Many people talk about the need to be flexible and able to quickly adapt, but to Paul Foelsch, it’s more than just words. Throughout his 13-year tenure as CIO at Mercy, he’s had plenty of practice, whether it was developing a disaster recovery plan during the 2008 flood, learning that McKesson was shifting its focus to Paragon — just as his team was implementing Horizon, or moving to Iowa, only to find out there was no local HIMSS chapter. Each time, Foelsch has been able to adjust his strategy. In this interview, he talks about the major decision his team faces, the organization’s focus on patient engagement, and why CIOs must be willing to look outside the industry for solutions.
- About Mercy Hospital
- McKesson shop (HBOC user since early 90s)
- Sunquest in lab, Cerner in radiology & Philips in cardiology
- Eyeing Stage 7
- One EHR for owned practices, 17 for affiliated docs
- Horizon vs Paragon
- Reimbursement concerns with telemedicine — “It’s still an issue”
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With some of these underlying technologies, we’ve been able to improve turnaround time and quality and accuracy of our reporting, as well as improve service and satisfaction both for the referring physicians and the patients.
We’re doing a deep-dive, looking not only on the workflow implications and the areas for improvement, but also at potential efficiencies and other cost savings, and balancing that against the inevitable disruption when changing from one system to another.
We’re really looking at what are the differences in the areas of clinical documentation, as well as some of the billing pieces. We have to be very careful looking at the MU attestation timing, as well as ICD-10 coming down the pike.
By being able to monitor the patient’s weight and get information on a timely and an almost daily basis, we’re able to intervene to make sure that a) the patient stays healthier, and b) we prevent those preventable readmissions.
We were in the top 10 percent nationally for our response time for cardiac incidents. We’re very pleased about that, and we’re pleased at the IT department’s role working closely with our ER and our cardiologists to be able to tie these things together.
Gamble: Hi Paul, thank you so much for taking the time to join us today.
Foelsch: It’s my pleasure to be here.
Gamble: To get us started, can you tell us a little bit about Mercy Hospital Iowa City — what you have in terms of bed size, ambulatory services, things like that.
Foelsch: Sure, I’d be glad to. Mercy in Iowa City is a 234-bed acute care hospital and regional referral center. We serve an area of approximately 10 counties in Southeastern Iowa. We have a dozen owned family practice clinics, several specialty clinics and services, as well as several joint ventures in radiology and ambulatory surgery.
Gamble: You said you have 12 owned practices — do you have practices that you’re affiliated with as well?
Foelsch: Yes. We have a number of independent physicians and specialists that are privileged here at the hospital — and only here, including a very strong orthopedics service line, cardiovascular services, and oncology.
Gamble: In terms of the geographic area, is it fairly rural? How big of an area do you serve?
Foelsch: It’s a 10-county area is the southeastern corner of a quadrant of Iowa, and there are several more urban areas — predominantly Iowa City, Coralville and Cedar Rapids in the anchor area, and that’s where we’re located in Iowa City. We’re bounded and surrounded predominantly by rural areas and small, critical access referral centers and clinics as well. The overall population in this area is approximately 350,000 individuals that we serve.
Gamble: How far is Cedar Rapids from where you are?
Foelsch: About 25 miles.
Gamble: Now in terms of the clinical application environment, what type of EHR system do you have in place at the hospital?
Foelsch: We’re predominantly a McKesson Shop. We’ve actually had the original Star hospital information system — the old HBOC System — in place since 1992, so we’ve been working with HBOC and then McKesson for a number of years. And we’ve expanded out over the years, first with some of the basic ancillary systems, and then to the rest of the clinical documentation, doing CPOE on the Horizon platform. We also include several other support systems, particularly lab and cardiovascular. We include a Sunquest Lab, a Cerner Radiology System and the Philips Expert System in our cardiology area.
Gamble: And you’re running Horizon now?
Foelsch: That’s correct. Earlier this year, after we completed our installations, we applied for and received the HIMSS EMRAM Stage 6 certification, and we’re very pleased about that. We’re working on expanding our connectivity phase using McKesson’s RelayHealth program, and with that we hope to attain Stage 7 in a little while.
Gamble: Right. That’s a great thing to get that type of designation. I would think it really shows the patient population that you are investing a lot in these technologies in trying to improve patient care.
Foelsch: We’ve definitely looked to be able to market some of those capabilities and features out — not only to our patients directly, but to also our surrounding practitioners and referral area. Some of the things we’ve been able to accomplish from a connectivity and information exchange standpoint include an outpatient outreach lab system where offices are able to place lab orders in their office and receive the results back to their office straight from our lab. With some of these underlying technologies, we’ve been able to improve turnaround time, quality and accuracy of our reporting, as well as improve service and satisfaction both for the referring physicians, and ultimately, the patients.
Gamble: For the owned practices, what systems are they using?
Foelsch: They’re using the Vitera Intergy EHR, and they’ve been live for a while. We took our first pilots in late 2008-early 2009, and we have all of our clinics up on the Vitera Intergy EHR. We also have the practice management piece, which is based on the old Medical Manager system, as part of that.
Gamble: As far as the affiliated systems, are they using a couple of different systems at this point?
Foelsch: One of the things that our physicians pride themselves on is not only quality service, but also independence. Out of the various clinics and practices, we have 17 different systems currently that are connecting at one level or another or interacting with our systems. So we have a little bit of everything.
Gamble: Yeah, I imagine. And you’re on Horizon now. Do you have any intention to migrate to Paragon? Is that in your plans, or are you not really looking at that right now.
Foelsch: We’re doing some of the early evaluations. When McKesson announced their Better Health 2020 vision, we quickly looked at what are the implications and the timeframes for that. At that particular point, we were in the finishing stages of implementing part of the Horizon platform, so we wanted to continue that and make sure McKesson will continue supporting that through our Meaningful Use attestations and so forth. They are, have been, and will continue to be supporting us there.
As we’re looking at options, including the Paragon system, we’ve done some reviews, demonstrations, analysis, and comparison. We’re in the process of going through that in detail now, doing a deep-dive looking not only on the workflow implications and the areas for improvement, but also at potential efficiencies and other cost savings, and balancing that against the inevitable disruption when changing from one system to another.
One of the advantages that we’ve found looking at that is that a number of the core support systems that we currently have in place would continue with our go-forward solutions for McKesson. A couple of points in case would be our medical records system, which is currently the Horizon Patient Folder. That system is compatible with and supports Paragon, so there would be no lost in continuity of medical records. Similarly, with the PACS system, we have the HMI or Horizon Medical Imaging System, and that, similarly, is compatible with both Horizon and Paragon.
So again, no problems with continuity or access to old records. There are a number of pieces that stay in place; a lot of our infrastructure would be similar or stay in place. So we’re really looking at what are the differences in the areas of clinical documentation, as well as some of the billing pieces. We have to be very careful looking at the Meaningful Use attestation timing, as well as ICD-10 coming down the pike, and make sure that all these things will come into place.
Gamble: There are so many moving parts that a decision like that has to be vetted out really carefully.
Foelsch: That is true. There are a lot of moving parts.
Gamble: Where do you stand at this point with Meaningful Use?
Foelsch: We’ve completed our attestation for Meaningful Use year 1, Stage 1. We’re doing a couple of upgrades, moving to our enterprise release 12 on the Horizon platform, which will put into place the last pieces for our next attestation phase. So we’ll have that in place. We’re also, in our spare time, doing some work on medication reconciliation — changing some applications there and doing a couple other minor changes within our Horizon platform to make sure that we’re able to keep moving forward in the interim and while we’re making our go-forward decision.
Gamble: Is a lot of your strategy right now based around optimization and taking the systems that have been implemented and working to get more out of them?
Foelsch: There’s a lot of focus on being able to fine-tune that. As I said, we’re doing some expansion, particularly with regard to meds reconciliation, which is a very, very big topic, not only from a physician standpoint and patient standpoint, but also with Joint Commission scrutinizing that. We just completed our tri-annual survey with Joint Commission, and we passed. But one of the things they said was, ‘you’re doing good work, but you need to do even better.’ So that’s an area we’re going to work on, and we expect to have some major improvements on that early in the spring.
Gamble: Having a largely rural population, are you involved with any telemedicine initiatives at this point?
Foelsch: We have a couple small pilots and a couple longer-term programs that we’ve had in place for some time. One of the concerns and issues, as always, has been reimbursement. Here in Iowa, that’s still a bit of an issue. One of the programs we’ve worked with is in our home health program with remote monitoring. We’ve had a number of programs working in that area for quite some time.
Another one we’ve been working on for a few years has been monitoring congestive heart failure (CHF) patients post-discharge. One of the key indicators for preventing readmissions — which of course is another quality goal — is changes in weight. By being able to monitor the patient’s weight and get information on a timely and an almost daily basis, we’re able to intervene to make sure that a) the patient stays healthier, and b) we prevent those preventable readmissions.
Another area we’ve expanded from our emergency room department is connectivity with our EMS services throughout the area. One of the programs we put into place allows us to transmit EKG readings from the ambulance straight to our emergency room. From there, we’re able to connect to our cardiologists, who are able to read and interpret EKGs before the patient even arrives at the emergency room, and make a determination as to whether this patient is suffering a cardiac event and we need to call in teams and prep the operating room, or when he arrives, just give him some Pepto-Bismol and tell him that he stop eating hot foods, depending on the situation for the patient. So through some of those programs, by extending out in that direction, we’ve been able to decrease our door-to-balloon times — in other words, the ability to bring the patient in for a treatment much, much quicker. At this point, we’re exceeding national averages consistently, and most recently, we were in the top 10 percent nationally for our response time for cardiac incidents. We’re very pleased about that, and we’re pleased at the information technology department’s role working closely with our emergency room and our cardiologists to be able to tie these things together and improve patient care.
Gamble: Sure, that’s a key part. What type of systems are the EMS units using to capture that information?
Foelsch: They actually have mobile units. They’re able to transmit that, and we use a third-party system to collect that information and relay it to us. Then we’re able to pull that in, integrate it to our systems, and turn around and be able to transmit that directly, basically through a web browser, to our cardiologist.