PDOC functionality, which will be used for our progress notes and for our other clinical documentation summaries throughout the inpatient physicians.

Guerra:  Tell me if I’m reading too much into this, but your experience that you’re describing with attempting that interface — did that establish your opinion that this just doesn’t work from an interface point of view; that you need systems functioning off the same database?

Rozmus:  Yeah, it really did. As much as we’ve tried to interface systems, there’s always that one piece of critical information that doesn’t transfer. And when you start looking at allergies and problem lists and all of these data elements that aren’t necessarily strict HL7 results transfer, you really get into the nuances of where you need to have a common platform.

Guerra:  Right, and if you have both applications that are continually being upgraded and new fields coming in, then you have something that’s never, ever finished. The interfaces always have to be adjusted as the applications are adjusted. Does that make any sense?

Rozmus:  Yes, correct.

Guerra:  So it’s just not sustainable. From what you tell me it’s not sustainable, especially when you multiply that by five, 10, or 20 throughout the hospital and you have a whole bunch of ancillaries on all different best-of-breed platforms. It just doesn’t work.

Rozmus:  Correct, and some of them actually worked better than others. I mean, the emergency department was fairly instrumental here because of the interaction between the emergency department experience and the transfer to med-surg and critical care, whereas in some of the areas, it works a little bit better. And we also use Picis as our OR and PACU system. It works a little bit better there because it’s a more self-contained experience, but we still have the same kinds of challenges between that system and moving into the EMR of the Meditech world. But it’s not as acute because 85 or 90 percent of our surgeries are outpatient surgeries.

Guerra:  Is Meditech going to not supplant some of the ancillaries, maybe some that you just mentioned, or is it going to roll it out everywhere that they have a module?

Rozmus:  We have and we made our decisions for Picis back in 2004 prior to Meditech, and at that time, we looked at what are all the clinical ancillaries that would be included in our initial go-live. And one of the things that we decided at that point was that Meditech at the time didn’t have a really strong OR module, and we decided that Picis certainly was the better option for us at that time. I don’t know if we will revisit that sometime in the near future to see if that integration capability with the Meditech application really outweighs our use of the current Picis tools. They’ve worked very well for us, so I think it’s one of those things where when we’re up to a major upgrade stage or we have a definite need for functionality that can only be achieved in a more tightly integrated system, that’s when we will make that decision.

Guerra:  Did you look at 6.0 at all? Is that in your future?

Rozmus:  We did not. Interestingly enough, we were the US beta for 5.6 back in 2007, and it was a bit painful to go through that experience. And I think anybody who’s done it has to weigh all of the options and weigh all of the risks and benefits, and we certainly did that. I think at the time, we were all scratching our heads wondering why did we sign up for this because we had challenges — not just with the technology and the software being beta code, but also with all the process change and everything that we were doing in the organization that really was a major disruption in itself, and when you compound that with some new untested software, and it becomes a challenging project.

But looking back on it, I think we’d probably do it again, because one of the things that we were able to attain at that time was that common look and feel from the graphical user interface that the 5.6 application brought. And 6.0 brings that same user interface, but it provides some other functionality that can’t be delivered in the client server code set.

Guerra:  But you said it’s not in your future?

Rozmus:  Not right now. We are certainly focused on continuing the pathway. In fact, one of the things that we even discussed, albeit very briefly, when we were first making our decision to go with the 5.6 beta was they had yhis other thing that I don’t even think was called 6.0 at the time. It was even earlier in the stage, and Meditech actually proposed to us, ‘Do you want to consider this?’ And we said, ‘No, we’re certainly comfortable with going beta on the 5.6 version, but we’re not necessarily ready for that kind of experience.’

Guerra:  When it’s offered up to you as ‘this other thing,’ that’s a little bit too early in the process.

Rozmus:  I mean, it was a little bit more mature. Anybody who knows the Meditech technology realizes that there’s a combination of technologies. The 6.0 code set is primarily built around the advanced clinical modules, and your earlier code sets for Client Server that we’re using today still exist in many of the modules we’re using.

Chapter 2