Jake Dorst, CIO, Meritus Health, Chapter 1

When Jake Dorst started as CIO at Meritus Health in late 2011, he came in with a pocketful of ideas. But he was soon hit with a reality check — a three-year wait for the Meditech upgrade that would hinder the process of attesting to stage 2. That simply wouldn’t do, so he and his team implemented a system that would help integrate ED and inpatient records. In this interview, Dorst talks about his ACO plans, his mobile device strategy, his motto when it comes to vendor management, and why job descriptions are never set in stone. He also discusses hiring a PR pro to help physicians ease into the electronic world, how he hopes completing his MBA will make him a better CIO, and how Meritus has benefited from employing a professional negotiator.

Chapter 1

• About Meritus
• Meditech in inpatient, Allscripts in outpatient
• Data sharing with CRISP
• Using Empower to create a unified patient record
• “One goal at a time”
• Physician advisory meetings
• Piloting PatientTouch in a small department — “We could control it better.”

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We’re hoping in the future as we pursue population health and ACO accreditation that we’ll be able to reach out a little bit more to those non-employed docs and do some data sharing with them.

We were on the long list, not the short list, and so we had to figure something out in the meantime. We’re hoping this is a good solution for us to train the doctors quickly on it, get it up and running, stand it up, and get CPOE inside the hospital and have a good percentage of physicians use it.

We still would have been faced with the discrepancy between what we were doing in the ED and the physician notes coming through on the PDoc side, because our physician groups in the ED really had a problem using that. So we tried to get a solution that would make everyone happy.

They were using it on Bluetooth, and it was a little sketchy with the laptops. So if they would get too far away from the laptop, it would lose signal. That was one of the drawbacks of the system — it wasn’t really mobile because you had to be in close proximity.

If there were problems — which there were a few that we ironed out — we were able to correct those. We wanted to see what types of workflow and patient flow situations would arise in a small controlled environment before we went whole-house with it.

Gamble:  Hi Jake, thanks so much for taking the time to speak with us today.

Dorst:  Hi Kate. Thank you for having me.

Gamble:  Why don’t we start by getting a little bit of background information about Meritus?

Dorst:  Meritus is a 272-bed hospital in Hagerstown, Maryland. We’re a not-for-profit. We see about 17,000 inpatient admissions per year, and we see about 75,000 folks through our ED every year. We also have a large employed physician outpatient service with about 90 docs, and we see about 200,000 outpatient visits a year. We also have home health, urgent care facilities, a medical lab, a surgery center, and pharmacies. We have several durable medical equipment storefronts and we’re partnered with diagnostic imaging services here in Hagerstown.

Gamble:  Is most of your patient base in Maryland, or do you stretch out a little bit further?

Dorst:  We stretch out a little bit. Our main base is Washington County where we’re located. We see about 83 percent of those patients from the county on the inpatient side. But we do get a little bit from West Virginia, Virginia, and Pennsylvania.

Gamble:  What about the clinical application environment? Which EMR system are you using?

Dorst:  On our inpatient side, we’re running Meditech Magic 5.6.4, and for our outpatient business, we’re running Allscripts Enterprise.

Gamble:  As far as Meditech, do you have any upgrades scheduled?

Dorst:  We have one in June that’s got little add-ons for the Meaningful Use 2 as far as I understand it. We haven’t really dug into it that much yet. We’re also running McKesson for our home health software.

Gamble:  Okay. You mentioned physicians before — do you have both employed and affiliated physicians?

Dorst:  Not physicians who are running Allscripts; we have affiliated physicians that practice at the hospital and have privileges here, but we don’t meddle in their EHR at this point. But we are members of the HIE CRISP initiative here in Maryland, so we’re hoping in the future as we pursue population health and ACO accreditation that we’ll be able to reach out a little bit more to those non-employed docs and do some data sharing with them.

Gamble:  You mentioned Meaningful Use. Where do you stand with that? Have you attested to stage 1?

Dorst:  Yes, we attested successfully to stage 1 and we are currently working toward stage 2. I can go into that a little deeper; I didn’t know if we we’re going to talk later about our strategy on that, but we’re planning on going live with our Empower product, our clinical overlay system, in October and we hope to attest at the end of the year.

Gamble:  Can you tell me a little bit more about the Empower system?

Dorst:  Sure. We were faced with a dilemma when I got here in about a year ago. We had about a three-year wait to upgrade our Meditech product, and we didn’t really relish the idea of trying to get Meaningful Use 2. We got through stage 1 because of our ED usage of the product.

We were trying to look at the big picture and unify our systems a little bit, and we found the Empower product. We looked at several others, but that was the one that was ready to go to market. It’s an overlay system that will fit on top of our Meditech HIS and become one record. Currently, we have some issues in our ED if a patient comes into the ED and gets admitted to the floor. Sometimes it can take up to 24 hours to get that information into the record. What Empower will help us do is unify that record so we’ll have immediate information throughout the facility for all of our patients.

It has some built-in core measure functionality and some very good Meaningful Use functionality that, once we get it implemented in the fall, will make it an easy-to-use system that everyone can learn quickly and get us past our Meaningful Use 2 requirements — and hopefully to stage 3. At that time we should have significant dollars banked from our Meaningful Use initiatives to be able to start looking at whether Meditech is the right decision for us to go to their new platform and see what else is out there on the market at that time.

Gamble:  That will be a pretty big decision, but like you said, at least you have time, and you’re focusing on one goal at a time.

Dorst:  One goal at a time. And like I said, we we’re kind of stuck there because we were on the long list, not the short list, and so we had to figure something out in the meantime. We’re hoping this is a good solution for us to train the doctors quickly on it, get it up and running, stand it up, and get CPOE inside the hospital and have a good percentage of physicians use it.

Gamble:  Previously there wasn’t CPOE usage?

Dorst:  We have it, yes. We have the Meditech platform — there’s a pretty good learning curve with that and there’s a lot of work on the backend. We still would have been faced with the discrepancy between what we were doing in the ED and the physician notes coming through on the PDoc side, because our physician groups in the ED really had a problem using that. So we tried to get a solution that would make everyone happy and fix that problem where we have that lag time and sharing information across one system.

Gamble:  When did you make the decision to go with Empower?

Dorst:  It was around Christmas time that we made the decision to move toward it, and we’ve been building it out. We’re pretty much through with the physician side of it now. We’re building out all the interfaces between the systems and working twice a week at 6:30 in the morning, to fit doctors’ schedules, basically just hammering out what they like, what they don’t like, and making changes and correcting things to make it more Meritus friendly.

Gamble:  Do you have a user group or an advisory committee?

Dorst:  Yes, we have physician advisory panel. That’s the one that meets in the morning twice a week, and we have a steering committee on Fridays where we go over what we’ve learned through the week and the progress we’ve made in preparation for the go-live.

Gamble:  How big is the advisory panel?

Dorst:  There are about 10 physicians on it, when they’re all there.

Gamble:  And they represent the different specialties?

Dorst:  Yes, we make sure we had ED doctors, hospitalists, internists — basically a good cross section of who’s going to be using the software.

Gamble:  And they’re able to come to an agreement fairly easily?

Dorst:  On some things.

Gamble:  All right, so obviously you’ve got a lot going on. You’re looking at the fall to go forward with Empower and I imagine you have several other IT projects on your plate. One of the ones I wanted to speak with you about was PatientTouch platform. Can you tell me a little bit about that?

Dorst:  One of the things I noticed when we came in is we were using barcode medication administration already in the hospital. The nurses did not like the scanners they were using. First of all, they were using it on Bluetooth, and it was a little sketchy with the laptops. So if they would get too far away from the laptop, it would lose signal. That was one of the drawbacks of the system — it wasn’t really mobile because you had to be in close proximity and dragging a laptop around with you.

At a previous job that I had, we implemented the PatientTouch product. It’s completely wireless, and it’s an iPod touch that’s very intuitive and easy to use. I brought it to the attention of my Chief Nursing Officer here, and he really liked it. We put it in front of several of the nurse managers who also liked it, and we went down and actually visited the hospital where I used to work, Southside Regional Medical Center in Petersburg, Virginia. They had gone live with the product and the nurses really liked it. It freed them up from a lot of manual work on the computer and putting in information. It’s very intuitive and easy to learn. We’ve got it up and running now. We just went live with it in our cancer center. They had no barcode medication administration system there, so they were really excited to get off the paper process down there.

Gamble:  So you rolled it out first at a department that hadn’t been using any barcoding — was that a deliberate decision? How did that work out?

Dorst:  It was deliberate because they’re an isolated department and they have a much smaller range of drugs that they actually deliver so we could control it a little bit better. If there were problems — which there were a few that we ironed out, but nothing serious; things we were expecting — we were able to correct those. We wanted to see what types of workflow and patient flow situations would arise in a small controlled environment before we went whole-house with it.

Gamble:  Were you able to apply some of those lessons learned?

Dorst:  Yes. We revamped our go-live plan to accommodate what we’ve learned in those situations.

Chapter 2