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 2
- Using NextGen in the practices
- Keeping an eye on LSS
- Marrying the inpatient and physician practice worlds using NextGen HIE — “It gets us half way there”
- Satisfying specialists with primary care-focused EMRs
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At that point, Meditech and LSS were still a little bit disjointed in terms of their integration and development cycles, which concerned me in terms of moving forward. I think that they’re stepping more into the ambulatory world of late, and their acquisition of LSS really has improved that portfolio for them.
The decision that we made for the emergency department back in 2009 really showed the value of that integration. We still have two different platforms for the ambulatory and the inpatient side, but we’re trying to simulate, as much as we can, the integration that we get between the inpatient units being on a common platform.
The vision that I’ve laid out is that when physicians are in their office, they will see everything that they need to care for that patient without having to jump into other systems. And if I could bring most of that relevant data to them for that patient encounter, then they won’t see the need to do that.
When we built our new facility and we built our medical office building and populated it with specialists, we designed that building to be an EMR model practice. So we didn’t build it for a paper workflow; we built it for an electronic medical record.
If we were to do it in the normal method, we would bring up primary care first and then bring the specialists on later, but we did it in reverse. We’re now catching up to that and bringing our primary care physicians on, and I think they are getting the value of the data that was created in the database by the specialists.
Guerra: Just to refresh my memory on your physician practice environment, you said you own some practices?
Rozmus: Yes, we have about 65 employed physicians. That includes hospitalists, specialty physicians, and primary care.
Guerra: So approximately how many physician offices?
Rozmus: I believe we have about 17 locations. When we built our new facility, we also built a medical office building as part of that facility, and we moved the majority of our specialty practices into that building because it makes a lot more sense. There are closer interactions with the hospital; certainly the surgical groups and the specialist moved closer to the facility. We actually had them at various offices around town because one of the reasons we built a new hospital is that we ran out of real estate.
Guerra: And what are you doing in the practices as far as an EMR?
Rozmus: We’re using NextGen. And that decision came about in the latter part of 2008. We started implementation of NextGen on the practice management side in early 2009 and got them up and running, and in 2010 we brought up the EMR.
Guerra: Did you look at LSS as a product that may have had better integration?
Rozmus: We did, and at the time we had concerns that it wasn’t quite the product that we would need. Our physicians were heavily involved in the selection process, and when it came down to it, they liked the integration but they were more interested in some of the other aspects that some of the other vendors that we looked at brought to the table. And I believe at that point, Meditech and LSS were still a little bit disjointed in terms of their integration and development cycles, which concerned me in terms of moving forward. I think that they’re stepping more into the ambulatory world of late, and their acquisition of LSS really has improved that portfolio for them.
Guerra: So the world you’re looking at is going to be a Meditech-NextGen environment. What are you looking at in terms of integrating those two worlds?
Rozmus: We actually also purchased the NextGen HIE product. It was previously called the Community Health Solution; it’s now known as NextGen HIE, and we’re using that to really take unsolicited data feeds from the Meditech environment like lab results, documents, and imaging results into the HIE and distributing that back into the NextGen EMR. So we’re building that integration. Again, I really recognize that the decision that we made for the emergency department back in 2009 really showed the value of that integration. We still have two different platforms for the ambulatory and the inpatient side, but we’re trying to simulate, as much as we can, the integration that we get between the inpatient units being on a common platform.
Guerra: Is LSS something you keep an eye on and you say, ‘I wish we could get that in here’? I don’t even know if it would give you that common platform that you would ideally have. What are your thoughts on that?
Rozmus: Well, I think I need to keep an eye on Meditech’s future development of the ambulatory platform. I just read something recently — and I don’t know if it’s fact or fiction — that Meditech is actually revamping their ambulatory product set and coming out with something that is really new for them with Web services and some other tools built into it. So yeah, I will certainly keep an eye on where they’re going, but we’ve invested a lot of effort into the NextGen environment, and we’re still continuing to roll it out. Because we started after our medical group was formed for the most part and we’re still bringing on some practices in our medical group, we’re continuing to roll out the EMR into the rest of those practices.
Guerra: The HIE solution that you’re looking into — how close does that get you toward the world you wish you were in? Does it get you halfway there or a quarter of the way there?
Rozmus: It probably gets us halfway there. There is definitely value in the fully integrated solutions; what Epic brings to the table is an inpatient and outpatient experience for the clinician that doesn’t change. They see the same application in their offices as they see in the inpatient units. That’s one of the things where again, I can’t simulate all of that experience, but the vision that I’ve laid out is that when the physicians are in their office, they will see everything that they need to care for that patient without having to jump into other systems. And if I could bring most of that relevant data to them for that patient encounter, then they won’t see the need to do that. Now when they come into the hospital, they’ll be fluent in Meditech and be able to access what they need in the EMR there, but at the same time, in the office they’ll be concentrating on the NextGen experience.
Guerra: It’s certainly telling though that with all the expense that’s put into the NextGen platform and the training, and the docs may be comfortable on it, you’re still sitting there saying, ‘I wish I could just get them all on the same platform.’ It’s that painful or it’s that much of an advantage to be on the same platform in the two worlds.
Rozmus: Well, it depends on the perspective. I mean certainly physicians that are in the primary care practices on the outskirts of the service area have very little day-to-day work in the inpatient systems. So that would be more of an issue for the physicians that are working closer to the facility.
Guerra: For the specialists?
Rozmus: Yes.
Guerra: Okay, so let’s talk a little bit about the specialists. One of the issues we hear about is rolling out a primary care-focused ambulatory EMR to specialists or a physician practice EMR to specialists, and some of them push back and say, ‘We know there’s products out there that are tailored for our specialty. Why can’t we get one of those?’ Have you run into some of those conversations?
Rozmus: Yes, we have. We actually run into some of those conversations mostly around the content. Certainly in the NextGen world, they have the foundational product and then there is a knowledge-based manager, which is what they call it, which is the clinical content or the templates that overlay on top of that foundation. Some of the specialist content isn’t as fully developed as others and certainly not as fully developed as the primary care content. I think the origins of NextGen came from OB practices — that was one of the first targeted practices in which they implemented their EMR, and those templates would be more matured than vascular surgery, CT surgery, or some of those templates that our specialists might be struggling with today because that content has not yet matured.
Guerra: And interestingly, the independent specialists that are coming to your hospital to do their procedures on their parents are the customers that you need to take care of most in a certain sense. They’re bringing in the biggest revenue, they’ve got the biggest voice with your CEO and your Board, and these are the ones you wouldn’t give short shrift to, right?
Rozmus: Right. The other interesting thing about our implementation here is we kind of did it backwards, and it was not by plan — it was by necessity. When we built our new facility and we built our medical office building and populated it with specialists, we designed that medical office building to be an EMR model practice. So we didn’t build it for a paper workflow; we built it for an electronic medical record. Well at that part of our journey of rolling out EMR, we had to concentrate on the specialists. They didn’t have all the value of the information that would have been gathered at primary care and sent to them in a referral; they had to start the database from scratch essentially. If we were to do it in the normal method, we would bring up primary care first and then bring the specialists on later, but we did it in reverse. We’re now catching up to that and bringing our primary care physicians on, and I think they are getting the value of the data that was created in the database by the specialists.
Guerra: I’m sure the specialists are happy they’re doing them a big favor, right?
Rozmus: Right.
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