Mike Mistretta, VP & CIO, MedCentral Health System, Chapter 1

A lot of organizations talk about innovation, but MedCentral walks the walk. Not only was it the first hospital in the country to attest to stage 1 of Meaningful Use, but the Mansfield, Ohio-based system also serves as a national showcase site for Siemens. For CIO Mike Mistretta, that means having the opportunity to drive technology and influence usability; however, it also means having to manage expectations and frustrations. In this interview, Mistretta talks about why he enjoys being on the cutting edge — but not necessarily the bleeding edge, his “wait and see” approach with ACOs, and the goal to create a unified patient record. He also discusses the work his organization is doing with analytics, and how he thinks the CIO role will continue to evolve.

Chapter 1

• About MedCentral
• Being a beta site for Siemens — “We get to influence the usability of the systems.”
• Quality measures
• Piloting portals with employees
• MU dream team: clinical program manager, nursing liaison & CMO
• Creating a unified patient record
• NextGen in ambulatory, Siemens Soarian in the hospitals

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Bold Statements

Our strategic plan over the last seven years was basically in alignment with everything that came out for the Meaningful Use mandate, so all we had to do was prioritize some of the initiatives that we already had on the books.

We have a pretty good reputation among the install base of the products that are out there. The other customers know that when we look at stuff and we’ve got it, they’re going to get a pretty solid product coming out of it.

With a mandate of having a certain percentage to download their results and data, you basically have no control over that. That can be a little bit of a scary proposition, but we have some plans to be able to drive some of that.

A lot of the stage 2 provisions are going to be driven from the physician side. We work pretty closely with the CMO, and in everything we’re doing, we try and push through the medical executive committee as well to get support from the physician leadership.

From an adoption perspective, we’re pretty far down the road. The piece we’re missing to get to the next level would be the physician progress notes, which we’re running a pilot for right now.

Gamble:  Hi Mike, thank you so much for taking the time to join us today.

Mistretta:  Sure.

Gamble:  To give our readers and listeners some background, can you tell me a little bit about MedCentral?

Mistretta:  MedCentral is a two-hospital health system located halfway between Cleveland and Columbus in Ohio. We have everything from rural healthcare to Level 2 Trauma at both of the facilities, and we do everything but burns and transplants.

Gamble:  And you have a surgical center as well?

Mistretta:  Correct. We have an outpatient surgical center at both facilities, so obviously there are active OR suites.

Gamble:  Do you have physician practices that are either owned or affiliated with the system?

Mistretta:  Yes — both, actually. We have about 12 physician practices that are owned and then about 200 physicians on staff.

Gamble:  In terms of the area itself, it’s between the two cities — so is it fairly rural, where you are?

Mistretta:  We are the biggest population center between Cleveland and Columbus in Mansfield, so we get everything in that corridor. We’re directly in the middle of Cleveland and Columbus, so we’re about an hour and a half in either direction.

Gamble:  As far as the clinical application environment in the hospitals, you’re a Siemens shop?

Mistretta:  Correct. We are a national showcase site for Siemens Soarian.

Gamble:  What does that entail — being a showcase site?

Mistretta:  We do a lot of beta work with them on a lot of their development; we help them with a lot of the intellectual capital to develop the Soarian product, plus a lot of the testing and new releases when they first come out. An example was when we did Meaningful Use — we were the beta product for the Meaningful Use release of their product in 2011.

Gamble:  And you were the first to attest to that, right?

Mistretta:  Yes, we were the first hospital in the country actually to submit for the attestation in April of 2011.

Gamble:  That’s pretty cool.

Mistretta:  We were fortunate when we did it. Our strategic plan over the last seven years was basically in alignment with everything that came out for the Meaningful Use mandate, so all we had to do was prioritize some of the initiatives that we already had on the books. We were already underway with the development of the longitudinal record, which is basically what the Meaningful Use stuff is all about. We were already down that road pretty far.

Gamble:  Going back to being a beta test site, from your perspective, I can imagine that’s an exciting thing, but then it also has challenges. Talks a little bit about what that’s like.

Mistretta:  It comes with both sides of that, obviously. I think the staff enjoys it quite a bit because they’re on the cutting edge of what’s coming out. But there also can be quite a bit of frustration, because not everything you get is perfect. It doesn’t always meet the expectations of what you’re doing because there’s a compromise into the existing architecture of what’s there versus what we need to do. But the really exciting part of it is we get to influence the usability of the systems more than anything. Some of the stuff we’re doing in the surgical space with them and SIS in between fits into that. But it’s being able to help drive the product for the industry; we have a pretty good reputation amongst the install base of the products that are out there. The other customers know that when we look at stuff and we’ve got it, then they’re going to get a pretty solid product coming out of it. So it’s pretty exciting for the staff.

Gamble:  I would imagine that it takes a group of people who are risk takers and who are excited by this type of thing.

Mistretta:  Yes, to some extent. We don’t always want to be necessarily on the bleeding edge of stuff, but certainly on the front edge of it. We do a lot of work with the staff in trying to manage expectations sometimes with that. They like to be on the front edge of it, but sometimes the frustration can get to them a little bit. So there is some management of expectations for sure.

Gamble:  I can imagine. Now in terms of Meaningful Use, so you attested back in 2011 for Stage 1. Where do you stand at this point with Stage 2?

Mistretta:  We are in the process right now of working through some of our workflows that we need to do from a clinical side, because we have to change some of the stuff in the way we capture data and what data we’re capturing. We are getting ready to take the certified release of code, probably next month, and have that up and running and in operation by the end of the year. Our plan right now is to drive for a 90-day window to be January to March, and then attest in April of 2014.

Gamble:  Okay. It sounds like you’re on a good track for it. What would you say has been the most challenging part of preparing for Stage 2? Is it data capture?

Mistretta:  It’s the data capture, and specifically quality measures, in the way they’re being done in this round versus the way they were in round one. They are substantially different, and they have to be mined directly from the data entry in the EMR now versus abstraction. They are significantly different in the way we have to capture the data and the format. So it’s quite a bit of work on our side to change the work flows for the clinician to be able to make sure that we have the proper data to generate those quality measures.

Gamble:  What about in things like patient engagement and hitting those numbers? Is that something that’s also been challenging?

Mistretta:  Patient engagement is going to be an interesting one because of the mandates out there. We’re installing the patient portal site of it for them to be able to get access to results, but with a mandate of having a certain percentage to download their own results and data, you basically have no control over that. That can be a little bit of a scary proposition, but we have some plans to be able to drive some of that. Our employee base is going to be our pilot group for that. We figure if we have 2,500 employees with another set of spouses, that’s roughly 5,000 patients right there that are going to be able to go out and download results right away. Hopefully, that will help push us toward the required percentages on the patient engagement side.

Gamble:  That’s definitely a challenge we hear from a lot of CIOs, because of the basic idea that it’s something that’s not necessarily in your hands, but organizations can try to take certain steps like getting patients signed up for portals right in the offices, things like that.

Mistretta:  We basically are going to hit our patients at three points of care. When they come in to the office, obviously they’ll get signed up at that point. But for all the inpatient stays, we’re going to sign them up when they register as an inpatient, but then at discharge there’s going to be a lot of reinforcement materials provided at that point in time. That way we can have all of the provisioning by the time they’re ready to discharge, and then it’s just a matter of handing them the information and maybe even walking them through the login process before they actually leave the hospitals.

Gamble:  In terms of attesting to Meaningful Use, do you have key people on the clinical side who have a lot of influence and are very key in helping to meet the MU requirements?

Mistretta:  I have a Clinical Program Manager in place who is responsible for running that, and we have a nursing liaison that works in the nursing administration. They work pretty closely together to make sure that everything’s done from the clinical side. Our Chief Medical Officer is also pretty intimately involved with what we need to do because a lot of the stage 2 provisions are going to be driven from the physician side of the house. We work pretty closely with the CMO, and in everything we’re doing we try and push through the medical executive committee as well to get support from the physician leadership to get what we need from the physician side.

Gamble:  In terms of the ultimate goal a lot of organizations have of having that single integrated patient record, how far along have you been able to have that one record for the patient throughout the system?

Mistretta:  We’re pushing along those lines. I would say the place where we are not there but are working on it from an HIE perspective is we have NextGen in the ambulatory setting and Siemens Soarian on the inpatient setting, but key data elements are passed between the systems through HIE. We do a lot with results, letters, lists and things like that where we’re in the process of building those interfaces right now to pass them through so that when the patient presents at the pertinent point of care, the data is all present there.

I think we’re pretty well along the way. We are EMRAM Level 6 certified, so from an adoption perspective, we’re pretty far down the road. The piece we’re missing to get to the next level would be the physician progress notes, which we’re running a pilot for right now. With Meaningful Use stage 2 2, I think we’ll be fully prepared to do the survey for Level 7 certification. We’re pretty far down that road as well.

Chapter 2 Coming Soon…