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.
- Success of CRISP — “They listen to the folks that are doing the work on a daily basis.”
- Preparing for ICD-10 & computer-assisted coding
- Improving workflow — “It can be very labor intensive”
- “Fragmented” portals
- Working with AT&T and Vivify to create Bluetooth-enabled kits
- “It has to be a clinical-IT partnership.”
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They listen, and they listen to the folks that are actually doing the work on a daily basis. They’re getting the requirements from those individuals and prioritizing what they work on next based upon that feedback.
Right now, the workflow is such that coders have to go through lots of documentation in the electronic world to identify the right code for a particular patient when he or she was discharged from the hospital. It can be very labor intensive.
One would have thought when you talk about patient portal, that patients are going love it; that they can’t wait to get in to get their information. That’s not been the case here.
We’re changing things a bit. We’re giving the patient access to information. We’re trying to educate the consumer in terms of all things health and wellness. But that’s going to take a while.
Gamble: We’ve heard a couple of people talk about CRISP. It seems like it’s one of the more functional HIEs out there. I wonder, what do you think CRISP is doing right?
Lara: The staff at CRISP do a really good job keeping in touch with the folks that are doing the work on a daily basis. They have a clinical advisory committee, they have a technology advisory committee, and they take the information from those committee members very, very seriously. They’re always looking for ways to improve or provide value added services to their customers — to the hospitals, to the provider base, etc.
The first thing is getting information about patients, and they did that. They accomplished that. They have an event notification service so that for providers that subscribe or even like case managers that subscribe to that, if a patient associated with them is admitted to any of the hospitals within the state of Maryland, they get an event notification that the patient was admitted. They’ve also worked with a number of the hospitals, including us, to help meet the transitions of care via the CCD requirement for Meaningful Use. They’ve set up their own direct trust accounts and things like that.
The other thing they’re doing is they’re working closely with other pieces and parts of the state government. For example, the organization that’s responsible for regulating the healthcare and healthcare services in the state of Maryland, HSCRC, they’re becoming a source of reports for that particular organization, and subsequently, for the rest of the hospitals in the state of Maryland. So if I wanted to take a look at my readmissions throughout the state of Maryland, I could probably get that information from CRISP.
So again, they’re doing a lot of really good things for the state, including supplying meaningful data. If you think about that, they have a rich source of data, so they’re supplying lots and lots of data for organizations within the state to make some decisions about patient care. We’re going to be all charged with this thing that I still can’t get my hands around in terms of population health — what does that mean? One of the things we know that we need with population health is data that tells about what’s happening with our patients. CRISP is doing a really good job making that data available, but at the same time, understanding the need for governance and the need for patient confidentiality and security, so they’re kind of building all of that into the framework and the services that they provide. Going back to the secret to their success, they listen, and they listen to the folks that are actually doing the work on a daily basis. They’re getting the requirements from those individuals and prioritizing what they work on next based upon that feedback. I think they’ve been very, very successful. They’re a good group of people to work with.
Gamble: Yeah. That’s what it certainly sounds like. As far as some of the other things that are on your plate, where do you stand with the ICD-10?
Lara: That’s a great question. One of the things I’m responsible for is not only health information services, but health information management, which back in the day, was medical records. I can say very proudly that our organization from our coding staff, is ready for ICD-10, and that’s due in part to the great leadership that we have in our HIM department. Our HIM director was very disappointed that the ICD-10 implementation was delayed, because they were ready. So we have that going on. She’s been spending a lot time making sure that her staff is educated, but she’s also spending a lot of time making sure that the providers are educated in terms of how ICD-10 may or may not impact them.
The other thing that we’re going to be implementing this summer is computer assisted coding. There are a number of companies are out there that have it. We decided to purchase computer assisted coding from 3M; what this program does is it actually helps coders. Right now, the coding workflow is such that coders have to go through lots of documentation in the electronic world to identify the right code for a particular patient when he or she was discharged from the hospital. It can be very labor intensive to make that happen. But now, with computer assisted coding, the whole notion behind that is the computer itself aids the coder in serving up the documentation that might be needed for them to code a particular chart or a particular episode of care. But also, in the event of audits, that information is readily available to the auditor so the auditor can see this the documentation that the coder used to make this selection about this particular ICD-10 code.
We’re really excited about starting this implementation. Our hope is that we’ll be live by the end of August with the computer assisted coding — well in advance of the ICD-10 deadline, so we’ll have a chance to kind of practice and use it before ICD-10 kicks in. We’re getting really excited about making that happen.
Gamble: Definitely. I would think that as part of that there’s a significant focus on education for the coders and everyone who uses the system.
Lara: Exactly. That’s the big project that we have going on this summer.
Gamble: You mentioned briefly before about patient portals. Is that something that you have at this point?
Lara: We do. We actually have the Meditech patient portal. It’s a great portal. Information is there for the patients to look at any services they can have done at Union Hospital. Our release of information folks, under the HIM umbrella, are the folks that actually control the access and make sure that the right security checks are done in terms of who gets access to the portal. They’re the staff that actually goes out and goes on the units and tells the patients about the portal and get patients to sign up for the portal. That’s been really a good adventure for us.
Interestingly enough — and I know that we’re not alone in this — one would have thought when you talk about patient portals, that patients are going love it; that they can’t wait to get in to get their information. That’s not been the case here. And in talking to colleagues throughout the country, meeting that 5 percent of all discharged patients actually going in and viewing, downloading, or transmitting their information has been a challenge. You wouldn’t think so. It sounds like a small number, but I really think that from a cultural perspective, we still need to change the culture a bit and to make patients and the community and consumers understand that they’re responsible for their own health and wellness, and part of being responsible is having the information about themselves, and one place to get that information is in the patient portals. We still have ways to go with that, but the tool is there.
I think the challenge is that there are multiple patient portals depending on what EMR is being used. My ambulatory practices use Allscripts as their EMR, so there’s an Allscripts patient portal to get pieces of information from, and then I have the Meditech patient portal to get pieces of information from. If a patient were to go to one of the hospitals down the road, there would be another patient portal, so it’s still a bit fragmented from a patient perspective. A patient conceivably may have to sign into multiple portals to get the full picture of what’s going on with them. So we have a lot of work in that area to make it easier and better for the patient, but I think the tool is there. We just have to think a little bit broader in terms of how do we make it more usable for the patient.
Gamble: Right. It’s definitely what we’ve been hearing; that there are so many challenges. It’s one of those things that sounds great in theory, but when you’re talking about patients who have a one-time visit to a hospital or are not chronic care patients, it’s definitely a challenge, and one that’s the focus of a lot of people right now.
Lara: And it’s a start. We’re trying to change the culture. We’re trying to make the consumer the captain of his or her ship, and that’s a different mindset, because traditionally, it’s always been the physician. And why is it the physician? Well, the physician has the knowledge and the experience and access to information. We’re changing things a bit. We’re giving the patient access to information. We’re trying to educate the consumer in terms of all things health and wellness. But that’s going to take a while. Again, the tools are there; we just have to figure out how to change the culture with the tools that we have and make the tools even better.
Gamble: Another piece of that patient engagement picture is remote monitoring and that’s something where I know a lot of people are in the early stages or the planning stages. What are your thoughts around that? Are you looking at that anytime soon?
Lara: That’s another great question and one I’m really happy to share with you. From an HIS or an IT world, I own the technology or have a say in terms of technology. I have a clinical background as a nurse, but I don’t necessarily own the patient population. So in order to make telehealth or remote patient monitoring successful, it has to be a clinical-IT partnership, and at Union Hospital, I’m happy to say that that partnership exists with the care management department. The HIS department has partnered with case managers to identify patients who may be at higher risk for readmissions, and those are the usual suspects — patients with chronic conditions like CHF, COPD, diabetes, etc. Are there opportunities once the patient leaves the hospital to monitor those patients, give them feedback in terms of how they’re doing, and give them the tools where they can self manage so they’re not going to end up in your ED or admitted to your hospital?
Union Hospital has worked with AT&T for the data plan and the technology to support remote patient monitoring, and Vivify, which is a company that actually has the tools. We purchased 10 kits, and in those kits, there’s a blood pressure cuff, there’s a pulse oximeter, there’s a scale and then there’s a tablet that can be used for the patient to enter information and answer questions. It’s all Bluetooth-enabled technology.
What happens is the case managers identify a particular patient that may be a good candidate for remote patient monitoring. They provide the patient with the kit and the education surrounding how to use it, and then the case managers monitor the patients on a daily basis. There’s a patient care portal that the case managers have access to, and they’re able to see on a daily basis any aberrations in the physiological monitoring of the patient. Is the patient’s blood pressure 190/90, and why is that? Has the patient’s weight changed from one day to the next, and why is that?
The patients also from a qualitative perspective answer questions in terms to how they’re feeling, and then the case managers can look at their responses and then pick up the phone and call the patients say, ‘hey, I saw that your weight increased from yesterday. Tell me about what happened. Do your legs look swollen?’ They can also tailor some education to the patients, whether that education is in the form of videos or things to read. And we didn’t purchase this piece yet, but there’s also the possibility of teleconferencing with the patient, so rather than just having the case managers pick up the phone, they can use the technology to kind of have a face-to-face chat with the patient.
I wouldn’t say we’re piloting it, but we’re just starting to use this technology. We just initiated it probably about six weeks ago. We currently have about four patients that are enrolled in the program so far. It’s a kind of a proof of concept for us in terms of is this another tool that we can have in our toolbox to help patients understand the importance of self management of their disease, and also a way for the staff at Union Hospital to interact and interface with the patients on a regular basis, with an objective of keeping them healthier and keeping them from having to make an ED visit. So we’re trying to intervene as early as we possibly can. We’re really excited about that.