In the current health system landscape, where organizations just keep growing, Calvert Health System is considered to be quite small. But it’s a “mouse that roars,” according to CIO Ed Grogan, who has spent the past 12 years leading Calvert’s transformation from a small hospital to a dynamic health system. In this interview, he talks about the Maryland eCare initiative and partnerships that have expanded Calvert’s reach and helped improve care for patients across the state. He also discusses the organization’s comprehensive EHR-selection process—and why they ultimately chose Meditech; their work with CRISP, including plans to implement a “Magic button” for physicians; the importance of team chemistry; and his “passion for technology integration.”
- About Calvert
- Allscripts ED, NextGen in ambulatory
- 9-month EHR selection process: deep dives of “the big 3”
- Meditech’s population health roadmap
- Using consultants
- 17 focus groups — “We wanted to engage all the major stakeholders in the organization.”
- Physician advisory council
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Population health management is very important for us — not only because it’s the right thing to do to help maintain the wellness of our community but also, it’s a requirement for our financial survival.
We wanted to make sure Meditech had a good roadmap for the future, and that’s what we concluded at the end of the selection process.
We had physicians and nurses talk about their experience with Cerner, with Epic, and with the newer Meditech platforms. So that was also very enlightening, and of course it also helped us garner stakeholder buy-in.
I don’t see the hospital making the decision or the health system making the decision necessarily. I think we certainly will engage the independent physicians as far as what our next move would be there.
Gamble: Hi Ed, thank you so much for taking the time to speak with us today.
Grogan: Thank you, Kate. I look forward to it.
Gamble: Great. So to give our readers and listeners some background information, can you just talk a little bit about Calvert Memorial — bed size, ambulatory offerings and where you’re located?
Grogan: Calvert Health System is a small health system located in Calvert County, Maryland, which is south of Annapolis and just out of the suburbs of Washington, D.C. We’re about 45 miles southeast of Washington, D.C., and about 60 miles south of Baltimore. Our primary service area for the system covers 125,000 people, about 90,000 residents of our county and the fringes of surrounding counties as well. We’re about 100 bed hospital, and we have a transitional care unit as well in our facility. We also have a number of medical office buildings spread throughout the county, north, south and east, providing outpatient services for imaging and lab. We have employed physicians, and our hospital provides a service to independent physicians as a management service organization hosting physician practice management systems and electronic health records for those independent physicians as well.
So we’re the sole provider in our county. We’ve been around since the early 1900s, and have recently received quite a few quality awards for the organization. In 2014, Consumer Reports acknowledged us as receiving the top score among all hospitals in Maryland and in the Washington, D.C. area for patient safety. We also were a top performer for Joint Commission for quality and also received the top 10 percent from Healthgrades recently for quality. We received Most Wired for the first time in 2014 for the breadth of the technology we’re deploying, and we also were one of 25 hospitals nationwide to receive the award from HIMSS Media for best hospital IT department.
So we had a great year this past year, and we’re doing very well financially. We’re an A-rated hospital. We have almost a year cash on hand, so we’re successful in terms of quality, we’re successful financially, and we’re independent. We’re a single-hospital health system, and many smaller organizations of our size have recently merged around us and in our states. There are very few hospitals and very few health systems of our size that are independent, and our board wants us to remain independent for the foreseeable future.
Gamble: Right. You’re certainly right about that. It’s a trend we’re seeing everywhere, and I definitely do want to get into that a little bit more. But just to further lay the groundwork, in terms of the clinical application environment, you are on Meditech in the hospital, correct?
Grogan: Yes. We currently use the Meditech Magic HIS. We installed that in 1995. We supplement that with other non-Meditech applications; we are currently using Allscript ED in our emergency department and we’re also using NextGen for our physician practices and for the independent practices that we host.
Gamble: Okay. You said you’re on Magic — are you looking to upgrade at some point soon?
Grogan: Yes. We spent the past nine months with the selection process. We had about 150 people in the organization provide input in that process. We had a selection committee of about 15 people representing physicians, nurses, clinical, ancillary, finance and IT and, also had our executive team also engaged in the selection process and we recently announced that Meditech in our vendor of choice. We’re skipping a generation of their technology. We’re skipping the client server generation to go to the new Meditech advanced technology platform, the latest generation of their product, and we’re in contract negotiations with Meditech currently.
We looked at the big three. We looked at Epic, Cerner and Meditech, and determined that for our organization the best fit and the best solution for us, would be Meditech at this time. But we’re currently in contract negotiations with Meditech; we haven’t signed a contract yet. We’re only committing to the hospital at this point. We’ve elected to wait a year or two to relook at ambulatory. We know that Meditech has a new web ambulatory product that they recently announced at HIMSS. We’ve seen the product. It looks very encouraging.
We’ve also looked at what they’re doing as far as population health management in the future. That’s something they’re also developing and have a roadmap for, and that’s very encouraging because our hospital has been capitated for four and a half years. In the state of Maryland, there’s rate regulation by the health services cost review commission. Right now, every hospital in Maryland with the exception of one, as of this year, is under capitation under one of two plans. And so population health management is very important for us — not only because it’s the right thing to do to help maintain the wellness of our community but also, it’s a requirement for our financial survival and to remain independent.
We did look at that very closely and we’re very happy that Meditech has a roadmap for that. Again, we’re going to be looking to make an ambulatory decision in the next year or two as to whether we stay with NextGen and go to their next generation platform, or whether we go to Meditech web ambulatory, or look at possibly another solution. Our target date for being live with the new hospital information system is September 1, 2016.
Gamble: Okay. You talked about the selection process which is something that’s been going on for a while, and the committee of 15 people. Is that something you put together right before it to try to get different representation throughout the organization?
Grogan: Yes. We actually also engaged a consultant to help us through the selection process, Huntzinger Management Group. We worked with Denise Reeser. I’ve known Denise from Maryland HIMSS; I was on the board with her, and she was president of Maryland HIMSS at one point. And so we utilized their methodology and they also provided us a template for the RFP. But, yes, we did want to take a collaborative approach and we wanted to engage all the major stakeholders in the organization, so we formed the selection committee and sort of developed the methodology last spring. We held 17 different focus groups during the summertime, engaging about 150 people, including physicians, a lot of medical staff members, nurses, etc. to help define the functional requirements for the RFP.
And so we went ahead and incorporated all those into the RFP. We took the boilerplate that HMP provided to us and we embellished it, added to it. We sent the RFP out and got the responses back. In terms of functional attributes, there were like 3,885 functional attributes that our committee, based on their subject matter expertise, divided up and evaluated, and so it was quite a thorough evaluation. We went from that to viewing the RFP responses and narrowing down to two vendors. We actually narrowed it down to Meditech, our incumbent, and Epic. The trend in Maryland recently has been that a lot of hospitals and health systems have been signing with Epic in the past five years, and so we gave them a further look. We went on site visits and looked at options, and at the end of the day, determined that, for our organization, the best solution was to stay with Meditech.
Gamble: Right. They are certainly it seems geared more towards smaller organizations and independents.
Grogan: Yes. When we looked at the functional needs of the organization, obviously Epic is a very mature product. I spent the last two HIMSS or prior to this past one basically spending almost the entire conference at the Epic booth and at the Cerner booth, and did a very deep dive into that. Both of those platforms are very good. Cerner’s excellent. Epic is excellent. And of course, Meditech has a lot of market share and it has a good solid product and has a good roadmap for the future. So that’s what we wanted to see; we wanted to make sure Meditech had a good roadmap for the future, and that’s what we concluded at the end of the selection process.
Gamble: I can see how that would factor in too when you’re talking about the trend of Epic hospitals in Maryland and all the pressure to connect.
Grogan: Yeah. We looked at affordability. We also looked at the functionality to survive in this capitated environment with population health management and we concluded that, although Meditech was a little bit behind Epic in their provision of population health management tools, they did have a clear vision and a clear roadmap, and they are clearly developing in the right direction to meet all of our needs. The Epic option still remains for us on the ambulatory side so we look to web ambulatory. It looks very promising. It looks to be a great product but it’s very early in its development so we decided to wait a year or two to make a decision on the ambulatory side.
So a year or two from now when we make a decision on the ambulatory side, our three options are to stay with NextGen and go to the next generation product, go with Meditech web ambulatory, which would provide a patient centric record for our community, or look at Epic hosted by a larger health system — we’re too small to host Epic — on the ambulatory side, which would connect our physicians with the rest of medical community through the Epic network. So those are sort of the three options on the table.
Gamble: One big decision down, another to go.
Grogan: That’s right.
Gamble: Did you find with having so many different focus groups that it was almost overwhelming having so much information and input from all these different parties?
Grogan: No, I thought it was very important. It actually was enlightening to hear folk’s comments, not only about what they wanted to see in a new system, but also in talking about other systems they worked with. We had physicians and nurses talk about their experience with Cerner, with Epic, and with the newer Meditech platforms. So that was also very enlightening, and of course it also helped us garner stakeholder buy-in. Going through the elaborate selection process engaged the organization to the point where folks are all committed. And by the way, it was a unanimous decision of the selection committee to go with Meditech. But, basically, it gets the stakeholders involved, engaged and excited for the next step which is the implementation.
Gamble: Do you think that your strategy’s going to be similar with deciding on the ambulatory product?
Grogan: Yes. We currently have governance on the ambulatory side because we serve as an MSO. We have the physician advisory council, the top level of governance. And so we have a physician from an independent practice who chairs that committee. We meet monthly, and they are very much engaged. We engaged the medical staff to a very significant extent back in 2009 when we selected and signed with NextGen, and we’ll go through that process again, engaging the physicians, the medical staff members, certainly those who are using the NextGen product today. We have about nine practices — some large, some small — and we’ll engage them in the evaluation and throughout the process. So yes, I don’t see the hospital making the decision or the health system making the decision necessarily. I think we certainly will engage the independent physicians as far as what our next move would be there. We’ll probably look at that in about again one to two years, probably two years.