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.
- Thoughts on MU — “It’s given us better information on the patient.”
- Using health coaches
- Meds reconciliation — “It was wrong about 98 percent of the time”
- Reducing readmissions & ED visits
- Standalone hospital in a large IDN world
- Being a “major economic force” in the area
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There have been a lot of details in the specifications that, in my mind, really didn’t add to the overall goal. It just made it harder to achieve.
Most of these platforms are not built well for doing that, and you wind up really creating a situation where you’re presenting a plethora of portals to a patient when really they only want one comprehensive one.
We’re very interested to see how we can integrate all the amazing new devices that are out there that you can wear on your body and track through your smartphone — how those types of things can give us a much better ability to monitor patients.
We as an executive team have been able to make a decision on something we wanted to do and have it implemented a week later. We’d never be able to move that quickly if we had to report up to corporate.
Gamble: Now as far as Meaningful Use, I know that this is a bit of a complex question, but what are your overall thoughts on the program and how it’s structured? Is it something where the industry is headed in the right direction but there are some things that could have been done differently?
Martz: Definitely. I think we absolutely support the Meaningful Use program in its entirety. It has made a significant difference in this industry in getting us much closer to the state of most other industries in this country. It’s dragged all of us much closer to being computerized and being much smoother in our processes, and given, frankly, better information on the patient. In the paper world, it’s much more difficult to have the full comprehensive view of the patient that you can have when you’ve got computer systems that are able to collect all of that and have it ready at hand when you need it.
So definitely the goals have been right. There have been a lot of assumptions in how the program was put together that I think were well meaning, but probably less informed by reality than was needed. There have been a lot of details in the specifications that, in my mind, really didn’t add to the overall goal. It just made it harder to achieve. For example, the concept of the patient portal is terrific and they definitely need to be there, but because of the way the Meaningful Use requirements are structured, a lot of organizations that have multiple EMRs would wind up setting up multiple portals — one for the hospital, one for each of the physician practices that they own, unless they are on single unified platform. Most of these platforms are not built well for doing that, and you wind up really creating a situation where you’re presenting a plethora of portals to a patient when really they only want one comprehensive one. That’s just one example of things that really need to be a little bit better shaped by reality.
Gamble: Yeah, it’s really interesting, the whole patient engagement piece, just trying to get patients to become more active in this. It’s hard when there are things like multiple portals, but then also as far as following the patient’s care more closely outside the hospital.
Martz: There’s a lot there still to be defined. We’ve been experimenting with following patients, especially the critical ones, after they leave the hospital. We’ve built a whole program called the Community Care Network using health coaches that follow our patients after they leave, often checking up on them in their homes weekly to see how they’re doing, making sure they’re taking the medications, following up on their appointments, that sort of thing.
We’ve rolled in some electronic monitoring of the patients as well. We have machines that will collect their daily blood pressures and weight and report those back to us centrally, and electronic pillboxes that actually have all their doses, up to four a day, preset in bins. The boxes will light up each bin when it’s time to take it and notify us electronically if they take the wrong bin at the wrong time, or just take something at the wrong time, or don’t take it at all. So that we get immediate notifications when they’re straying from their medication routine, and then we can send out a coach or a nurse or whatever is required to see what kind of intervention is necessary. We’ve been experimenting with a lot of that, but it’s not to the point especially financially where it’s a sustainable thing for us yet.
Gamble: Right. I’m sure it’s also hard to really measure the success or really get hard numbers on something like that.
Martz: Actually we have. This is a project that we put together with the local Blue Cross carrier who has been funding it for us, and we’ve recorded some remarkable statistics from it. The combination of the people and the technology to back them up, we’ve been applying this to the high-risk patients. For those patients who are using the electronic pillbox, we’ve gone to a 96 percent compliance rate on the medication regimes that they have.
We have dramatically increased our medication reconciliation. One of the fascinating things we found is that no matter how much effort we put into our med reconciliation here in the hospital, when our coaches and our nurses went out to the patient’s home and said, bring out the shoebox of all your meds and let’s go through and see what you’re actually taking, we found our med reconciliation at the hospital was wrong about 98 percent of the time, which is dramatic, especially for taking care of that patient. It was extremely common that the patient had the same drug multiple times from different doctors, different pharmacies, and under different brand names, so they had no clue that they actually were taking the same medication and were getting overmedicated. We were able to dramatically change that.
As far as some end outcomes, for the population in this program, we’ve been able to reduce the readmission rate by 40 percent across the board. We’ve been able to reduce their ER usage by 25 percent. We’ve reduced their inpatient hospital stays by 45 percent, and we’ve reduced the hospital cost by 40 percent. So it’s a pretty powerful combination of things going into some terrific results.
Gamble: It’s just obviously a matter of, like you said, being able to sustain it financially.
Martz: Yeah, unfortunately there’s no ongoing compensation for this. We’re doing it through grants from the Blue Cross carrier right now and that certainly is not a sustainable way to move forward.
Gamble: Right. What about Telehealth, especially being in a rural area? I’m sure it’s something that you’d like to do.
Martz: It is. There’s so much opportunity for that. It’s more than we can bite off at the moment. We need to get through these new EMR implementations first thing and get ourselves under the new platform. But that being done, we’re very interested to see how we can integrate all the amazing new devices that are out there that you can wear on your body and track through your smartphone — how those types of things can give us a much better ability to monitor patients. Some of them are remarkable things, like the little postage stamp-sized chips that you can stick on your arm and monitor your blood glucose continuously with much better accuracy than we could even do in the hospital sticking the patient once an hour and give the patient and whoever’s monitoring that patient regular, very good data on how well the blood sugar has been managed. The capabilities there are really phenomenal, and we’re looking forward to leveraging that.
Gamble: It’s pretty amazing. Some of the apps are really coming up with great ways to monitor information.
Martz: Yeah, there’s too many of them. I’ve been trying to learn more about the new integrated approaches to all of these health apps that companies like Apple are coming out with for the IOS platform, and I hope that they really do pull all of that together in a much more comprehensive way. It would make our side of things to be able to gather and use all the data tremendously easier than I think what we see right now.
Gamble: It’ll be interesting to see. I wanted to just talk a little bit about being a standalone hospital and some of the challenges and also the benefits of that. There are so many large health systems and giants in Pennsylvania, which I’m sure you know of.
Martz: Yes, we’re surrounded by them.
Gamble: I can imagine that sometimes it is a little bit tough to be on your own.
Martz: It is, but there are some strong benefits to it. We are a bit blessed in that we are pretty much the sole provider in our county, in our area. With the nearest other hospitals being 30 miles away, we’re not faced with the direct across town competition like many hospitals are. That helps us a lot, and we are a pretty strong referral source out to the two big networks that are in our area, so it helps us maintain good relationships with us because they don’t want to lose those referral sources, so they tend to be very cooperative with us and play well.
We’re very convinced that there are a lot of advantages to having the local ownership and the independence locally. For example, five years ago, our organization was able to build a comprehensive cancer center here locally that included the best linear accelerator available in the market anywhere at that time. We could match anyone in the country when that was put in. It’s a fully integrated radiation and medical oncology program; it became, frankly, such a strong program that we were pulling patients from the major metropolitan areas around us.
And if we were part of a large chain, a larger healthcare organization, we would have never gotten the blessing to make that kind of an investment locally out here in rural Meadville, and have that kind of care this close to home. People would have to drive 45 minutes to an hour and a half away to the nearest large city to get the kind of services that we can offer locally. So that’s why we think being independent is critically important for us, and our community very much supports to us. We are the largest employer, not just in our city, but in the entire county. We’re seen as a major economic force here. So we have a lot of support from the community to stay independent, keep the jobs local, and keep those types of services and capabilities local.
Gamble: Right. I’m sure there’s just not the same amount of red tape that you’re dealing with.
Martz: No. It is so much easier and faster to get things done. In my past life before healthcare, I spent most of my career working in manufacturing, distribution, and government and worked in some very large organizations. So I’ve had firsthand experience with the kind of red tape and bottlenecks that you have to jump through. In an organization this size, we as an executive team have been able to make a decision on something we wanted to do and have it implemented a week later. We’d never be able to move that quickly if we had to report up to corporate somewhere else.
Gamble: Absolutely. I think it’s important to get past the idea that sometimes the smaller standalone hospitals aren’t as progressive towards health IT when that’s not necessarily the case at all.
Martz: It’s not. I came here from a hospital out in the Seattle area that was considerably larger in an extremely urban, extremely wealthy area of the Seattle suburbs, and this little rural hospital is easily one to two years more advanced as far as its use of technology and the EMRs than that big metropolitan was.