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.
- Integrating PatientTouch with nurse call — to “completely mobilize the nurse”
- Agnity MobileCare’s secure text messaging
- Happy nurses = happy doctors = happy patients
- Participating in CRISP
- Being the new CIO — “I had ideas in my back pocket”
- His need for autonomy
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Our goal is to completely mobilize the nurse and reduce the phone, the pager, or whatever other handheld they’re carrying around, to one device that can be a one-stop shop for communication and drug administration.
I am a firm believer that happy nurses equals happy doctors equals happy patients. So we focus here a lot on nursing and making sure they’re satisfied with their job technology-wise.
I had those ideas in my back pocket, but I in no way thought I was just going to put them in just to put them in. They had to be a good fit. And I think that what we’re doing here is a good fit.
They’re just starting up, so they’re very willing to make changes to the software and really get into the hospital workflow, which has been very beneficial to us. It’s not right out of the box, so it’s taken a little longer, but I like when it takes longer if we’re actually the ones giving input.
I decided it was time in my career to look for a hospital where I would have a little bit more control over the budget and what we put in and how we implemented it.
Gamble: What devices are the clinicians primarily using in the hospital?
Dorst: Most that we have a mix of standalone fat-client PCs and laptops on carts. Most of the clinicians we see in the hospital use the carts to be mobile around the units, and there’s a good mix there as well. We’re looking at increasing the amount of work stations and we’re moving toward virtual desktops in our clinical areas. So we’re hoping to add a lot more peripherals, basically, for our users, especially with the coming of Empower and CPOE and documentation.
Gamble: What about as far as mobile devices? Are you using iPhones?
Dorst: The PatientTouch right now is an iPod Touch and it’s in a rugged case. I actually saw the PatientTouch folks at HIMSS — they have their prototype available now for the iPhone 5, and it looks pretty sleek. We have actually a clause in our contract that’s going to allow us to upgrade to those probably in the summertime.
Gamble: Had you been going with a bring-your-own-device type policy with the clinicians?
Dorst: No. Before, they were using those Bluetooth scanners; that was all they did. Basically, they have pagers, and we have voiceover IP Ascom phones that we use. We want to integrate PatientTouch — the device that they’re going to be carrying — into the nurse call system. We have a secure texting program that we’re implementing now called Agnity MobileCare, and that works on the IOS. Our goal is to completely mobilize the nurse and reduce the phone, the pager, or whatever other handheld they’re carrying around, to one device that can be a one-stop shop for communication and drug administration.
The other thing about PatientTouch that’s really nice is that you can enter information into the interface that flows into your electronic health record. They can take vitals at the bed side and easily transfer those into the device, which then flows during HL7 interface into our electronic health record. So it’s almost real-time updates for those that can afford wired diagnostic devices.
Gamble: You talked about the Chief Nursing Officer. I would imagine that’s somebody who you really want to have a good relationship with. Is this someone you’ve been working with for the year or so that you’ve been at Meritus?
Dorst: He and I actually started the same day; we were in orientation together. We were the two guys wearing suits, so he said, ‘You must be the CIO.’ And I said, ‘You must be the CNO.’ We hit it off; he’s a great guy. And I am a firm believer that happy nurses equal happy doctors equals happy patients. So we focus here a lot on nursing and making sure they’re satisfied with their job technology-wise where we can in helping to put new, useful technology into their hands.
Gamble: That’s a smart strategy. You definitely want to keep the nurses happy. Everybody knows how much of an enormous role they play in patient care.
Gamble: Now as far as the health information exchange, what’s your involvement at this point?
Dorst: Well, like I said, we’re part of the CRISP Initiative in Maryland, and we’re fully integrated with them as much as they can take right now. It does get used in our ED so if we have patients that come in that have been here before, the physicians in our ED will look up those patients to see if they can get some records on them. And they’re successful. It’s been going pretty well. That’s going to obviously expand and we’ll start getting a little bit more in-depth information. Hopefully, when we start working down our ACO path and our population health path, it’ll have even more information that we can glean out of it to run analytics.
Gamble: Is that something that covers a certain area of the state? What size is that HIE?
Dorst: It’s the whole state. You get everything with the hospitals that are participating. It’s not free for the hospitals. I want to say there are 40 or so in there. It’s pretty big.
Gamble: You started at Meritus about a year or so ago. As far as your first year as CIO, what was your approach when you first got there? Was it something where you jumped in right away with big plans or did you really want to wait and get a feel for the organization?
Dorst: I had some plans coming in from some of the new things I was doing at my prior facility, and PatientTouch was one of them. I didn’t just come in and assume that that was going to work here. But I was approached by the CNO, and one of their complaints was that their barcode readers were breaking and batteries were always hard to find and it was not very usable, so that was an obvious fit. The Empower decision was what I found when I was faced with the challenge of what we had to do in a two-and-a-half year time frame for our upgrade path. So I had those ideas in my back pocket, but I in no way thought I was just going to put them in just to put them in. They had to be a good fit. And I think that what we’re doing here is a good fit.
One of the things we’re putting in now — Agnity MobileCare secure texting — I didn’t even know about that. I went out to market looking at the secure texting solutions; there are a lot of them out there. But all they really do is texting, so in my mind, I was going to spend 200 and some thousand dollars on a product that basically does texting. If you have a physician that can text in two or three clicks, but now you’re going to add 10 clicks to log in to something else — that’s basically never going to get used. In my mind, that was a waste of $200,000.
I started searching around and I found a company that’s just starting to get into the space, and what they’re going to be able to do is actually attach patient information to the call list. So say I’m a hospitalist on the floor and I need a cardiology consult. I can now flag that patient, look up in real time on a list for who’s on call for cardiology or pulmonary or whatever I want for that specific patient, and send over that information as a skeleton. Nothing’s stored on the phone; it’s all a push mechanism. So that doctor doesn’t have to call back to the floor, find out who paged him, find out who the patient is — what’s their name? What are their recent labs? They’re able to look at all of that right on their handheld and can then text back securely what they want or what they’re consult is back to the hospitalist.
Our whole goal behind that is obviously better patient care and quicker care — because time kills in hospitals — and also to reduce length of stay so we’re not waiting a day or adding a day for a separate counsel. Hopefully they’ll want to use that because it gives them extra information and that’s what they’re always begging for — just give me the information I need to make a decision. Hopefully in a year’s time when it’s up and running, I’ll overhear someone in the hall saying, ‘No, send that to me with the Agnity software. Don’t page me normally, I don’t want it. I want my patient information attached to it.’
Gamble: Yeah, that would be some nice validation. That seems to be the goal behind almost every initiative — to give clinicians the information they need at the point of care, and do that in a way where the information is protected. And if you can find something that meets that exact criteria, that’s great.
Dorst: Yeah, it’s a good product. And like I said, they’re just starting up, so they’re very willing to make changes to the software and really get into the hospital workflow, which has been very beneficial to us. It’s not right out of the box, so it’s taken a little longer, but I like when it takes longer if we’re actually the ones giving input.
Gamble: Okay. So what was it that drew you to the job at Meritus?
Dorst: I came from Community Health Systems, which is a great company. It really helped me grow for the 12 years I was there. I was on the road a lot and did a lot of go-lives. I worked at the corporate office, so I got to see the country and how healthcare is spread out and how different it is in different areas. I also got to see the common thread between all the hospitals and how patient care works. Then I moved to a permanent spot. I got married and had to get off the road, so I took over the hospital in Petersburg, Va. and had the opportunity there to be at that facility at the time that we were building the new hospital. That was very good for me to really learn from the ground up, the right way, to build things, and how patient flow is critical — especially with all your ancillaries and how everything works together.
And then in 2007, CHS purchased Triad, and my autonomy started to dwindle a little bit once it got to be a little bit of a bigger corporate situation. One of my job satisfiers is being able to innovate and to do new things. It just got harder to do that — it’s not that CHS wasn’t innovating, but it was taking longer, and there’s much more red tape to get those types of things pushed through. I decided it was time in my career to look for a hospital where I would have a little bit more control over the budget and what we put in and how we implemented it.