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.
- Working with Nuance on speech recognition
- One size doesn’t fit all
- Leveraging committees and task force
- Rockingham’s new life with Sentara Health
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We got a very good partner in that regard, and that really improved the physicians’ perception and certainly their experience with the clinical documentation system. And those reports got interfaced back into the Meditech EMR — they were timely, they were of high quality, and their experience really improved.
We wanted to make sure we didn’t force them into only one solution. So for fast-track care and for less complex cases, they will want to use Dragon and complete their documentation that way. For the times when the ED is really busy and they’ve got some complex cases, we said just pick up the phone and dictate.
We learned when we developed the templates around the speech recognition that we need to make sure we can accommodate all three of those workflows.
If we’re sitting down with internists and specialists that aren’t represented at the table, they might defer that particular concept and say, ‘We really need to talk to the obstetricians about this because they are more likely to order that particular procedure or to order that particular drug.’
They are very accomplished in their use of technology. So we’re trying to both emulate some of that success and also utilize some of their experience to our advantage to help roll this out in a very consistent manner.
Guerra: One of the things a lot of the CIOs are trying to do is the physician satisfiers, let’s call them, that make the EMRs a little easier to use. Some think about enabling a bring-your-own-device policy with handhelds, which we can talk about. But another thing is speech recognition, and I know you’ve done some work with Nuance. So tell me little bit about what you’d done with them.
Rozmus: We’ve done a couple of things with them; in fact, our relationship with them has grown over the last several years. Back in 2009, we had really a very dissatisfied physician customer when it came to transcription services, and in my role here, I also have health information management reporting to me, so I got certainly the dissatisfaction from the physician directly to me. And we looked at what we could do to improve their satisfaction. Certainly they were for quality of the output, they were looking for ease of documentation, and they were looking for the timeliness of the documentation.
So we looked at improving that situation, and our first foray into Nuance technology really was with eScription, which was a company that Nuance acquired, and their model is backend speech recognition. A lot of what we did with them initially was to bring up eScription as the platform for our clinical dictation. That improved as the voice models got learned by the technology and we actually outsourced the medical editing and transcription services. We got a very good partner in that regard, and that really improved the physicians’ perception and certainly their experience with the clinical documentation system. And those reports got interfaced back into the Meditech EMR — they were timely, they were of high quality, and their experience really improved.
When we started bringing up the EMR in the hospital, we reached out to the emergency department physicians again, who were very heavy users of transcription services, and said, ‘What we can do to balance the use of frontend and backend speech recognition technology opportunities?’ So that’s when we introduced Dragon Medical to them, also being a Nuance company and we were very, very successful with our emergency department physicians. They’re great group to work with and they’re really interested in applying the technologies. We have probably about 40 percent of all of our ED work today done on Dragon, and because we have such a busy emergency department, we wanted to make sure we didn’t force them into only one solution. So for fast-track care and for less complex cases, they will certainly want to use Dragon and complete their documentation that way. For the times when the emergency department is really busy and they’ve got some complex cases, we said just pick up the phone and dictate. You’ll go into eScription mode and actually be transferred back into the document. So the physicians usually use both technologies, depending on their needs.
Guerra: Right. How did they receive the frontend? I can’t imagine they were jumping up and down saying, ‘Hey we get to correct your own dictation — fantastic!’
Rozmus: Well it’s interesting because we piloted it first. We certainly didn’t just put on their desktops and said, ‘Go ahead and use it.’ We took three physicians that were interested in the technology. We took one who has the latest gadgets from Apple — there’s always going to be one like that. We had another who really was not one of the technologically advanced physicians in the group. We brought him along, and we brought in our CMIO, who actually happens to be a practicing ED physician. So the three of them went through a pilot, and we said, let’s do an evaluation of the accuracy of the record, the ability to use the technology, and the timeliness of getting that report back into the record, and let’s talk to the physicians who are going to be seeing that document later on and seeing how they react to it. So we did all of that and we were very, very pleased with 1) the acceptance, 2) the quality, and 3) the ability to incorporate it into their workflows.
But the interesting thing about it was we have three physicians and all three of them have different workflows. So it’s interesting; once you get into that type of analysis, you find that, for example, one physician would do a lot of his documentation after he saw a group of patients. So he would come back to the computer, bring up the information, bring up Dragon, and start his dictation on the patients. And at that time, the lab results would be back and some of the imaging results would be back — he would be able to provide that full picture documentation. One of the other physicians would document as he went. He would go and see a patient, he would come back out, and he would complete that documentation, file it, sign it, and move on to the next patient. And then our third physician would do a combination or a hybrid of the two. He would start documentation and have similar patients in various stages of complete documentation, and he would finish them up as the rest of the information came in. So you have to accommodate all three of those, and we learned when we developed the templates around the speech recognition that we need to make sure we can accommodate all three of those workflows.
Guerra: So that would takeaway advice for some of your colleagues?
Rozmus: Yes, definitely look at the workflows of the individual physicians and don’t just assume that they all practice the same way, because they don’t.
Guerra: When I was doing some research for our interview, a couple of times I came across the concept that you created a committee or a task force. I don’t think that’s extremely unusual; it’s probably very common, but maybe you have some best practices around that after doing it a few times over the years. Because with these kinds of things, you can either have too many people on them and they become unwieldy or you can have too few and people feel left out, so give us your thoughts around that.
Rozmus: We have two groups right now that are actively working on our CPOE; our clinical transformation. Really it’s all embodied into our product we call eHealth, and there are several groups working on different aspects of that. We have a physician information technology advisory council which, in fact, just met this morning, and they’re at a higher level. They’re being presented to be able to provide feedback on some of the higher order issues. We’ll talk about things like here is what our progress is with our ambulatory roll out; here’s what our progress is with our CPOE and eHealth initiatives; and here are some of the issues that we’re tackling around critical communications and alerting. We bring some of those to that group.
Some of the real work, though, is happening in we call the PAGS — physician advisory groups. We have one for the emergency department and we have one that is looking at the development of order sets and physician-driven options in the Meditech system as we go forward and build that out.
Both of those groups are smaller groups. Our ED physician advisory group has been meeting weekly for the last month or so to get those final issues ironed out that need to go into the final build for the ED rollout of CPOM. But at the same time, those groups are also bringing forth the voice of the other physicians that aren’t in the room. For example, if we’re sitting down with some internists and specialists that aren’t represented at the table, they might defer that particular concept and say, ‘We really need to talk to the obstetricians about this because they are more likely to order that particular procedure or to order that particular drug.’ So we’re talking about how to set up drug strings and how to present the data in the CPOE module. Some of those decisions are being made at the table with the physician as it’s being built instead of as a final product.
So those are certainly some best practices. We didn’t come up with that; we actually are using some of the best practices both in the industry and of our corporate parent. One of the things we didn’t discuss yet in this conversation is we’re now part of Sentara Healthcare — RMH merged with Sentara a year ago in May. And at the same time, we are trying to take the experiences; as you know, they are very well accomplished. Bert Reese, CIO of Sentara, has really led the eCare effort there for the last several years and they are very accomplished in their use of technology. So we’re trying to both emulate some of that success and also utilize some of their experience to our advantage to help roll this out in a very consistent manner.
Guerra: They’re an Epic shop, correct?
Rozmus: They are.
Guerra: How has your relationship been with Bert? How close have you guys been working together?
Rozmus: We’re working very closely with Bert. His team has really embraced the fact that we’re pretty far along in getting close to Meaningful Use stage 1 and we’re pretty far along in our EMR adoption model maturity, and they want to help us out as much as we can to move that forward.
Guerra: And has there been any thought in further distributing their Epic product into your organization?
Rozmus: We’ve had some of those discussions and certainly that’s a longer term decision for us. I think if we were at the stage coming into this relationship where we really needed some help to move our clinical IT forward, we probably would have wanted to accelerate that process. But we already had a plan and a strategy to achieve Meaningful Use and also to continue to mature our EMR technology here, and there’s the fact that we have pretty good platforms. NextGen and Meditech are decent platforms and can perform very well for a hospital our size.