There is perhaps no better way to learn the importance of disaster planning and recovery than having to spend 11 straight days in a hospital in the wake of a hurricane. For Sonya Christian, who was then CIO at Slidell Memorial Hospital, living through the experience of Katrina taught her how to be a leader. Now CIO at West Georgia Health, Christian is applying the lessons she learned during that stressful time and ensuring that disaster planning is a top priority. In this interview, she talks about her experience with Katrina, what it was like to take on a CIO position during a major Meditech implementation, her concerns about the proposed Stage 2 rules, and the one piece of advice she has for MU attestation. She also discusses the benefits of earning a CHCIO certification and why all CIOs need to give back to the profession.
Chapter 1
- About West Georgia Health
- Being a Meditech 6.0 beta site
- Offering Allscripts Professional to independent docs
- “Lunch-and-lunch” sessions for physicians
- Lessons learned from attesting to MU
- “Pulling our quality measures was one of the most difficult things”
- Assembling an MU task team
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Bold Statements
Being able to work with their beta product at their first non-Meditech hospital to go live with the product was just exciting to me. The other thing was the team here at West Georgia. They were excited, they were enthusiastic, they had strong board and administrative support for the project, and I felt like I was sitting in the catbird seat, so to speak, when I came here.
What I’m finding with Allscripts Professional is that there’s not a long ramp-up time to meeting your Meaningful Use requirements. It’s built into the application, and if they follow the workflow with that, they could meet the metrics fairly easily.
Our project manager for the Allscripts project, who is also working with Meaningful Use for our physician offices, audits their use on a regular basis, and so she can bring their specific pain points to them and sit down and talk with them about how to overcome these.
If I was going to share one point with anyone about preparing for Meaningful Use, I would tell them to start with quality reporting first. We didn’t; we grabbed some of the low-hanging fruit, and pulling in our quality measures was probably one of the most difficult things.
Our hospital already tracks stroke and VTE measures, but they used the paper abstracting method that is used by CMS for accounting for these quality measures. With Meaningful Use, you had to have those measures inside the electronic patient record, and so putting in contraindications and things like that were a little bit challenging in that environment.
Gamble: Hi Sonya, thanks so much for taking the time to speak with us today about your organization.
Christian: Thank you, Kate. I’m pleased to talk with you.
Gamble: Why don’t you start out by giving us some information about West Georgia Health — number of beds in the hospital, and what you have in the way of ambulatory care and clinics, things like that.
Christian: West Georgia health is located about one hour southwest of Atlanta. We have 276 licensed patient acute care beds and we have nine employed physicians in our organization. We also have 250 long-term care beds.
Gamble: Okay. Do you have clinics that are affiliated with the health system?
Christian: The employed physicians have family practice and other multi-specialty clinics and we have also have about 80 independent physicians that are affiliated with our organization.
Gamble: And you said you’re about an hour from Atlanta. Are you in a rural area or a suburban area?
Christian: I would say it’s probably a suburban area. We are the only hospital within a 40-mile radius of our location, but certainly we do have some rural areas included with that. We cover a three-county area of Troup, Heard, and Harris counties in Georgia.
Gamble: Okay. Let’s talk a little bit about the clinical application environment in the hospital. You’re using Meditech, correct? And if so, what version of that are you on?
Christian: We are using Meditech 6.0. We were one of the first two hospitals to live with Meditech 6.0 back in January of 2008. We were one of their beta sites and I’m going to be honest — it was a very interesting journey. The application obviously wasn’t fully completed at the time that we went live with it. But we’re four and a half years into it, and we’re very happy with our success with it.
Gamble: When did you come on board as CIO?
Christian: I came on board in July of 2008.
Gamble: So you came on board in the midst of this?
Christian: I did. They had gone live with their first 15 modules on January 1 of 2008, and since then we have been adding our advanced clinicals. Since I’ve come on board, we’ve added nursing documentation, we’ve added the emergency department application, we’ve added OR management, and we’ve added CPOE, our computerized provider entry. We’ve done a lot of work with the patient problem lists and we’re getting ready to go live with bedside medication verification later this year.
Gamble: So when you were in the process of interviewing for the job, you were aware that you were going into something where West Georgia Health was a beta site. Did you have an idea of what that would entail and what you were getting into?
Christian: I did, and actually, I found it to be a very exciting challenge. Meditech has had their foot in the door of about 2,500 hospitals across the United States over quite a few years, and being able to work with their beta product at their first non-Meditech hospital to go live with the product was just exciting to me. The other thing was the team here at West Georgia. They were excited, they were enthusiastic, they had strong board and administrative support for the project, and I felt like I was sitting in the catbird seat, so to speak, when I came here.
Gamble: I’m sure that played a huge role — knowing that you do have that support right from the get-go.
Christian: Absolutely, and the capital was fully funded from the very beginning. There was a $12 million commitment for our community hospital to pursue the EHR, and this is even before Meaningful Use had even made a wave in the media at that time.
Gamble: Before the storm hit, right?
Christian: Before the storm hit. I was so thankful that we had actually started our journey at the time that we had.
Gamble: Definitely. I think there are a lot of organizations that wish they had gotten that foot in the door sooner. So as far as the physician practices that refer into the hospital — are they using Meditech or are they using different systems?
Christian: Our physicians that belong to our physician service organization, which is West Georgia Health Physicians Inc., are using Allscripts Professional. We chose Allscripts Professional as our partner based on a fairly wide vendor selection process. We felt like that product met our needs as an organization, and not only do we provide this to our employed physicians, but we also offer it as software-as-a-service to any of the independent physicians who wish to use the application. We have one physician — a pediatrician — right now who is using our services, and we have several others in the pipeline for that.
Gamble: And for the docs who are using Allscripts, was there resistance at all to it or are they pretty amenable to using that particular system?
Christian: They’ve been very amenable. When we went through our vendor selection process, our selection committee was comprised of four physicians as well as some of our hospital staff. They did site visits when we got our short list of vendors in place, and so Allscripts was the unanimous choice of that physician selection team.
Gamble: And what kind of adoption rates have you seen so far?
Christian: We’ve actually had quite a few good experiences with this. Our primary care and family practice physicians are using clinical summaries very effectively. The physicians are using the physician documentation segments of Allscripts; some are using voice recognition with it.
One thing that I would also share with you is that their medication orders are all being placed through this. What I’m finding with Allscripts Professional is that there’s not a long ramp-up time to meeting your Meaningful Use requirements. It’s built into the application, and if they follow the workflow with that — and there’s some adaptability to their specific specialty — they could meet the metrics fairly easily.
Gamble: Okay. You said that there was a process, but once that was chosen, is there a group of physician champions or something along those lines just to help deal with issues they might be having?
Christian: Because our group is small — we have nine employed physicians — we have about three that really take a leadership role. So we have a monthly physician lunch-and-learn for Allscripts physicians. We invite them in for lunch and we talk about specific issues that they may be having. Our project manager for the Allscripts project, who is also working with Meaningful Use for our physician offices, audits their use on a regular basis, and so she can bring their specific pain points to them and sit down and talk with them about how to overcome these. So far it’s been very well received by our physicians.
Gamble: I would imagine that knowing that they can address any problem like that makes a big difference and gives them peace of mind.
Christian: Right, and while this project manager works as an extension of my department, she’s wholly dedicated to those physician offices. She does not split her duties with other hospital-based applications at this point.
Gamble: Okay. So we talked a little bit about Meaningful Use on the physicians’ side. As far as on the hospital side, how are you positioned? Have you attested to Stage 1?
Christian: We attested to Stage 1 for the Medicaid program in fiscal year 2011. We will be attesting for Medicare in 2012. As of yesterday, we were meeting 91 percent of the Meaningful Use criteria; we have three issues that we‘ve got to square away, but I expect them to be completed in the next 30 to 45 days, so we’re kind of excited.
Gamble: You’re on track, that’s a good thing. It’s so different no matter who you speak to. We speak people in different states and there a lot of issues involved but it’s got to be a good feeling to be ahead of the game.
Christian: It is. And if I was going to share one point with anyone about preparing for Meaningful Use, I would tell them to start with quality reporting first. We didn’t; we grabbed some of the low-hanging fruit, and pulling in our quality measures was probably one of the most difficult things. I can say that as of today, all of our quality measures are accounted for, but it was a difficult battle because of the workflow changes that were necessary inside the hospital to support those initiatives.
Gamble: Were there certain changes you had to make to try to work through that?
Christian: I would say that the stroke and the VTE protocols were the most difficult for us. Our hospital already tracks stroke and VTE measures, but they used the paper abstracting method that is used by CMS for accounting for these quality measures. With Meaningful Use, you had to have those measures inside the electronic patient record, and so putting in contraindications and things like that were a little bit challenging in that environment. We tried as much as possible to match them to our existing protocols for stroke and VTE, but they were some new things that came with some of the Meaningful Use criteria that we had to work in.
Gamble: Did you have, if maybe not a committee, then a specific person or a group of people who were the point people for this? How did that work?
Christian: We actually have what we call a Meaningful Use Task Team that we work with. Some of the members are our chief operating officer, our chief nursing officer, and myself. We have representation from nursing leadership — one of our nurse directors is on that committee. We have our decision support manager on that committee, and just several other folks who are very active in working with our EHR. We built our metrics based off of the regulations. We’ve kept a score card for the last year and a half building up to this attestation period, and it’s been good to have the support of a larger group.
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