Sometimes it’s all in the approach. When Gary Barnes was making a case for a new EHR system — one that would help achieve the goal of integration across the system — he knew it wouldn’t be an easy sell. So he used a clever analogy, explaining that buying a new system is like building a house — “You don’t want to put your old furniture in it.” In this interview, the 30-year health IT veteran talks about the “tremendous improvement” his organization has seen since creating a combined strategic plan, how the CIO role has evolved through the years, the role CHIME has played in advancing the position, and how he feels about Meaningful Use. He also discusses his team’s plans with analytics, his thoughts on physician engagement, and why he loves teaching.
- About Medical Center HS
- 2-year process to select Cerner
- Best-of-breed vs integrated solution — “It was overwhelming.”
- Economics of integration
- Selling to the board — “It’s like building a house.”
- 5-7 minute training intervals
- “We want to make sure that we’ve built something that people will use.”
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We had a vision of where the health industry was going so we could lay it out and say, ‘here’s what we need today. We want an integrated solution and we want something that will be able to do population health in the future.’
I explained to our board of directors it’s kind of like building a house. When you build a house, you really don’t want to put your old furniture in it, plus you want to landscape your yard.
They were impressed that we had went through the process and really looked at what it was going to cost and what it would also take to get full adoption of a new system.
We want to make sure that we’ve built something that people will use but also how do we do adoption. So we also put quite a bit of money into our training program.
By doing that, it gives us the ability to go back to our physicians and say, ‘You got the order in there, but if you would have done it this way, you would have saved a lot more clicks,’ and it builds a better adoption model.
Gamble: Hi Gary, thank you so much for taking some time to speak with us today.
Gamble: Just to give our listeners and readers an idea, can just tell us a little bit about Medical Center Health System.
Barnes: We’re a 402-bed community hospital. It’s actually an integrated delivery system. We have the main hospital, we have four urgent care centers across town, and we employ about 100 physicians anywhere from primary care to a lot of specialties with cardiology. We have a hospitalist program, anesthesia, pathology, wound care, so a lot of different specialties within that group. We’re also a part of the Texas Tech Medical School.
Gamble: What about as far as the area where you’re located — what’s the nearest city?
Barnes: We’re in Odessa, and 20 miles away from that is Midland. We’re in the middle of the Permian Basin. Our economy is all based around the oil industry, so it’s got its highs and lows; a little slow now, but we’re coming off of a four-year tremendous boom, so it’s been a challenge. It’s a good thing we were progressive and built the urgent cares because our ED just couldn’t handle the volumes that we’ve had out here.
Gamble: Oh wow.
Barnes: We’re halfway between El Paso and Dallas. We have a huge geographical area. We cover about 17 counties. We have two helicopter services that feed into our level 2 lead trauma hospital, so when the oil economy hits a boom, there’s a lot of activity going on here as the lead trauma hospital.
Gamble: Right. Now in terms of the EHR system, I had read that you’re in the process or planning to migrate to a new system?
Barnes: Yes. We’re working on finalizing our contract with Cerner for an enterprise EMR, which includes all their products, including patient accounting. The one thing we’re really looking to do is have an integrated solution. In the past we were a McKesson Horizon Shop and had all the inpatient portions, and then we had some McKesson products in our ambulatory and physician offices, but they weren’t integrated; they were interfaced, and we had a lot of struggles with those. The bottom line is with McKesson Horizon sunsetting their product in the near future, we had to move forward.
Gamble: You’re talking about becoming an integrated delivery system, and so obviously you have to have that data flow back and forth.
Barnes: Right. We’ve done really well. We’re an early adopter of Meaningful Use stage 1, and then we did that in the beginning years and now we’re Meaningful Use stage 2. We’re also a HIMSS analytic stage 6 hospital.
Gamble: As far as making this move to Cerner, was this challenging as far as selling it to the board and taking that leap?
Barnes: Absolutely. That’s something when we spent our time when McKesson announced they were going to be sunsetting the product. Of course the first thing we did was to look at their go-forward product, Paragon. We decided what we needed to do is create a committee and actually go out and evaluate what our needs were. We hired Leidos Health Consulting to help us with the voice of the customer and determine what we were really looking for in our systems — not only what we need today, but also what we’ll need in the future. We had a vision of where the health industry was going so we could lay it out and say, ‘here’s what we need today. We want an integrated solution and we want something that will be able to do population health in the future.’
That committee spent about almost two years reviewing the marketplace. We took our time demoing the lead products out there — Cerner, Epic, and McKesson — and reviewing what was out there, and whether we wanted to do a best-of-breed approach again or if we wanted to go with an integrated solution. Definitely it was overwhelming that everybody wanted to get away from the problems with best-of-breed and go to integrated solution. After that, we went out and started doing our site visits and created our RFPs, sent that out, spent a lot of time just reviewing and looking at the successes of what other people had done with both Epic and Cerner.
Gamble: Okay, so obviously a lot went into that. And like you said you had outside help looking into it, so once you decided, you were really able to present a very thought-out case and say, ‘here’s what we have. We put all this into it.’ I would imagine that makes the process a little easier.
Barnes: Right. The thing that everybody kept telling me is once you determine what system you’re going to be buying, it’s going to end up costing you about double what the core software product cost you for a five-year total cost membership, which I had a problem trying to figure out. I said, ‘I just can’t believe that it’ll be double whatever that cost is,’ which includes hardware and software and everything. And as we went through it and we started looking at all the pieces to be successful, you got to make sure you have the infrastructure, you have the people, you have your legacy support, and all those things really added up.
So as we moved forward, I was just kind of overwhelmed with the numbers. I explained to our board of directors it’s kind of like building a house. When you build a house, you really don’t want to put your old furniture in it, plus you want to landscape your yard. But when you’re looking at what we’re looking at, you’re not looking at just a house; you’re looking at a lake house. And when you build a lake house, you have to have a dock, and then you have to a boat, then you have all these friends come over so you have to build a guest house, and it goes on and on and on. I explained it to our board of directors with that analogy and they were impressed that we had went through the process and really looked at what it was going to cost and what it would also take to get full adoption of a new system.
Gamble: That’s interesting. When you said that it ends up doubling, that is really surprising to hear.
Barnes: Yeah. When I heard it the first time, people told me that and told me that, and I was like, ‘I can’t believe that.’ Then you start hearing all the people who have put in the systems, whether it was Epic or Cerner, you kept hearing the tremendous cost overruns and you started seeing that they ended up spending double what the system cost. I spent a lot of time thinking about that, and the more I put the numbers together it was like wow, it really is going to end up costing that.
Gamble: Yeah. I guess it’s better to present something like that upfront than to have to explain it in two or three years.
Barnes: Absolutely. And that’s exactly what our board of directors said, ‘We would rather know the cost now.’ I tried to think of everything. We put it in there and then we came back and we said, ‘Okay, we’re going to put a 20 percent contingency fund in there for anything that might go over.’ And they were very pleased that we thought far enough ahead that we would do that. Now the whole plan is we don’t get into that 20 percent contingency fund, but if we do, at least we’ve thought about it and we’ve budgeted it and we end up putting the product in the right way.
Gamble: And this will be a couple of years for the implementation?
Barnes: We’re actually looking at a go-live of April 1, 2017. One other thing that was kind of important to us is that adoption model. We want to make sure that we’ve built something that people will use but also how do we do adoption. So we also put quite a bit of money into our training program from the breakaway group with an adoption model, and that adoption model kind of helps us do training programs.
People in today’s society learn things by going through certain smaller increments of something. For example, we’re going to break our training modules down for the physicians in five to seven minute intervals. So if they want to learn how to do medication reconciliation, they could go down to a module and it shows them how to do it and they would be clicking on it like they would if it was really actually the system. It will grade them and show them how many clicks it takes. By doing that, it gives us the ability to go back to our physicians and say, ‘You got the order in there, but if you would have done it this way, you would have saved a lot more clicks,’ and it builds a better adoption model for that.
Gamble: Right. They can actually learn by doing it instead of just trying to process the instructions. That’s interesting.
Barnes: Exactly. And the good thing about this model and everything from the breakaway group is we’ll have that for the next five to seven years. So when new physicians come in that’s always a struggle of getting the proper training, because somebody trains them and they don’t know exactly how the product works. We’ll keep that training environment out there so that that tool, they could go through that and learn how to use it before we have to actually give it to them in a live environment. It’s better for patient safety that way.