Talk about hitting the ground running. When Lee Powe started as CIO at Hugh Chatham Memorial Hospital, he had just five days to familiarize himself with his new surroundings before kicking off a major system installation. Fortunately, it was the same ED system he had implemented at his previous organization. But still, it gave him a taste of how much work needed to be done — and how different it would be to lead a smaller organization. In this interview, Powe talks about the risks and benefits of using cutting-edge technology, Hugh Chatham’s approach to data exchange, the importance of having a true open-door policy, why it’s impossible to keep everyone happy, and what keeps him up at night.
- About Hugh Chatham
- CPSI at the core, Medhost in the ED
- Skipping the warm-up & jumping right into the CIO role
- Patch Tuesdays — “We’re constantly fixing something.”
- Weighing privacy and sanitation issues with palm vein scanning
- Iris biometrics — “I liked the cutting-edge technology”
- Attesting to MU
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We install patches probably about every week to two weeks, so we’re constantly fixing something with a patch. It’s kind of like Patch Tuesday with Microsoft.
I had an opportunity to use some of the iris biometrics when I was in the military. I knew the technology was proven. I knew it worked, but it was really difficult for me. I liked the cutting-edge technology, but sometimes when you reach out a little too far, it hurts. So it took them a little while to convince me to take it for a test ride.
Once it properly identifies you when you go through your verification process, it will actually log in to CPSI, pull up the patient’s medical record, and create the next account number. So it’s helping us reduce duplicate medical records. It’s helping us to be a little more efficient and faster.
Think about the technology that we’re bringing in here. It does get a little scary, but our board of directors has been tremendous about embracing the technology that we brought in here. They get it. They know what we’re doing. It’s for patient care, and it’s the right thing to do.
Positive identification of a person? Healthcare needs to be there. This is our step toward that to make sure we have the right person at the right time being given the right medication so that we don’t cause any harm.
Gamble: Hi Lee. Thanks so much for taking the time to speak with us today.
Powe: Thank you.
Gamble: To start off, why don’t you give our listeners and readers a little bit of information about your organization — what you have in terms of bed size and where you’re located, things like that.
Powe: Hugh Chatham Memorial Hospital is a small hospital located in Elkin, North Carolina. We’re about 20 to 25 miles from the Virginia state line on Highway 77, and about 77 miles north of Charlotte on 77. We’re an 81-bed acute care hospital. We have a nursing center with Alzheimer’s unit of approximately 107 to 110 beds. We have a retirement community, a home health agency, and approximately 10 physician practices covering everything from internal medicine to orthopedics to urology. The area is laid out pretty much in a campus style, so it’s over quite a few acres. Our home health agency is actually in another county so we’re kind of spread out and cover a tri-county region, because three counties come together right about where we are.
Gamble: As far as the physician practices, are those physicians employed by Hugh Chatham?
Powe: Yes, they are. Hugh Chatham has partnered and went out and employed several of the practices and by doing so, it pretty much brings them into the hospital realm. We do have some physicians that stay in practice on their own. So they have their own practices and they practice at the facility also.
Gamble: Is it a fairly rural area where you are?
Powe: Yes. Our closest trauma center is about 45 miles to our east in Winston-Salem.
Gamble: Alright. Tell me a little bit about the clinical application environment in the hospital. What type of inpatient system you have?
Powe: In the hospital, we have actually several systems which make up the care in our organization. Our primary core system is CPSI, which is used for our inpatient status — for physician order entry, the document repository, clinical repository, and registration, so it handles the majority of the core components. Medhost is actually one of our products in our emergency department so folks are coming in through the emergency department, which makes up probably about 60 percent of our patients. They go through our Medhost system, and then they will transition into the CPSI system.
Gamble: How long have you had CPSI in there?
Powe: CPSI has been here probably since 1989. It goes quite a ways back, so I would say yeah, it’s been here for a little bit.
Gamble: I imagine Medhost is a newer project.
Powe: Correct. Medhost was actually installed five days after I arrived here. That was in 2006.
Gamble: That’s an interesting way to start a new role.
Powe: The good part was that I was in a 400-bed facility in Texas, and after being there for several years, we actually installed a Medhost there. It was under me so I had the opportunity to install it there. So when I was going through the process of getting hired here, they said we’re installing Medhost, and I was like, oh okay. Five days later they installed it. It was fortunate I had enough experience working with them and knew all the people, and so it was a very smooth installation.
Gamble: It’s got to be helpful when it’s something you just did. I’m thinking maybe you had something like lessons learned or takeaways, things like that.
Powe: Oh yeah. You always learn when you’re installing new stuff — ways to do it better at other places.
Gamble: With the CPSI system, is it something where you’re doing upgrades every so often?
Powe: CPSI actually does approximately one significant version upgrade a year, maybe a year and a half or so. But we install patches probably about every week to two weeks, so we’re constantly fixing something with a patch. It’s kind of like Patch Tuesday with Microsoft. CPSI has something very similar for their system.
Gamble: One of the initiatives I wanted to talk to you about was the biometrics. This is pretty interesting because I had read that Hugh Chatham was originally looking into palm vein biometrics but instead chose to go with iris biometrics. Can you tell me a little bit about that project and what was required to roll this out?
Powe: Actually, to give you a little bit of that history, two or three years ago, we started looking at getting rid of the paper at the front of the hospital. When you first walk in the door, you sign your name on a log that says that you are the next person in line and the person after you looks and sees who’s in front of him, so it kind of became a privacy issue. We engaged one of our companies to help us eliminate that. We put in place a Topaz signature pad with a piece of software on the backend, so after clicking on it, you print your name on it and your name shows up on a work list for the registration clerk. That got rid of the paper for our red flag rules.
We actually implemented the palm scanning. We had it up and running for about a year or two. It was a real challenging process for the registration clerks to do it. It worked, but there were some issues. First of all, you had to lay your hand on it. People usually don’t come to the hospital because they’re healthy; they come here for a procedure or because they’re sick and so touching anything without washing your hands wasn’t ideal. And you had to clean the device.
We were speaking with M2Sys about coming in, and actually, it was a little bit of a challenge for them to convince me that this is the way to go. I’m actually retired from the military so I had an opportunity to use some of the iris biometrics when I was in the military. I knew the technology was proven. I knew it worked, but it was really difficult for me. I liked the cutting-edge technology, but sometimes when you reach out a little too far, it hurts. So it took them a little while to convince me to take it for a test ride.
When we had previously done the palm scanning, we did a lot of education and a lot of documentation to make sure everybody knew that it wasn’t going to be one of those biblical things and scare everybody to death where we had all kinds of information on you and all that stuff. We had done such a good job with that education that we didn’t put out any information on the iris scanning. We implemented it as a pilot test project at the front of our hospital where we have our outpatient ambulatory center, and people accepted it immediately. As a matter of fact, some of them said, ‘While I’m here, can you take a picture of my child?’
The fact that they connected it really quickly — what I’m doing is properly identifying you, taking your picture, associating it to your medical record and it’s just going to be safer for you, and especially for me in identifying you. It’s a one-to-one match; the iris is closer than the palm and you don’t have to touch it. So I removed the infection control problems. I’ve got an actual picture of the patient, and I’m properly identifying them.
Now, what the company did for us was they allowed it so that once it properly identifies you when you go through your verification process, it will actually log in to CPSI, pull up the patient’s medical record, and create the next account number. So it’s helping us reduce duplicate medical records. It’s helping us to be a little more efficient and faster.
Gamble: That’s interesting, and the fact that you had already, through the palm vein scanning, dealt with patient concerns about having their information. I imagine that kind of got a big piece of it out of the way, because it is something people are still pretty hesitant about, as we’ve seen.
Powe: When you’re in a small community — we have 5,000 people in Elkin and 5,000 in Jonesville, so it’s a small community around here — think about the technology that we’re bringing in here. It does get a little scary, but our board of directors has been tremendous about embracing the technology that we brought in here. They get it. They know what we’re doing. It’s for patient care, and it’s the right thing to do.
Gamble: Pretty interesting. When you first talk about iris biometrics it makes me think of the Mission Impossible movies. It’s funny to think that these technologies have evolved so quickly into the mainstream.
Powe: It’s interesting. There were a couple of television stations that came out and did an interview with us about it. We had a conversation and we talked about minority report technology where you walk into a store and it scans your iris and starts showing you all the stuff that maybe your spouse likes or wants and they actually did that, which was kind of interesting, but positive identification of a person? Healthcare needs to be there. This is our step toward that to make sure we have the right person at the right time being given the right medication so that we don’t cause any harm.
Gamble: Just looking at some of the other priorities you have, where do you stand as far as Meaningful Use? Did you attest to stage 1 at this point?
Powe: We attested two years ago to stage 1, and received our money. We’ve attested to stage 1 year 2, and received our money. We’ve attested to Medicaid for Meaningful Use and received the money. We’ve attested in the majority of our practices and our physicians have all received their money, so we’ve done a pretty excellent job about getting technology in places so that we can achieve Meaningful Use. We’re doing well there.