Being CIO at a community hospital has its advantages and disadvantages. On the one hand, smaller organizations can be more nimble and implement change at a faster pace. On the other hand, there are fewer resources, which means less room for error. In this interview, Frank Fear talks about the need to be willing to “stick your neck out” and be innovative, while also recognizing that if something isn’t working, you need to shift gears — quickly. Fear also discusses his enterprise application strategy, the “secret sauce” when it comes to portal adoption, Memorial’s efforts to create strategic partnerships, and his role as staff motivator.
- About Memorial Healthcare
- Competition with nearby cities
- Integrated system vs best-of-breed
- Meditech in the hospital, Allscripts in ambulatory
- Getting practices on one EHR — “It’s been a long road.”
- Memorial’s rollout methodology
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It’s been a major focus of ours to employ docs to try to create a relationship with them that’s a win for both sides; where we can work directly with them to provide a strong continuity of care.
We selected enterprise-level systems, and our policy states we only look outside that if we can’t provide the functionality that is needed. We stick to that pretty strongly. It’s been one of our key tenets in IT and as an organization.
The providers have told me, ‘I don’t even want to see people outside the network because it’s so difficult faxing and going back and forth.’ They’ve become accustomed to the data being there, and when it’s not, it really impedes the efficiency and workflow of the practice.
When you’ve been on an EHR for a year, you recognize that your first year is just scratching the surface. They want to continue to optimize the system, and they don’t have the staffing or the time to do that.
I give them to the opportunity and say, ‘hey, if you want to be involved in that and drive where our EHR is going, come and be involved.’ At a large hospital system that has 5,000 providers, it’s much more difficult.
Gamble: Hi Frank, thanks so much for taking the time to speak with us today.
Fear: Hello Kate, thanks for inviting me.
Gamble: To give our readers and listeners some background, why don’t you tell us a little bit about Memorial Healthcare?
Fear: Memorial Healthcare has 1,100 employees with 115 on our medical staff. We’ve been around since 1921. We have the main hospital, which is about 150 beds, and then we have satellite ambulatory offices throughout our community, within about a 25-mile radius of the hospital. That represents about 15 physician office and different ancillary services. We’re located in Owosso, Michigan. We compete directly with three major metropolitan areas — Lansing, Mich., which is the state capital; Saginaw, Mich.; and also Flint, Mich. The outskirts of each of those cities is about 25 minutes from the hospital. We’re designated as rural, but we do compete directly with those organizations in that folks are willing to drive 20 to 25 minutes for care if their provider recommends it, or if they have an established provider. So we compete for patients and we can compete for physicians, and it’s a challenging environment due to those three major areas that we compete with.
Gamble: I imagine. Do you have both owned and affiliated doctors that are part of the system? How does that work?
Fear: The majority of our 100-plus medical staff are either employed or we have a contractual relationship with them. For example, our ED physicians are not employed, but we have a contractual relationship with them, and it’s the same with our radiology group. So a minority are independent. It’s been a major focus of ours to employ docs, when it makes sense, to try to create a relationship with them that’s a win for both sides; where we can work directly with them to provide a strong continuity of care with primary care physicians and specialists.
As we talk a little bit about technology, that’s been a primary focus of ours. We have a pretty strong employed base, and we need to make sure we use technology to make that seamless transition of information between providers to improve the quality of care and continuity of care, as a patient is seen in our ER, then in the primary care setting, and then potentially sent to a specialist. Oncology, orthopedics, and urology are all specialties we employ. The patient needs to be seamlessly cared for between those different care settings, and we’ve played a major role in that to try to make it an efficient process between the different care providers.
Gamble: I would imagine we’re talking about providers using different EHR systems.
Fear: Well, in our organization, we set a strategy a few years ago where we selected enterprise-level systems, and our policy states we only look outside that if we can’t provide the functionality that is needed. We stick to that pretty strongly. It’s been one of our key tenets in IT and as an organization that due to the cost of integration of having an enterprise system — meaning data floating between entities, it has tremendous value to our patients and our providers. We stick pretty hard and fast to that. There are some exceptions where we have a system that doesn’t have the functionality that is needed, and so we’ll select a system outside our two primary core enterprise systems. Those two systems are Meditech, which is in the hospital environment and the ED environment — basically our facilities environment, and Allscripts Professional EHR, which is in our ambulatory environment. Those are our two core systems that we stick with, unless we can’t due to cost integration.
We do quite a bit of rigor when we select a system where we list all the functionality and put weights on those and go out and see what the vendor landscape is. But I’ll tell you, our enterprise systems hit the mark 95 percent of the time — and for the 5 percent they don’t, we have to go outside our core systems. But 95 percent of the time they hit the mark, and we can utilize those systems that are already fully integrated.
It’s been key for us to be able to lower the overall costs — not only for software, but also to maintain that software. I have a representative on my team who supports Meditech lab, rad, pharmacy — those three modules all have commonality because they’re part of Meditech’s enterprise system. If we were to purchase separate lab, rad and pharmacy systems, I’d surely have to hire at least two people to cover those — maybe even three, not to mention the complexities that come with interfacing. We’d probably have to have a separate interfacing person. So it’s really lowered the costs for us to maintain, both from a staffing standpoint and a software cost standpoint.
But really the big value is that those modules are fully integrated as patients flow through the system. For example, when a patient goes to the ED, the meds are documented, the allergies are documented—all that patient information is documented. We have a full eMAR so the administrative information is documented. When the patient is sent to the inpatient setting, that whole electronic record, with the meds and the allergies, is seamlessly there. It’s the same tool our inpatient staff uses; it’s just tweaked to meet the workflow needs. But all that data just flows seamlessly without any interfaces. It’s fully integrated, and that’s very powerful — both from a quality standpoint and from a patient care standpoint. They don’t have to answer the same questions over and over again about what meds they’re on and what their allergies are — all those things that can impede the patient experience. So that’s an overview of where we’ve been as an organization and where we’ll continue to focus.
Gamble: And those are the owned practices that are using Allscripts, correct?
Fear: Yes. And again, a majority of the physicians who practice in our ambulatory outpatient setting are employed. We have a few independents left, but even the independents in our system, when the Stark Laws lifted a few years ago, we offered our EHR to them and they took us up on it. Because again, when a primary care physician refers to a specialist and they can do it fully electronically within a system, and they don’t have to fax or send a letter, it’s just much easier. The providers have told me, ‘I don’t even want to see people outside the network because it’s so difficult faxing and going back and forth — I can’t see a meds list and I can’t see an allergy list.’ They’ve become accustomed to the data being there, and when it’s not there, it really impedes the efficiency and workflow of the practice.
Several of our independents have taken us up on it, and that has improved. We’re really fortunate; we only have a few providers in our community now that have decided to go on their own ambulatory EHR, but most are on our system now. And it wasn’t overnight; we started implementing in 2006. It’s been a long road to get there, but we’ve gotten there, and it’s definitely been a win for us.
Gamble: You mentioned before about having to compete with other organizations for physicians. How have you approached that situation?
Fear: Speaking from the IT side of things, for some providers — not all — I think it’s increasing that if you have a fully functioning EHR and a strong support infrastructure, physicians really appreciate that, especially independent physicians that are looking at becoming employed. They may have tried to achieve Meaningful Use on their own, or they did achieve it, but now realize the burden it’s put on them to support and maintain a system, plus Stage 2 requires a lot more functionality. And when you’ve been on an EHR for a year, you recognize that your first year is just scratching the surface. They want to continue to optimize the system, and they don’t have the staffing or the time to do that. And in some cases where they’re interfacing with HIEs or interfacing with labs, they just don’t have the expertise to do that, not to mention the time.
So I think providers really appreciate coming in and saying, ‘here’s a site that’s been live on an ambulatory EHR for 7 years with support people that sit with me.’ Our rollout methodology allows our EHR administrator to sit with a provider for basically a month and work with them to develop templates, they go live, and then for two weeks we have someone sitting there working closely with them. And then we have 24-hour support after that if they need it. For example, we implemented a patient portal a year ago. They don’t have to build it, they don’t have to think about it, they don’t have to figure it out. Basically, if they want to be on a committee to help build it, wonderful. We have an EHR steering committee and they can be involved in — if they don’t want to, they know they have trusted providers involved in the build process and the governance process. And they have the functionality. They don’t have to go out and buy it; it’s all built in.
Having employed providers is a win for the organization in that we can leverage their referral patterns and try to push more business to our network and our ancillary services. So it’s a win all the way around as we try to attract providers with the EHR. We’re a small-to-medium-sized independent hospital. That allows providers to be more actively involved in decision-making than if they went with a huge hospital system. And that’s attractive to them. One example is our EHR steering committee governance. I give them to the opportunity and say, ‘hey, if you want to be involved in that and drive where our EHR is going, come and be involved.’ At a large hospital system that has 5,000 providers, it’s much more difficult for them to be involved if they want to be. Providers are looking for different things, and we’re able to attract providers that want to be employed, but also have active involvement and have a little more say in say in decision-making than they would at a larger organization.
There aren’t a tremendous amount of independent hospitals our size left anymore, and so it’s definitely attractive. Thirdly, being our size, we’re nimble. We can implement things rapidly and can respond quicker to change. And again, it takes a certain type of provider that wants to be in that environment, but if you are, we’re very attractive. We really haven’t had any difficulties recruiting physicians, which I think is a testament to our organization and some of those core things we offer our providers. It’s been exciting, and I’m very proud that we’re able to compete against other organizations in attracting doctors and advanced care providers, nurse care practitioners, and PA’s.
Chapter 2 Coming Soon…