When it comes to assembling an EHR selection committee, organizations have to think like Goldilocks; not too big, and not too small. Too big of a group means too many opinions to reconcile, and too small gives off the impression that only a few voices count. And so when Firelands Regional put together a group, CIO Mike Canfield opted for somewhere in the middle, a move he believes will pay off come decision time. In this interview, he talks about why the organization is ripping out its EHR system and why it’s critical to have a vendor that will serve as a true partner. Canfield also discusses the major changes he faced after joining Firelands, why having a solid knowledge of project management is a must, and what 20 years in health IT has taught him.
- About Firelands Regional
- Meditech 5.6.6 in acute, eClinicalWorks in practices
- Looking to layer on analytics
- Patient engagement struggles
- MU final rule delays — “We just don’t have enough time to recover.”
- Bracing for ICD-10
- Ripping out the core EHR — “We’re going to have to be able to do more advanced analytics.”
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From an interfacing perspective and a staffing perspective, it’s nice to have that commonality, but in terms of actually layering on some tools to allow us to do some advanced analytics across the whole community, we are not there yet.
It’s been, for us, a real struggle to get patients to go to a website to look at their information. This community just doesn’t seem to be very motivated to do that.
If they decide that they’re not going to adopt some of those changes, our organization — and I think a number of others — will not meet it for the year, because we just don’t have enough time to recover.
We’ve done a lot to try to remain ready. We’ve had certified coders and coding trainers on staff for a couple of years now. We’ve been pushing informational on to our physicians pretty much constantly for the last year, trying to help them understand the impact to their practices and doing anything that we can to support them.
We’ve got too many silos of data to be effective going forward. We recognize that at some point, we’re going to have to be able to do more advanced analytics and have better information all tied together for billing and other quality initiatives.
Gamble: Hi Mike, thanks so much for taking some time to speak with us today.
Gamble: To give our readers and listeners some background information, can you just talk a little bit about Firelands Regional?
Canfield: Sure. Firelands Regional Medical Center is a 255-bed hospital. We’re a regional medical center. We’re surrounded by a couple of independent community hospitals that send some of their more complicated cases here, and then anything that gets very complex, we ship out to either Cleveland or Toledo. We’ve got a wide range of services for a hospital our size. We have a very active behavioral health service, both inpatient and out, as well as cancer and complete cardiac care. We’re roughly a $250 million organization in terms of our net revenue.
Gamble: What’s the closest major city?
Canfield: We’re located in the north central Ohio, pretty much halfway between Cleveland and Toledo.
Gamble: You said that you’re surrounded by some community hospitals, and then I know Ohio has some big systems, too.
Canfield: Exactly. The Cleveland market is heavily consolidated with the Cleveland Clinic and University Hospitals, and the Toledo market is similar with ProMedica and pieces of the Mercy System.
Gamble: I’m sure it’s an interesting situation for you guys, being somewhere in the middle between the large systems and the community hospitals?
Canfield: Exactly. So far, the large systems haven’t been very interested in coming out to the middle of the state aggressively. There are four independent hospitals out here; I think we’re probably the last four in northern Ohio.
Gamble: In terms of the clinical application environment, what type of EHR system are you using in the hospital?
Canfield: The main system here is Meditech Client/Server 5.6.6. We’re scheduled for a 5.67 upgrade at the end of the year. We also have a number of McKesson Horizon applications that are still in production here for central scheduling, surgery, and materials. Our CPOE application is actually separate from Meditech. It’s a product called Meds Tracker that was created by Design Clinicals, who has since been acquired by First Databank.
Gamble: You said you’re scheduled to upgrade to 5.67 at the end of the year and how big of a step is that from the current version?
Canfield: We’ve been keeping up really well with the Meditech updates. We have that in our test ring already, and it doesn’t seem like it’s going to be a very dramatic issue. There are a couple key features in there that we’re pretty excited to finally see. Meditech’s IV spreadsheet has been a real problem for us for a number of years and there are some promised improvements in there, so we hope that will solve some issues for us, but I don’t think it’s going to be a major disruption to do that upgrade.
Gamble: Is there any other features of the 5.67 that you’re excited about.
Canfield: No, the IV spreadsheet has been a huge pain point for a very long time for us, so that’s our biggest hope here.
Gamble: And Meditech’s been in place for a while there?
Canfield: They have. I’ve only been here for four years and it was well established before I got here, so it’s probably been eight or 10 years since they installed it.
Gamble: What about in the clinics and physician practices — what are they using?
Canfield: We have an employed physician group of about 50 providers and they’re on eClinicalWorks. Our employed physician group also hosts eClinicalWorks for independent providers. They do that for, I think, seven or eight practices, and then there’s a large multispecialty group in town here that has also moved over to our hosted eClinicalWorks platform, so we have the luxury of the overall majority of physicians in the community being on a single application.
Gamble: Okay, that makes things a little easier, I guess?
Canfield: Yes, it certainly does.
Gamble: As far as how that talks to Meditech, how has that been?
Canfield: We used Iatric to do that integration. Again that was about four years ago, right as I was coming on board, when it had been struggling along. I think it’s to the point now where it is quite stable. We don’t get a lot of complaints about it, but there’s still some manual effort on the physician practice side for some results that come back that for one reason or another haven’t been tied to a specific order and those have to be manually matched, but that’s a relatively small number. So the basic order interface and the result interface back has been working for a couple of years now.
Gamble: In terms of the number of docs who have gone on eClinicalWorks through the hosted platform, is that something that kind of surprised you? Because I know that can be a challenge obviously when you have to deal with multiple different systems among the physicians.
Canfield: The multispecialty group in town used to be on NextGen. They became an Advance Payment ACO, and they felt that that platform wasn’t going to be able to provide them the access to data that they needed to be successful, so they took a look at some different options and elected to land on eClinicalWorks. It’s a fantastic gift to have the whole community on one platform or one application like that, but we haven’t put anything in place that really leverages that at this point. That’s something that we’re looking at how to do that going forward. Clearly from an interfacing perspective and across the community from a staffing perspective, it’s nice to have that commonality, but in terms of actually layering on some tools to allow us to do some advanced analytics across the whole community, we are not there yet.
Gamble: Where do you stand with Meaningful Use at this point?
Canfield: We’re in our second year of stage 2 and waiting for a final rule.
Canfield: We’re in great shape for stage 2 as long as they go with the proposed view, download and transmit. It’s been for us, like many organizations, a real struggle to get patients to go to a website to look at their information. This community just doesn’t seem to be very motivated to do that.
When we did year one, we had a very large, mostly volunteer push from a bunch of different departments to actually get patients to register and log in while they were still in the hospital, and that’s the way we were able to barely made it the first year. But outside of that, we feel really comfortable with the rest of stage 2.
Gamble: It seems like the jump as far as that requirement really took a lot of people by surprise, especially organizations where the patient population isn’t necessarily walking around with their smartphones all day, logging into things.
Canfield: Exactly. This is a rural part of the state here; it’s not like the west coast or the east coast where people are heavily connected and very technically savvy.
Gamble: Yeah. Now, other than that aspect of Meaningful Use, otherwise you said you’re pretty much on track with the requirements, at least as they stand now?
Canfield: Yes. We’re in good shape today.
Gamble: I can imagine the frustration just as far as this waiting game. Are you surprised that things aren’t more set in stone at this point?
Canfield: I’m very disappointed, along with everybody else. The proposed rule came out with plenty of time, and I think there was some good feedback on it. There wasn’t really anything in it that was highly contentious. The normal professional organizations weighed in and made suggestions, and I certainly would have thought that they would have been able to make a final rule by now. With it being September, if they decide that they’re not going to adopt some of those changes, our organization — and I think a number of others — will actually not meet it for the year because we just don’t have enough time to recover.
Gamble: Right. I guess it’s not something where you can really expect the staff and everyone to be able to do that quick of a turnaround. It seems like it’s asking a little bit too much.
Canfield: Right. And there’s that little ICD-10 thing coming along too that’s going to be somewhat distracting for at least a few months and most likely the better part of the year. So it’s not like we can scramble and do an ‘all hands on deck’ and try to get a bunch of people that had been in during the year to log in. We’re going to have other larger issues that are more directly related to the revenue stream.
Gamble: Right. And how do you guys stand with the ICD-10?
Canfield: We think we’re good. We’ve done a lot of testing. We were ready a year ago. We’re disappointed in that delay, and we’ve done a lot to try to remain ready. We’ve had certified coders and coding trainers on staff for a couple of years now. We’ve been pushing informational on to our physicians pretty much constantly for the last year, trying to help them understand the impact to their practices and doing anything that we can to support them.
So as a health system, we feel like we’re quite ready. I’m not sure how the physician offices, especially the independent practices, are going to fare. I think there might have been a little bit of confusion over the one-year allowance that physicians have gotten to not have to be as specific and as detailed in their coding in ICD-10, but to just have the right top-level code in place and Medicare says it will accept that. I think quite a few of our physicians have interpreted that as, ‘well, we can just kind of code whatever we want for you and we’re going to be fine,’ and that’s clearly not the case.
Gamble: Yeah. When you run into issues like that with the physicians, how is that dealt with? Are there structured meetings? How do you approach that?
Canfield: For employed physicians, it’s really straightforward. There’s a lot of information that comes out through their practice that keeps them up-to-date and informed. For the independent practices, we do everything we can to push information out to them, but there’s not a lot beyond that that we’ve been able to do. From an IT perspective. I do have some concerns that October 2, some people are going to start showing up and saying, ‘oh, I guess we really didn’t look at this and now we’re in a bind and we’d really like some help.’ We’re not prepared to do that at this point.
Gamble: Yeah. From your position, I imagine that’s a challenge because it’s not like when you’re in some of these systems where you can kind of put somebody in charge of that. When you don’t really have necessarily the staff or resources, I can imagine it becomes a little trickier when you have to handle a whole of lot concerns at once from the independent and employed physicians.
Canfield: Absolutely. If things go that way, it’ll be a little easier for us. Again, having everybody on a common system, it’s the same answers regardless of the practice, but in terms of how the system works, we don’t have to learn 23 different EHRs at the last minute. It’s still going to be a challenge that we’re not staffed to, if it occurs. Maybe everything will go great and there won’t be any problems at all.
Gamble: Right. Now as far as some of the other things on your plate, what about analytics? Is that something you’re looking at any time soon?
Canfield: With the size and complexity of our organization, we have not gone deeply into the analytics route. We do recognize, through Meaningful Use stage 2 and a number of other activities, that we’ve got too many silos of data to be effective going forward. We recognize that at some point, we’re going to have to be able to do more advanced analytics and have better information all tied together for billing and other quality initiatives.
At this point, we’ve just made the decision to rip out our core EHR and move to the some new platform which we’re still deciding on. But from an analytics perspective, our goal and our strategy has been to simply keep adding capability on a stepwise basis without really committing to any particular direction. So it’s pretty immature here in terms of analytics.
Gamble: With ripping out the core system, is this something that’s a couple of years out still?
Canfield: So we’ve got a really aggressive timeline. The lack of integrated information is painful and inefficient already today, and we don’t want to remain that way any longer than we have to. So our goal is to make a product decision just after the first of the year and then be probably 24 months after that before up and live in two years.