When Brian Sterud meets with his staff, he often asks two questions: “What can we do to make this more productive,” and “What did we not do well enough?” Not just because continuous improvement is a key priority for the organization, but because it provides a platform for construction criticism, something he feels is crucial. In this interview, Sterud talks about the momentous decision his team is about to embark upon, why switching from one EHR system to another is almost more difficult than going from paper to electronic, the “sense of urgency” across the industry to beef up security, and the “holy grail” when it comes to portal adoption. He also talks about the enormous impact CHIME Boot Camp has had on his professional growth, and the characteristics CIOs need to have going forward.
- About Faith Regional
- Being independent — “From an IT perspective, it’s incredible.”
- Soarian in the hospital, NextGen in clinics
- EHR evaluation process in Q1 2016 — “We’re exploring our options.”
- Data flow between hospital & clinics
- Biggest MU 2 hurdles
- Leveraging MobileMD to hit thresholds
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The advantage is that all the decisions are made here. We are able to act quickly and we can be very agile. We have the ability to control our own fate and have the input that we need and the autonomy that we need to be successful.
You want to make sure that you fully vet out all the options because that’s not a decision that you take lightly, and not a decision that you would change direction on in a short amount of time. So you need to do your due diligence and make sure that you’re making the appropriate decision.
There’s definitely more work that we could do. But given the feeling we’ll probably end up on a platform that has a unified database among the ambulatory and inpatient environment, we’ve put a hold on some of that because we feel like we’ll be making a decision that may negate that work.
We’ve been able to work with patients while they’re here and implement some strategies that have allowed us to be in a really good position where we have 20 percent on our view, download, transmit. I don’t know exactly where the rest of the country is, but I would imagine 20 percent would be fairly positive relative to our peers.
Gamble: Hi Brian, thank you so much for taking some time to speak with us today.
Sterud: Hello. My pleasure.
Gamble: To give our listeners a little bit of an idea, can you just talk about Faith Regional Health Services — what you have in terms of bed size, ambulatory services, where you’re located, things like that.
Sterud: We’re located in Northeast Nebraska, in Norfolk, Nebraska. We are a 227-bed hospital but we have a full continuum of care. We have actually two campuses in Norfolk as a result of a merger a number of years back, and we primarily operate on one of those two campuses. We have about 26 clinics and own physician practices; 10 of those are scattered around northeast Nebraska in our service area. We run the full gamut, cradle to grave with births, and we have a nursing home, an assisted living, home health, and hospice. So we really have a nice combination of services and offer quite a few services that I think many in our type of organization may not offer as far as being in a community of about 25,000 people.
Our service area geographically expands to the west quite a ways. We actually cover probably over 100,000 lives in our service area. We have heart program and a cancer program, and those are types of things that might make us a little bit unique as far as relative to other facilities that are maybe our size or in similar-sized cities.
Gamble: And you’re an independent hospital, right?
Sterud: We are. We are an independently owned hospital. There’s not a ton of those left, it seems like, but we are.
Gamble: So obviously there are benefits and drawbacks to that as far as not having the financial backing, but you do have some of that agility. I can imagine that’s a nice thing to have with everything kind of changing so fast.
Sterud: From an IT perspective it’s incredible. While we don’t have the ability to lean on the mothership, so to speak, or to lean on sort of a corporate or central central or corporate office — there would be so many nice things about that, certainly the advantages, in my opinion, outweigh the disadvantages. The advantage is that all the decisions are made here. We are able to act quickly, and like you said, we can be very agile. We have the ability to control our own fate and have the input that we need and the autonomy that we need to be successful.
We’re working towards a strategic alliance of sorts, that will allow us maybe to have a little bit better partnerships in our state, but there’s no ownership interest there. So I think that’s very exciting to be able to partner with some other organizations, but still have our local autonomy and governance.
Gamble: Alright. So in the past, you’ve been part of a provider network — is that something that you’re still doing?
Sterud: We’re working towards building some of those relationships in the region. We’re more than a community hospital. We are in stride to be a regional referral center, so we work hard on relationships in the region with other providers. We have some affiliations. Right now, currently, we don’t have a formal provider network other than the obvious alignments with our employed physicians and also the rest of our medical staff — our independent physicians are important to us as well.
Gamble: In terms of the clinical application environment, what type of EHR system are you using in the hospital?
Sterud: On the hospital, we are a Siemens Soarian shop. So we have Soarian Clinicals.
Gamble: That’s been in place for a while?
Sterud: Yeah. I’ve been here for about three years and it was in place before I got here. I think 2010 was when it was put in.
Gamble: What about in the clinics?
Sterud: In all of our clinics, we’re live on the NextGen product.
Gamble: So the Soarian product, obviously it’s making that move to Cerner. But is that something where it doesn’t really affect you this far or you don’t anticipate it will?
Sterud: That’s an interesting question. Our financial and revenue cycle package is a Legacy Siemens product called MedSeries4. Thus far, there’s no formal need to make a move, but it is nice that we’re exploring our options to see if we were to transition with Cerner. We’ll probably take a look at more than just that transition starting next year. We’ll take a pretty close look at what makes the best sense for us; whether it’s Epic or Cerner or something else, we’re going to take a look and make sure we know the right move for us.
Gamble: So that’s something you’re looking to gear up for as far as putting together a team and doing all that research and work that needs to be done?
Sterud: Yeah, exactly. We’ll start that evaluation process in the first quarter of next year.
Gamble: I imagine that will be interesting. Obviously, it takes a lot of time and effort, but probably it’s an interesting experience to go through.
Sterud: I think it’s one of those things where you want to make sure that you fully vet out all the options because that’s not a decision that you take lightly, and not a decision that you would change direction on in a short amount of time. So you need to do your due diligence and make sure that you’re making the appropriate decision. I know that in the industry now, it seems like everybody was fixated on putting a product in a couple of years ago. But now you’re starting to see this next wave of replacement of products, and I’m not sure it’s easier. Going from paper to electronic, that’s a big jump. There’s no comparison because electronic is electronic and paper is paper. Other than the whole paradigm shift, it’s different than going from one electronic system to a different one. Then you run into ‘well, my previous EMR did this, and my previous EMR had this alert mechanism.’ I think it almost could be more difficult.
Gamble: Yeah, and I’m sure it’s going to be on your mind and on everybody’s mind in this type of financial environment that you don’t want to have be doing this in another four or five years. I’m sure that’s the goal, but maybe that puts even more pressure on making sure you pick the right system.
Sterud: That’s exactly right.
Gamble: Now you said the clinics are on NextGen?
Gamble: And then how has that been as far as the integration back and forth?
Sterud: It’s proven to be fairly challenging. There really wasn’t any integration between the systems when I got here. We’ve done a couple of things to make that process a little bit easier and to allow the ease of accessing data among one another.
Now the difference would be if we knew or felt that our long-term strategy was going to be to stay on this particular platform, there’s definitely more work that we could do. But given the feeling we’ll probably end up on a platform that has a unified database among the ambulatory and inpatient environment, we’ve put a hold on some of that because we feel like we’ll be making a decision that may negate that work. So we’ve put a hold on a lot of those initiatives.
Gamble: That kind of segues nicely to Meaningful Use and a lot of the challenges there. First off, as far as where you stand, has the hospital attested to Stage 2?
Sterud: Yes, we attested in the first eligible year, which was last year. We’ll attest to the second year of Stage 2.
Gamble: What would you say has been the biggest challenge as far as keeping up with attestation and the requirements?
Sterud: It’s interesting. Specifically, I think the issues we struggled with are the portal — and I’ll get into that in a second — and the other one was transitions of care. So in Stage 2, I believe it was 10 percent of transitions of care that needed to be done electronically and you had to do 50 percent total, so we chose to do all of them electronically and to do greater than 50 percent electronically, which, in essence, would cover both.
Working with area providers and making sure that we have the ability to perform those transitions properly electronically was probably the toughest thing we ran into — our most vulnerable area — in Meaningful Use. With the other one, as with many others, being the provisioning and then the view, download, and transfer in the patient portal. In the inpatient environment, we’ve been able to work with patients while they’re here and implement some strategies that have allowed us to be in a really good position where we have 20 percent on our view, download, transmit. I don’t know exactly where the rest of the country is, but I would imagine 20 percent would be fairly positive relative to our peers.
Honestly, those were probably the two most challenging points, but our team here has been fantastic. You take that with a grain of salt because we really achieved Stage 2 with a lot less challenges than we thought we would. Those were the two most challenging, but even those our team buckled up and got those done in a pretty short order. They rolled their sleeves up and got it done.
Gamble: Right. In working with the transitions of care with the providers, how was your team able to kind of get past the initial challenges?
Sterud: It was a matter of working with our nursing staff to understand where their patients were transitioning to, and whether or not we had set them up with our clinical portal. For our patient portal and for our clinic portal, we use a product called MobileMD. By using that tool and understanding where the majority of our patients were going, it was able to get above that 50 percent threshold. The challenge would be if you need to get to 90 percent, the difference between the 50 or 60 percent and 90 percent or 100 percent is a lot of little providers. So as far as our discharges, we were able to hit where most of our discharges are going, and we could hit the big ones.
For example, if we wanted to move that another 20 to 30 percent, we may have to locate and work with 40 or 50 providers, because once you kind of have that lion share accomplished, the rest of them are going to be few and far between. As far as discharges, it’s just a small slice of that pie.