Tom Stafford, CIO, Halifax Health
We’ve all heard the phrase, ‘if it ain’t broke, don’t fix it.’ What if a product isn’t broken, but could use some improvements, and what if that maker of that product is willing to listen to feedback? If you’re like Tom Stafford, CIO at Halifax Health, you jump at the chance, which is precisely what he did to help Meditech make sure its 6.1 platform included the capabilities that customers wanted. In this interview, we spoke with Stafford about why he’s willing to roll up his sleeves and get involved, whether it’s helping to develop software or leveraging Vocera badges to break down communication barriers. Stafford also talks about his core objectives, why intra-operability should be a higher priority, what his past experience taught him about change management, and what he loves most about his job.
Chapter 1
- Halifax’s 2-hospital system
- Meditech 5.6.6 in hospitals, migrating to 6.1
- Working with Meditech to improve functionality — “They’ve been very transparent & helpful in getting this done.”
- “IT exists to support our clinical & physician base”
- Eliminating overhead paging with Vocera badges
- “Everyone is mobile, and we had to find a more efficient way to communicate.”
- Sepsis alerts with Point of Care Advisor
Bold Statements
It’s going to be amazing to see physicians walk around with tablets and be able to tap to find all the data they need. They’ll even be able to dictate to the tablet, so they can take it into the room with the patient instead of being behind the computer.
That’s really why we’re here. IT exists to support our clinical base and our physician base, and to make sure that technology enhances their daily workflow process.
We wanted a way to bring information to the nurse or the physician without them having to go back to the computer. Part of that problem is that they’re not always in front of the computer — and they shouldn’t be. They should be with the patient.
If all alerts are sent to everyone, even those not caring that for patient, pretty soon people don’t listen, and then when an alert is applicable, they miss it.
Gamble: Hi Tom, thank you for taking some time to speak with us. Can you start by giving an overview of Halifax Health?
Stafford: Sure. We’re a two-hospital system totaling 680 beds. We have the main hospital in Daytona Beach, and a satellite hospital in Port Orange; they’re about five miles apart. We’re a Level 2 trauma center, and we have the area’s only neonatal intensive care and pediatric intensive care units. We provide behavioral health services for Volusia and Flagler counties, and we have hospice locations, physician offices, and urgent care facilities. We’re going to open our first freestanding ED in a few weeks.
Gamble: Are the physicians in those clinics employed by the health system?
Stafford: Yes. We have about 30 physicians that are employed by Halifax Health in the ambulatory space, and we have a residency for family practice physicians with about 20 residents.
Halifax Health is a little unique. We’re a public, safety-net hospital, and we’re owned by the state. Our mission is to care for everyone in our community — not just to triage and send patients to another hospital.
Gamble: Do you have any affiliations with other hospitals or health systems?
Stafford: We have a joint venture with Brooks Rehab for inpatient rehabilitation. They’re industry experts, and so we partnered with them years ago and we’ve worked together to build an excellent inpatient rehab facility. We‘ve also partnered with University of Florida for cardiology, and our outcomes have improved significantly.
Gamble: What type of EHR system are you using in the hospitals?
Stafford: We’re on Meditech Client/Server 5.6.6, planning to upgrade to 5.6.7 by August. We utilize their ambulatory product, LSS, and we’re working with Meditech right now on their 6.16 platform, which is Web-based. We plan to go live with that in the future.
Gamble: That’s going to be a big change moving to the Web-based platform. In terms of your strategy, are you waiting until it’s more developed?
Stafford: Actually, we contracted early with Meditech. When Meditech designed 6.1, they started with their 6.0 platform. We were missing some of the functionality that we had become used to with Client/Server, and so we got a group of hospitals together and worked with Meditech to make sure they were implementing the right things to enable clinical functionality.
They follow an agile development process. We’ve done storytelling with them; we’re part of sprint reviews, and we’ll be doing utility testing. We’ll get the new code in July and then we’ll go on it a year later. I wish we didn’t have to wait, but the good thing is that Halifax Health was able to work with Meditech to make sure the product meets our needs and other hospitals’ needs. And in the end, it will be worth it.
Gamble: Talk about the process of working with Meditech to improve the product. Clearly there are benefits, but I’m sure it involves a lot of effort on your part.
Stafford: There definitely are benefits. We’re working with Meditech’s technical side right now and we’re clustering the 6.1 environment so it will become more highly available, which is something we’ve wanted to do for a long time. Meditech is really listening to their customers to create a product that’s mobile for physicians, on the inpatient and ambulatory sides. I’m excited about that because it’s going to be amazing to see physicians walk around with tablets and be able to tap to find all the data they need. They’ll even be able to dictate to the tablet, so they can take it into the room with the patient instead of being behind the computer.
That’s what we care about more than anything; for clinicians to be with their patients. Unfortunately, the advent of technology took some of that away, but the tablet is going to enable them to enter the data electronically while still being close to the patient.
Gamble: Was Meditech receptive to the feedback that you and the other organizations gave them?
Stafford: Absolutely, they’ve been completely receptive. They invited four hospitals to their Canton facility where 6.1 was being developed. We brought our analysts in and we sat with the developers and went through the stories, and they asked the right questions to get a better understanding what functionality we needed. Meditech has been very transparent and helpful in getting this done, and all of the hospitals will benefit because some of the specs that weren’t in the 6.0 platform will be in included in 6.1.
Gamble: With Halifax Health being a customer, you already had some experience with them, so I imagine that helped.
Stafford: We’ve been on Client/Server since 2000. During that time, we’ve done many upgrades with Meaningful Use and we’ve improved functionality along the way, but 6.1 is a platform replacement. It’s a whole new system, and that has given us the opportunity to correct some of workflows that we might not have done as well when we initially installed the system. And so through this process, we’ve been able to learn from ourselves and make the system better for our clinical users.
That’s really why we’re here. IT exists to support our clinical base and our physician base, and to make sure that technology enhances their daily workflow process.
Gamble: Another big project your team recently undertook was revamping the communication system. Can talk about what that entailed, and why you decided to take that on?
Stafford: There’s actually quite a bit of history there. When we opened up our France Tower in June of 2009, we did not want to have overhead paging in our ED. In our former ED — which was smaller — overhead paging was used to contact everyone. It was loud, obstructive, and stressful trying to capture those overhead pages. So when we moved to the new ED — which is 99,000-square feet and has 102 treatment rooms — we knew it was going to be extremely difficult to communicate using overhead paging.
And so our chief nursing officer at the time, along with our ED manager, met with Vocera at a conference about two months before the France Tower opened, and began working with them to install Vocera badges and hands-free technology in the ED. And it’s not just clinicians that use badges — every ancillary staff member there has one. Everyone is mobile, so we had to find a more efficient way to communicate, and Vocera provided that for us.
Our units that are above the ED and the France Tower are also very large — they’re essentially the size of a football field, and the nursing managers constantly had to run around the units to find nurses, which made their jobs difficult. And so we started utilizing Vocera on those units as well, and it quickly spread to the point where any staff member that’s truly mobile, from environmental services, to the dietary clerks that deliver food, to the receiving techs that roam around the two million square feet of the hospital, are using this tool to effectively communicate.
Once we had that platform down, we started looking at other things. We wanted a way to bring information to the nurse or the physician without them having to go back to the computer. Part of that problem is that they’re not always in front of the computer — and they shouldn’t be. They should be with the patient. But sometimes there’s information that needs to get to them, and so we worked with Vocera to start integrating our HCIS and create alerts to Vocera badge.
Gamble: What are some of the other ways in which you’re looking to expand that?
Stafford: We use a tool called Staff Assignment which allows us to assign a nurse or a CNA (certified nursing assistant) to a patient room. And not only could we start sending alerts, but we could send specific alerts. Because if all alerts are sent to everyone, even those not caring that for patient, pretty soon people don’t listen, and then when an alert is applicable, they miss it. Staff Assignment enables us to send a patient care team member — whether it’s the nurse, CNA, case manager, or charge nurse — very specific alerts about that patient. That helps reduce alert fatigue.
The first one was a discharge alert. With that, when the physician enters the final discharge order in Meditech, the patient care team gets an alert that the patient in room 1402, for example, has been discharged, and they get it without going back to the computer. Probably the biggest benefit was that it allowed our nurses to go into the patient’s room as soon as they hear the alert. What happened before was a physician would tell a patient she’s being discharged, but then there would be a delay before the physician’s order reached the nurse, and delays in communication were really frustrating. To patients, three minutes can feel like three hours. Now, when discharge alerts are sent automatically, the nurse can go right into the patient’s room and start talking to them about it right away. That quick feedback really helps with patient satisfaction.
Another area we were able to focus on — and this is really exciting — is improving sepsis outcomes. With sepsis, timing is everything, because after a certain period of time, it becomes very hard to treat. And so we’ve partnered with Wolters Kluwer. They have a product called Point of Care Advisor that looks at about 300 data points per patient from the HCIS and sends them into the cloud, where a decision engine then determines if a patient could be mild, moderate or severely septic. Once that is determined, an alert is sent back through Vocera badges both to the patient care team and sepsis care teams. All of this happens in 30 seconds, without human intervention. This is a great example of predictive alerting and intra-operability in action.
We’re taking that even further so that not only will we be able to send an alert, but also information (not including PHI, of course) about that patient, and the nurse or physician can acknowledge the alert from their badge or from their phone. We’re planning to roll that out soon.
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