Sometimes the smallest detail can result in major downtime. It was a lesson Michael Martz learned nine months into his tenure as CIO at Meadville, and one his team will never make again. Because as frustrating as it was when the hospital lost its main data center because of a battery that failed during a generator test, the experience strengthened the organization’s disaster preparation strategy. It’s that philosophy of always learning that has helped Martz lead the organization through major changes during the past three years. In this interview, he talks about being an early adopter of Meditech 6.1 and a beta site for the a new web-based ambulatory product, why he opted to use consultants , what it’s like being a standalone in a large IDN world, and his honest take on Meaningful Use.
- About Meadville MC
- Migrating from Magic to 6.1
- Beta site for Meditech’s web-based ambulatory product
- “We definitely approach it with our eyes wide open.”
- Getting practices on a single unified system
- Challenges with CPOE & public reporting interfaces — “That kept us sweating for a while”
- Using consultants to help with “heavy lifting”
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The new web-based product that they’re building is probably the most attractive intuitive EMR I’ve ever seen. You show it to physicians, within a couple of minutes they’re taking the iPad from you and navigating themselves.
Probably the thing that I’ve enjoyed the most is that every time our staff comes out of meetings with the Meditech team on the ambulatory system, they generally are grinning, and I’ve never seen that before.
It’s given us a very fragmented view of the patient, and that’s probably the key problem that we’re trying to overcome with moving everybody to the single unified system.
It took a lot of political will and a lot of political muscle, all the way up through our executive team, to bring a lot of the physicians on board.
There was a lot of load balancing to work through on that. And a lot of education — much of this technology is new to everybody, so we weren’t always able to go about and find someone with experience who knew this right offhand.
Gamble: Hi Michael, thank you so much for taking the time to join us today.
Gamble: Can you start off by telling us a little bit about Meadville Medical Center — number of beds, what you have in the way of clinics, things like that?
Martz: We are a relatively full service community hospital, independent. We’re in Northwest Pennsylvania, kind of between Pittsburgh and the area of Pennsylvania, close to the Ohio border. We have about 230 beds, and there’s a strong emphasis on patient safety here. We’ve been recognized by Leapfrog and Consumer Reports for safety.
We have a very strong orthopedic program here — right in the top hundred for hip and knee replacement. We have a comprehensive oncology center, four rural health centers, about 120 physicians, with roughly 48 percent of them employed. We have 23 practices, two urgent cares, two community dental centers, and a reference lab. We have about 1,600 employees in the organization. We have hospice, psych, nursing, occupational health, inpatient mental health, inpatient/outpatient rehab programs, even a community transportation program to help people get to their healthcare providers. So it’s a broad range of things that we do here. We’re in a fairly rural part of Pennsylvania, and the nearest other hospitals to us are at least 30 miles away, so we have to be pretty comprehensive in serving the community that we’re in.
Gamble: Let’s talk about clinical application environment. Are you Meditech in the hospital?
Martz: We are. We’ve had Meditech Magic here for, oh gosh, probably 18 years or so, and we’re actually in the process now of migrating to Meditech 6.1. Our go live for that is scheduled for November 1st and then the following spring, we’ll be the beta site for Meditech’s new web-based ambulatory product. So we’re very much looking forward to that.
Gamble: That’s really interesting. Is that something where is there some hesitancy because being a beta site there are some risks involved?
Martz: No, not really. We definitely approach it with our eyes wide open. But we’ve been carefully evaluating what Meditech is offering. The things that attracted us to this was, number one, usability. The new web-based product that they’re building is probably the most attractive intuitive EMR I’ve ever seen. You show it to physicians, within a couple of minutes they’re taking the iPad from you and navigating themselves, and they just love it. It almost looks like an iPad app rather than a regular system, so it’s a very, very well built thing. The other thing that was a key criteria for us is that the ambulatory product is just a module of the main acute EMR. So it’s a single database, single patient view, single patient record, and one of our core goals is to get a comprehensive, unified view of the patient and not have patient information in different silos where it’s hard to get.
Gamble: Right. So it seems like the pros outweigh the cons.
Martz: Very much so. There are certainly some risks, but we have been very, very pleased with the level of engagement and support that we had with Meditech and the developers so far. They’ve kept us very much involved as they had been going into the development process, showing us the versions of as they come out with them and taking our suggestions. We have a lot of cheerful debates in adjusting about how things should work, but it’s been a very, very good collaboration.
Gamble: I’m sure it’s a pretty cool opportunity to be able to be the one to test this out.
Martz: It is. Frankly, probably the thing that I’ve enjoyed the most is that every time our staff comes out of meetings with the Meditech team on the ambulatory system, they generally are grinning, and I’ve never seen that before.
Gamble: Yeah, that’s a good sign.
Martz: It’s a very good sign.
Gamble: Okay. At this point, I’m guessing there are multiple systems being used in the physician practices.
Martz: There are. The majority of them are using a system from McKesson called Medisoft and that, unfortunately, is not one system supporting all the offices. They’re each separate databases, and so it’s given us a very fragmented view of the patient, and that’s probably the key problem that we’re trying to overcome with moving everybody to the single unified system.
Gamble: Right, and there are several benefits there such as the fact that you’ve had a good experience and you’re happy with Meditech in the hospital, and being able to keep that in place and still have that unified record.
Martz: Right, exactly. And in the hospital itself, we’re trying to consolidate everything to the single platform as best as we can. So we are moving the best-of-breed systems out, especially as we move to the new Meditech 6.1 system. But there are some exceptions. There are areas where we still need some specialty systems. In our oncology center, we have Varian for the EMR there. We have a GE CPM system for our perinatal, a separate system from MUMS for the hospice, and a couple of other odds and ends like that.
Gamble: Now with 6.1, I don’t believe that I’ve heard there’s that many people on it right now. Is that something where it’s still early adoption?
Martz: Yeah, very much so. There are only three that are currently live. One of them is the hospital run by Anne Lara who you had interviewed, I think, six months ago. So we will be the third or fourth hospital to go live on it. And it’s an incremental growth from Meditech 6.0, which has probably two or three hundred hospitals running on it. There are some modules that had been rebuilt in the new technology and those are really the areas that are delightfully new, but there’s also a bit of risk that comes with being an early adopter.
Gamble: And the hope is that it will meet the organization’s needs more effectively than the Magic system.
Martz: It will. Magic has been a very good system for us, very effective. In fact, we just finished our stage 2 attestation on Magic. But Meditech 6 does a very good job of pulling together a lot of the internal silos. For example, with our clinicians, there’s a whole lot less navigating from module to module to module to see all the information for a patient. It brings everything together from all those diverse points onto a single screen, and makes it a lot easier to get to what you need. We definitely are seeing some potential for productivity improvements from that.
Gamble: Okay. So you finished the stage 2 attestation.
Gamble: What did you find to be the biggest challenges in stage 2 as compared with stage 1?
Martz: Many of them. Probably the biggest challenges were one, CPOE — I think that’s consistent with a lot of hospitals, just getting physicians used to using a CPOE. It’s definitely a big step, and it was kind of hairy edge for us for a while as to whether we would make the numbers on that. And it took a lot of political will and a lot of political muscle, all the way up through our executive team, to bring a lot of the physicians on board for that.
The patient portal turned out to be an interesting challenge for us. Getting it up and running wasn’t that bad and offering it to the 50 percent was not a problem at all, but getting that 5 percent to actually come in and use it caused us to do some marketing and offering gift cards — things that are definitely not normal. We’re continuing to look for ways that we can make that a much smoother process so that we don’t have to get into some of the extraordinary measures we went through.
Gamble: That’s also very consistent with what we’re hearing. That’s a very difficult thing.
Martz: The other area that was a surprising challenge for us that we weren’t expecting was the public reporting interfaces. We have been doing public reporting interfaces before, but the new versions of them and the requirements of line codes and such that were not with the older versions turned out to be a much bigger challenge than we expected it, and that kept us sweating for a while.
Gamble: How did you eventually worked through it?
Martz: We had some consulting help. Probably the biggest problem for us was that we had hoped to complete Meaningful Use 2 in the first quarter that you could last fall, which was before we began the big Meditech 6 conversion project in seriousness. Unfortunately that didn’t happen for a variety for reasons, so we wound up with the two projects — Meaningful Use 2 and the Meditech 6 implementation competing for our time. That probably was our biggest challenge, having two very critical things going on simultaneously, and so we have to bring in some help just to get through the heavy workload for that.
And there was a lot of deep-in-the-system plumbing that had to be redone. The Meditech system includes intelligent medical objects (IMO) that do a lot of the translation between our internal language and the standardized code sets like line codes and others, and getting all the mapping put in place for that was a difficult body of work to get through.
Gamble: So you used consultants to kind of just get through having two such huge projects going on at the same time.
Martz: We did. We wound up with our staff doing a bit less of the Meditech 6 work than we wanted because we had to divert them to the Meaningful Use stage 2 work, so there was a lot of load balancing to work through on that. And a lot of education — much of this technology is new to everybody, so we weren’t always able to go about and find someone with experience who knew this right offhand. We had a lot of self-teaching and learning to do, and a lot of debugging to do. Also with the interfaces, the State of Pennsylvania wasn’t always ready when we were ready, so we would do a bunch of heavy work and then have to wait and then dive into a bunch of more work when the State was ready to go.
Gamble: Yeah, that’s got to be frustrating.
Martz: It comes with the job.
Gamble: Sure. As far as the experience with the consulting, was it something that worked out pretty well because it was just what you needed at the time?
Martz: Yeah. The primary consulting firm that we’ve been working with has done a terrific job supporting us and being very flexible to meeting our needs. We’ve had very good results.
Gamble: I imagine it’s something where you don’t want to spend any more money, but you have to bite that bullet and say there’s just too much going on.
Martz: Yeah, but when you’ve got a million dollars of stage 2 Meaningful Use money sitting on the line, it becomes not too hard to justify the extra expense.
Gamble: Sure. Now, as far as the attestation, did you have a kind of Meaningful Use team? Were there people kind of tasked with certain things as far as everything that needed to be done for attestation?
Martz: Sure. It was a very broad effort. Stage 2 Meaningful Use for us wound up being in about 20 different projects all running simultaneously, each of them focused on the individual measures. And then many of the measures, we were already meeting them from stage 1 — beating them in many cases. So there were some things that were easy, but we had multiple projects going simultaneously to knock off some of the hard ones.