When it comes to running a 23-hospital health system, Michael Warden believes too many decision-makers can spoil the broth. So when his organization merged with another to form Banner Health, Warden was fully on board with the goal of implementing a centralized governance model. However, he knew that this meant getting separate departments to communicate more effectively, and finding a way to combine budgets. In this interview, he talks about what it was like to walk into a merger, why it’s critical for CIOs to take control of the budget, the system Banner has for evaluating new ideas, how the organization is working to facilitate data exchange with physicians, and his clinical application strategy.
Chapter 3
- HIMSS Analytics Stage 7 at 21 of 23 Banner hospitals
- Banners clinical app environment — Cerner inpatient, NextGen in the clinics and practices
- “It’s the horse we’re riding”
- Exchanging data with both employed and non-employed docs (Report2Web)
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At any of our 22 hospitals, that lab test is accessible to you immediately. We’re all on one common patient number across the organization. So anywhere you go, any electronic medical record we have on you is accessible at any location.
We’re sharing data in both directions and have access to data in both directions. We’re not finished with that and I’d say today the data is only moderately complete, but we’re moving hard in that direction.
Today our standard is NextGen, so we’re deploying it and deploying interfaces and exchanges of data as rapidly as we can. It’s the horse we’re riding today; it’s the car we’re driving. But we do realize that at some point, a truly fully integrated application would be nirvana, and so you want to keep your eye open.
We’re looking at not only how to integrate our own systems, but also what are we going to do for physicians that are not Banner employed physicians and are not running our EMRs — how can we engage them as well and share data between them and all the rest of the Banner physicians. We have lots and lots of pieces that we’re trying to put together right now.
We’re not printing anything. We’re not sending things across. You have access to the reports as quickly as they’re available. You can look at your portion of the report, or we can show you the whole report if that’s more appropriate. You don’t have to print it because it’s in an archive in which you can continue to find it in the future.
Guerra: I want to switch gears a little bit and talk about your clinical application environment. I did some research and I found some different things pop up — Cerner, NextGen, and Allscripts. Also, I want to congratulate you on achieving Stage 7 at a number of your 23 hospitals. So things are working, even if you have a best-of-suite environment. Take me through your application environment — what direction you’re going in, and whether or not you’re a candidate for one of those big enterprise buy announcements where you sweep everything away and just put in one vendor. Take me through that.
Warden: Well, I want to be a little careful in this area because some of the information you’re asking about is at least slightly proprietary, perhaps. Today we have 21 of our hospitals qualified at HIMSS Stage 7. I don’t think they published the last couple of them yet, but they’ve all been accepted as Stage 7. There are only two that haven’t. One is a behavioral hospital, and they never did certify any behavioral hospitals, but since they were running the same suite as everybody else, we believe they’re going to certify our behavioral hospital. And then lastly is our hospital in Fairbanks, Alaska, which is kind of the one unusual hospital in our chain. That’s a hospital that we just have a management agreement with, and they retain a fair amount of autonomy in terms of their clinical systems. So we work very closely together, but we’re not in lockstep like we are in all the other 22 hospitals.
What we do is, basically, in our inpatient systems, we run a very broad suite of Cerner applications. We run those applications in one data center on one computer, one database. In the Cerner lab system — and we only run one instance of the Cerner lab system, if you’ve ever been a patient at Banner beginning back in 1999 (I think it was Samaritan), and had a lab test done, that lab test is in our database. And at any of our 22 hospitals that you go to, that lab test is accessible to you immediately. We’re all on one common patient number across the organization. So anywhere you go, any medical record that we have, any electronic medical record we have on you is accessible at any location if that makes sense to you.
Now from an ambulatory side, we would have selected the Cerner Ambulatory system some years ago, but we couldn’t because their ambulatory system was not ready for prime time. So we looked and the best we could find at the time was NextGen, and we started putting NextGen in what were just a few clinics that we associated with at that time. Over the years, those few clinics have grown to probably 650 to 750 doctors in 150 or so clinic locations, and we continue to deploy NextGen. Only recently has Cerner fielded an ambulatory product that is worth looking at, and we of course are going to look at it. But as of today, we’re still deploying our NextGen product. The NextGen product is also run on one computer in our single large data center here across all of our 150 clinic locations and 600 to 800 doctors. So again there, any patient in that NextGen database is accessible by any other physician in any other of our clinics.
Guerra: Are you moving information between NextGen and Cerner?
Warden: We are, more and more. We’re sharing data in both directions and have access to data in both directions. We’re not finished with that and I’d say today the data is only moderately complete, but we’re moving hard in that direction.
Guerra: You say you’re ‘moving hard.’ You never want to go down a path too far if you’re going to switch courses. You don’t want to throw money away, so to speak, so how do you decide how much to work on at NextGen-Cerner integration as you keep one eye on the Cerner Ambulatory product.
Warden: Today our standard is NextGen, so we’re deploying it and deploying interfaces and exchanges of data as rapidly as we can. It’s the horse we’re riding today; it’s the car we’re driving. But we do realize that at some point, a truly fully integrated application would be nirvana, and so you want to keep your eye open to say, is there a time when we would make that decision and make a change. But in the meantime, we’re trying to deliver the very best patient care at the very best cost we can and so we’re going to make investments in what we’re running.
Guerra: Are you doing something with Allscripts for discharge?
Warden: We’re involved in a pioneer ACO project. What we’re doing is we’re looking across Banner to try to move the whole corporation in the direction of accountable care and team medicine. We’re looking at not only how to integrate our own systems, but also what are we going to do for physicians that are not Banner employed physicians and are not running our EMRs — how can we engage them as well and share data between them and all the rest of the Banner physicians. We have lots and lots of pieces that we’re trying to put together right now.
Today we’ve acquired what’s referred to as the Aetna stack of applications, and we’re using that for data analysis and data sharing with non-Banner employed physicians. And then of course we’re using our existing systems and our large Banner data warehouse for Banner-employed physicians.
Guerra: And one of those tools is called Report2Web — is that something you’re using?
Warden: It is.
Guerra: Can you tell me a little bit about how you’re using that for physician integration or what that stands for?
Warden: Report2Web was a system that was acquired some time ago to try to figure out how to push data out to physicians. So physicians ordered things and if we needed to send them reports or any kind of information, the tools we were using at that time were pretty primitive. It turned out that a really smart guy on our staff named Bill Beaver, came up with this. He stumbled across Report2Web, and we use it now for a lot of things. We use it to distribute reports of all kinds, not only to our physicians but to employees throughout the organization because it’s just a way to take what would have been a printed report and literally chop it into pieces — isolate those pieces from different employees and then send you an email and tell you your report is ready and you can go online and view it.
So we’re not printing anything. We’re not sending things across. You have access to the reports as quickly as they’re available. You can look at your portion of the report, or we can show you the whole report if that’s more appropriate. You don’t have to print it because it’s in an archive in which you can continue to find it in the future. So if two years from now you want to go back and look at your budget reports, they’ll be there just as they are today. It’s just a very efficient way for us to distribute processed content effectively. It’s turned out to be quite a valuable product for us.
Chapter 4 Coming Soon…
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