Most people would be surprised to learn that UMass Memorial Healthcare was a late starter in the EHR game. But while the organization is behind the curve in some respects, it’s leading the way in others, boasting innovative initiatives such as a diabetes-focused portal and an eICU. In this interview, CIO George Brenckle talks about what’s like to play catch-up, how UMass become a best-of-breed shop by default, his three-pronged approach to ICD-10, and the momentous task of cleaning up data . He also discusses his social media strategy, and his “backyards without fences” leadership philosophy.
- About UMass Memorial
- Playing catch-up
- Siemens in the hospitals, Allscripts in ambulatory
- Integrated system vs multiple vendors
- HealthAlliance’s Level 7 model
- Bringing in a CMIO — “You can never have enough hands on deck”
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We started building a plan to say, what do we have to do? What do we have to get in place, particularly in light of both the HITECH Act and the Affordable care act, and how do we position ourselves going forward?
The nice thing about bringing up the tail end is that you’re not breaking trails yourself — you have a lot of lessons learned out there from all the pioneers.
You need clinical input and you need operational input. The worst thing in the world is to try to have IT try and drive these things, because they have huge implications outside of IT.
You can never have enough hands on deck for this kind of initiative. These are fundamental changes in the way an institution works, and when you’re trying to do it quickly, you are introducing a lot of operational change very, very quickly.
In addition to having a good CMIO, you also need your physician leaders out in the community that are supportive in helping you move this forward. Because if you don’t have that, it just appears to be an IT-driven initiative, which is not going to work.
Gamble: Hi George, thank you so much for taking the time to speak with us today.
Brenckle: You’re welcome.
Gamble: To get things started, can you just give us a little bit of information about UMass Memorial Health Care? I know it’s a fairly large system, but just tell us what you have in the way of hospitals and ambulatory, things like that.
Brenckle: We’re located in central Massachusetts, headquartered in Worcester, and we’re the clinical partner of the University Of Massachusetts School Of Medicine. We consist of UMass Memorial Medical Center, which has three campuses in the city of Worcester, and in addition, we have four community hospitals: HealthAlliance, Wing, Marlborough, and Clinton, which are spread throughout Worcester County. We also have a large medical group that’s primarily the faculty of the school of medicine. Plus, we have a community medical group and about 80 physician offices, again located throughout central Massachusetts.
Gamble: And are those practices employed by the system?
Brenckle: Those are all employed physicians. They’re all part of the system, so both the medical group and the community medical group are employed physicians.
Gamble: Now looking at the clinical application environment, starting with the hospitals, what are you using for your EHR?
Brenckle: On the acute side we’re using Siemens Soarian and on the ambulatory side we are using IDX for practice management, scheduling, and professional fee billing, and we’re using Allscripts Enterprise as the ambulatory EMR.
Gamble: So now as far as the whole journey that UMass is going through and has been going through with the EHR, this was part of a big project kind of launched a few years ago called Cornerstone.
Gamble: Can you talk a little bit about this initiative and where the health system was before it, in terms of whether there were different EHR’s in place or what the picture looked like?
Brenckle: The health system had gone through a period of under-investment in IT back in the early 2000s, and so we’re playing catch up. We’re the only academic medical center in Massachusetts that does not have CPOE in place yet on the acute care side. So in the 2008-2009 timeframe, we started building a plan to say, what do we have to do? What do we have to get in place, particularly in light of both the HITECH Act and the Affordable care act, and how do we position ourselves going forward?
So that was the situation we were in. The nice thing about bringing up the tail end is that you’re not breaking trails yourself — you have a lot of lessons learned out there from all the pioneers. But a chief disadvantage is that what you’re trying to do, you’re trying to do very fast. You have an idea of where you need to go, but there’s a huge amount of change, and rather than being able to absorb that change over five to ten years, you’re trying to do it in three. And so that puts a little bit more pressure on you in terms of change management.
When we got here, there was already a significant investment in Allscripts Enterprise as an ambulatory EMR, and there was a considerable amount of satisfaction with that product. And so one of the first things we had was a decision of do we try and go with a single vendor solution or are we going to end up being in a multi-vendor situation. Because the desire was to keep Allscripts as the ambulatory EMR — and at that time Allscripts did not own or have an acute care product — that, by definition, moved us into multi-vendor approach. We went through a product selection process and we selected Siemens Soarian as our acute care EMR.
One of the things that drove us in that direction is tgat one of our member hospitals, HealthAlliance, had actually implemented the Soarian product. They are actually at Level 7 of the HIMSS model for EHRs, and they have been very successful. They’ve actually qualified for stage 1 of meaningful use in the acute care side. They have the complete product roll-out, and so we’re trying to follow their example and roll that out across the other institutions within the health system.
Gamble: That certainly makes sense if you have a hospital that’s doing as well as they are to go with that product. It can be kind of a blueprint for the other hospitals. Now where does the initiative stand at this point — are all of the hospitals up on Soarian at this point, or are their plans in place for that?
Brenckle: The Medical Center, Marlborough and Clinton are all up on Soarian Financials, Clinicals and Pharmacy, and we’re in the process right now of rolling out medication administration and building CPOE. Our goal is to go up on CPOE as soon as we can. It’s probably going to be sometime next summer when we’re really ready to roll that all the way out. We’re in the process of bringing medication administration up this fall and into the spring across the institutions. And so the transition from what we were on to the Siemens platform is well under way. We’ve just got a little bit more work to do to get it all in place and up and running.
Gamble: So it sounds like you really are on a compressed schedule. You know what you have to do, but like you said, you have less time. In that respect, was that maybe the impetus for bringing on a CMIO and just having more hands on deck?
Brenckle: You can never have enough hands on deck for this kind of initiative. Clearly these are fundamental changes in the way an institution works, and when you’re trying to do it quickly, you are introducing a lot of operational change very, very quickly. And so you need clinical input and you need operational input. The worst thing in the world is to try and have IT try and drive these things, because they have huge implications outside of IT. The major issues all center more around workflow and much less around the actual technology.
Gamble: From a leadership standpoint, are there particular individuals like point people at the hospitals, or even physicians who have stepped up into a leadership role?
Brenckle: Yes. Over time, they tend to identify themselves in the process. There are some clear physician leaders that help with this. We have a physician action committee that’s here at the medical center and the physician that’s leading that is ideal. He’s not a technologist; he’s a practicing physician, but he has the right vision and he sees where we’re trying to go and is very supportive about bringing these things together.
Gamble: I imagine that’s the type of leadership you need when you’re talking about making something like this happen in a short time frame.
Brenckle: Absolutely. And again, this is ‘all hands on deck.’ The CMIO is a very important position, but a lot of times, the CMIO tends to be looked at as an extension of IT and not necessarily as a practicing physician. And so in addition to having a good CMIO, you also need your physician leaders out in the community that are supportive in helping you move this forward. Because if you don’t have that, it just appears to be an IT-driven initiative, which is not going to work.
Gamble: Now as far as the decision to stay with Allscripts, was that something where you spoke to some of the physician leaders just to get their input? Because you had said that they were happy with it and you didn’t want to change that if you didn’t have to.
Gamble: Was there an organized meeting process, things are like?
Brenckle: Yes. On the ambulatory side we have about 1200 or 1300 physicians up and using Allscripts right now. Basically we have about 1700 people log on to Allscripts every day and we’ve had, I’d say, about 90 percent of our physician community qualify for meaningful use on the ambulatory side. So we’ve made good progress on the ambulatory side, and now we’re working to kind of catch up with HealthAlliance on the acute care side.
Gamble: And like you said before, you’re eyeing up CPOE in the near future?
Gamble: How long have you been at UMass?
Brenckle: I’ve been here for five years.
Gamble: So you weren’t there for too long before the drive really started for the Cornerstone initiative. Was that something that you kind of knew going in, that you were going to be part of this big project?
Brenckle: Yes. I knew we had to move in this direction. It was very clear we were not particularly positioned well as the HITECH Act was passed and then the affordable care act. It would have been nice if we had a little bit more time, so yes, we’re really feeling the pressure to keep moving on this.