Springhill Medical Center has history of doing things differently. In fact, its founder, Dr. Gerald Wallace said he wanted an organization that would “rewrite the traditional and make the most advanced a common occurrence.” The organization has done just that, becoming the first hospital in the state to achieve Stage 7, and doing so with an entirely outsourced IT department. In this interview, CIO Mark Kilborn explains how he engages Allscripts as any CIO would despite the arrangement (and in fact, is “a very difficult customer”). He also discusses the benefits of being a vendor showcase, how the organization leverages its high-level IT adoption to recruit clinicians, and the “drive” that has made Springhill so successful.
- Docs pushing for CPOE — “That tells me they’ve embraced technology”
- Going live with Allscripts in 2004 (pushed back by a hurricane)
- “Workflows have changed dramatically.”
- Keeping clinicians “happy”
- Outsourced IT department — “My job is to be CIO.”
- IT as a “diving buddy check”
- Honesty in vendor-client relationships
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For the doctors to come forward and say they want to make the EHR mandatory tells me that they have embraced technology at Springhill Medical Center. And that’s evidenced by seeing how these guys practice and the efficiencies that they’re seeing day in and day out.
A written order takes something like two to two and a half hours to execute from the time it’s written to verification and delivery. It’s something like 35 to 40 minutes when it’s done electronically. Think about that when you’re talking about healthcare, which is so centered around the expedient delivery of care. That’s huge; that’s absolutely huge.
You’re always going to get somebody that’s unhappy with something or they want you to reduce the number of clicks or they need this information or that information, but overall, I’d say we have a very happy community.
It’s worked because the people in IT understand their role, and we have a great end user community that has embraced the EMR. We never lose sight of the fact that while we’ve got these great tools at our disposal, it still takes highly educated, discipline, well-trained, compassionate caregivers to pull it all together.
Gamble: At this point, do you have physicians that are both owned and affiliated with the system?
Kilborn: We only have a handful. This organization never did really get into the big practice move back in the 90s when everyone was buying up physician practices.
There’s something else I want to point out about the system and adoption by the physicians. The only physicians that were required to do CPOE when we first went live were our ER physicians. For all the other doctors that came in here, it was up to them to decide if they wanted to chart on paper or on the system. So for several years we teetered around 40 and 50 percent of the physicians choosing to put their own orders in with CPOE versus writing the orders and handing them to somebody else.
The doctors themselves came to hospital leadership and said, ‘It’s time to make this mandatory.’ They wanted everyone singing off the same page of music. It’s extra work for the physician, but it helps ensure quality care. For the doctors to come forward and say they want to make the EHR mandatory tells me that they have embraced technology at Springhill Medical Center. And that’s evidenced by seeing how these guys practice and the efficiencies that they’re seeing day in and day out.
Gamble: Right. So now, when was the EHR actually implemented?
Kilborn: Our first go-live was scheduled in October, but a hurricane decided to show up that day, so we had to pull the plug. Then the following month in November when we went live, we had 150 super users that were trained for the go-live. It was one of the busiest months we’ve ever had. The house was full and all our super users were taking care of patients, so it was quite a challenge. We went live in November of 2004.
Gamble: That’s obviously a pretty long time to have had this in place.
Gamble: What do you think has been the biggest change, looking back from 2004 to now, in the use of the EMR?
Kilborn: That’s a tough one. Certainly the workflows in the entire organization have changed dramatically. But when you look at some of the outcomes, one example of the improvement is with orders. A written order takes something like two to two and a half hours to execute from the time it’s written to verification and delivery. It’s something like 35 to 40 minutes when it’s done electronically. Think about that when you’re talking about healthcare, which is so centered around the expedient delivery of care. That’s huge; that’s absolutely huge. It really comes in to play when your census is peaking. Look at our ER where we have seen record growth. We’re hitting about 4,250 patients a month now. I don’t think they would be able to handle that volume without the electronic record.
I can remember back when Hurricane Katrina came. Of course, we hadn’t been live that long and there was some concern that in the event we had an influx of patients, that the EHR might get in the way, so the president of the hospital’s instruction to the ER docs was use this system, but if it becomes cumbersome and you can’t manage the load, then most certainly go back to manual. At the end of that hurricane event, the physicians told us they wouldn’t have been able to manage the load without the system. We had over 70 patients in the ER at one time, which is significant. It was one of the busiest days in the history of the organization, and the system worked flawlessly. So being able to handle that volume was crucial.
When you ask me the biggest change in rolling out an EMR, there really are too many to single out any specific ones. So much has changed. We’ve won, I believe, 17 national awards, nine state quality awards, and four international awards for IT and clinical performance in the last 15 years. With the rollout of our EHR we’ve made information more accessible, more practical. We’ve streamlined workflow efficiencies, eliminated errors and are providing more pertinent information for the medical practitioner. In doing so, we’ve improved patient outcomes. That’s what it’s all about.
Gamble: Now, what about the physicians? I would guess that there was a bit more pushback back in the day, but is that something that’s not really a concern anymore?
Kilborn: No, not at all. Because you have to remember, the docs are having just as hard a time as hospitals are with EMR’s. They’ve had to roll out EMR’s in their practices and having to do the same preparation for ICD-10. Unfortunately those guys have a lot of technology forced upon them all at once, so I think they feel our pain little bit better.
We really have a great campus and physician staff that is very technically astute. All of them are ahead of the game in comparison to other physicians in the community. You’re always going to get somebody that’s unhappy with something or they want you to reduce the number of clicks or they need this information or that information, but overall, I’d say we have a very happy community.
Gamble: What about outsourcing — how would you describe the model you’re using?
Kilborn: I’m actually a managed services outsourcing area vice president for Allscripts on a 21-year contract. The entire IT department at Springhill is outsourced to Allscripts Managed Services.
Gamble: All right, so that’s how obviously things were set up 21 years ago?
Kilborn: It originally was a seven-year contract, but they’ve been very happy with what we’ve been able to do. Our job is to serve as the IT department at Springhill Medical Center. Working for Allscripts and representing the customer makes us an interesting client to deal with I think. We have an excellent relationship. When you’re in outsourcing, especially in a position like this, your job is to represent your client, and that’s the hospital. The fact that we represent them with our employer is a unique position to be in.
Gamble: So it started out as a seven-year deal. What has made it work and what has made both parties want to keep doing it?
Kilborn: Both organizations are result-driven. Springhill has really embraced technology, and as I mentioned before, sees it as an excellent tool to help bond with their admitting physicians. We want technology to be at a level where it’s difficult for doctors to want to go practice somewhere else, because they get what they need here at Springhill Medical Center.
It’s worked because the people in IT understand their role, and we have a great end user community that has embraced the EMR. We never lose sight of the fact that while we’ve got these great tools at our disposal, it still takes highly educated, discipline, well-trained, compassionate caregivers to pull it all together. Those kind of professionals are in abundance at Springhill.
It has been an excellent relationship. The leadership at Springhill is very tech savvy. Having leadership so appreciative of technology and what it can do to help advance their organization and its outcome has been wonderful for me as the CIO.
Gamble: Right. Is it ever a challenge having to balance those two roles?
Kilborn: No. I work for the hospital, I’m the CIO. That’s why I say I’m a difficult customer for Allscripts. I engage them as any CIO would a vendor. Being an outsourced CIO, I don’t think they treat me any different, quite frankly.
Gamble: And you’re not afraid to be honest?
Kilborn: Oh no, I think you’ve got to be honest in any vendor-client relationship. You’d better be wide open if you want to be successful. The worst thing you can do is start building a bridge from opposite sides and they don’t connect in the middle.
Chapter 3 Coming Soon…
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