Call it history repeating itself. In the fall of 2013, Anne Lara and her team were knee-deep in plans to become one of just two organizations (at the same) to migrate to Meditech 6.1. A year and a half later, Union Hospital of Cecil County is at it again, paving the way by going live with Meditech’s scribe functionality. In this interview, Lara talks about what it takes to be an early adopter, the biggest hurdles with attesting to stage 2, how her team is partnering with DataMotion to enable direct messaging, and the complexity of HIE when you closely border two states. She also discusses the culture change needed to increase patient engagement, her key concerns as CIO, and why she feels “very positive” about where the industry is headed.
- About Union Hospital
- Early adopter of Meditech 6.1 & scribe functionality
- “The organization has embraced the concept.”
- Partnership with Meditech — “We have a very clear escalation path.”
- MU 2 challenges
- Direct messaging with DataMotion
- Maryland & Delaware HIEs
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It wasn’t just an IT project; it was an organizational commitment to making the go-live a successful event.
We continue to look at the opportunities to use our EMR to help improve our patient outcomes as well as improve our clinical workflow.
We have weekly calls with them. We identify issues. We have a very clear escalation path if things need to be escalated. So we work really closely with Meditech, both from the clinical workflow perspective but also on the revenue cycle end.
The transmission of CCD is there. We want to now take that information and consume it right into the Meditech record so that the information is readily available to the provider.
The information is there; it’s just a matter of knowing where to find it.
Gamble: Hi Anne, thank you so much for taking the time to speak with us today.
Lara: No problem. Happy to speak with you, Kate. Thank you.
Gamble: We’ve spoken before, but if you could just give a little bit of background about Union Hospital Cecil County, what you have in terms of bed size, ambulatory care, things like that.
Lara: Sure. Union Hospital Cecil County is the healthcare system for all of Cecil County, Maryland. We’re licensed for 122 beds. We have a medical staff of close to 400 providers. We’re all about servicing the community and we’re a very mission-driven organization in terms that we feel responsible for maintaining the health of the population of Cecil County. We have a number of owned physician practices providing primary care, a number of the specialties like pulmonology, rheumatology, OB GYN, GI, GU, etc. So we’re a pretty broad-based community-based hospital.
Gamble: Okay. And you are in what I guess is considered the northern part of the state?
Lara: We’re close to Delaware and we’re actually close to Pennsylvania, so it puts us in a unique position. From a population perspective, we have a number of customers that we serve that are in what I guess is called the western part of Delaware and right across the border in Pennsylvania. But I would say we’re in the northern or northeastern part of the state of Maryland.
Gamble: When you and I last spoke, you were preparing for the go-live of Meditech 6.1 and you were a very early adopter. So I wanted to start by seeing how everything went with that.
Lara: That’s a wonderful question, and interestingly enough, yesterday was the anniversary of our go-live. We’ve been live with Meditech’s 6.1 since February of 2014. The go-live event went very, very well. The organization embraced this particular adventure, and that was the key to success. I think I’ve said this before, but it wasn’t just an IT project; it was an organizational commitment to making the go-live a successful event. So because of that support from the top down, we’ve moved forward very, very well with the Meditech 6.1 go-live.
Since that time, we’ve actually taken on some additional functionality that Meditech had to offer. We actually went live with 6.1.3 in February. In December of 2014 we went live with 6.1.4, which was another iteration of the Meditech 6.X platform. It has some advancements in terms of meds reconciliation, discharge process, transfer process, etc., that we found very helpful from an organizational perspective. So we went live with that in December of 2014, and we continue to look at the opportunities to use our EMR to help improve our patient outcomes as well as improve our clinical workflow.
The other interesting thing we have going on is we are going to be going live with physician documentation in the ED. And you can say, physician documentation isn’t a big deal. Well, we’re the first hospital actually to go live with Meditech’s scribe functionality. The workflow to the ED these days is there is a scribe to actually help the provider do their documentation while they’re seeing the patient in an effort to improve patient outcomes and allow the provider to focus on patient care. So we have scribes — actual individuals — who document with the providers. Meditech did not have that scribe functionality in their product until 6.1.4. They do now. Our team has spent a lot of time working with our Maryland Emergency Physician group to create templates in Meditech and work on the workflow. So we’re going to go live tomorrow with that functionality in our ED, and we’re really looking forward to that.
Gamble: Wow. So this is pretty good timing. Obviously things have continued to go pretty well just as far as being an early adopter and being willing to take on these things before they’ve really been established.
Lara: Yes, and again, it’s an exciting time. As I said, the organization has embraced the concept of being an early adopter and understands what it means to be an early adopter, and Meditech has been right there with us helping us along the way. We have weekly calls with them. We identify issues. We have a very clear escalation path if things need to be escalated. So we work really closely with Meditech, both from the clinical workflow perspective but also on the revenue cycle end of the business.
Kate: Okay. Now, with 6.1.4, you talked about some of the upgrades as far as meds reconciliation but also discharge and transfer. This is something that is such a huge theme, and you can see why, with everything going on now and all the regulations focusing on being able to clean up that whole process.
Lara: Yeah. It’s been great. The other thing is that we really wanted to make sure that we were able to successfully attest to Meaningful Use Stage 2, and as you mentioned, the whole transition of care and communication outside of the four walls of the hospital is an important component in the Meaningful Use Stage 2 requirements. So we did our 90-day attestation from July 1 through September 30 and we attested on Halloween to the Stage 2 Meaningful Use requirements. Meditech helped us with that in terms of making sure that we were gathering the right information and collecting the right information regarding core measures and CPOE metrics.
The other interesting part that was a new requirement in Stage 2 was the whole concept of the patient portal, as well as being able to generate this continuity of care documentation (CCD) — how do you do that and what does that all mean? So in order to meet that requirement, we had to figure out how to transmit that CCD document from Meditech to some of our community providers. There’s another concept out there called direct messaging or making use of a HISP, which is a health information service provider. So we engaged Meditech. A number of the EMRs have their own HISP; Meditech opted not to. They’re what they call HISP-agnostic.
There are a number of companies out there that actually provide that direct messaging functionality. We were fortunate enough to discover a company called DataMotion, and we worked very closely with DataMotion and Meditech to create our direct messaging service. As a matter of routine, when we have a patient that’s discharged from the hospital, we’ve included a provider’s direct messaging address in our Meditech address book, so when the patient associated with that provider is discharged from either our ED or from one of our in-patient units, that provider is automatically sent a continuity of care document from Meditech to them. When that patient goes back to see that provider for the first time after being discharged from the hospital, the provider has ready access to the patient’s information in terms of what happened to them in the hospital. That was a great partnership with DataMotion and with Meditech to make that routine almost seamless, and then because of that, we were able to realize and very competently attest to meeting that requirement from a Meaningful Use perspective.
Gamble: Right. I’m sure that from a workflow perspective, there were benefits for the clinicians.
Lara: Yes, definitely. The next step we’re working on is when we get that direct message or that CCD from a provider or from another hospital, we’re working on getting that information consumed into our Meditech system. So that’s what we’re working on right now, to take all that information that we may receive from another provider — be it somebody in the community or from one of our neighboring hospitals or from a hospital in California — that the technology is there. The transmission of CCD is there. We want to now take that information and consume it right into the Meditech record so that the information is readily available to the provider taking care of that patient.
Gamble: Okay, so that’s kind of a next step.
Lara: Yep, and we’re actively working on that right now.
Gamble: Do you run into some challenges being located where you are and having some patients who are in Delaware and Pennsylvania just as far as having that continuity of care?
Lara: There are challenges, but when I think about it, the information is there; it’s just a matter of knowing where to find it. One of the other sources of information resources that I think we’re doing a really good job with here at Union is we’re tapping into the statewide health information exchanges. The state of Maryland has a statewide health information exchange called CRISP. We have partnered with CRISP for the past three or four years since they’ve come into existence. And what we do is that we share admission/discharge/transfer information about our patients with CRISP, we share laboratory work, dictated reports, etc., to the HIE. That information is available to any provider who may have a relationship with that patient. And that’s really important — no one can just go into CRISP and say, ‘I want to find out about Anne Lara.’ You need to have a relationship with the particular patient.
So if we were to send a patient down to one of the Baltimore hospitals, and let’s pretend the CCD, for whatever reason, didn’t work. A provider in one of the hospitals in Baltimore, if they subscribe to CRISP, could actually get all the information about that patient while they were under Union Hospital’s care through the HIE. So that’s a really good place to get patient information. We also are partnering with the Delaware Health Information network (DHIN) to do the same thing, to make sure that we’re making the information about our patients available to any providers that might be in the Delaware area.
Now Pennsylvania has three regional HIEs, and from what I understand, they’re not as far along in terms of development and the services they offer as those of Delaware or Maryland. So as soon as they get online, we’ll definitely be exploring what we can do to partner with probably the southeastern Pennsylvania HIE to make sure that we’re providing another source of information for providers when they’re seeing our patients.