When Tom Kurtz was interviewing for the position of CIO at Memorial Healthcare, it was made clear if he accepted the role, he’d be spearheading a major EHR transformation. But instead of balking at the idea — which would have been understandable, with this being his first foray into healthcare — Kurtz seized the opportunity to “help guide the organization.”
Five years later, Memorial has an integrated platform in place, something that has certainly come in handy in battling the myriad challenges stemming from Covid-19. Recently, Kurtz spoke with healthsystemCIO about his team’s multipronged strategy to maintain care continuity during the pandemic, the hurdles they faced implementing an EHR during a period of significant growth, and the tremendous pride in being an independent hospital.
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- Memorial Healthcare, which will celebrate 100 years of independence in 2021, seeks to become a “top-tier community hospital” with world-class offerings in neurology and orthopedics.
- Several initiatives have been delayed to enable IT to focus on managing Covid through three channels: telemedicine, increased bed capacity, and alternative care sites.
- Setting up an alternative care site required “significant coordination across the organization” to be able to “operate somewhat as a practice and somewhat as an ER.”
- Having in-house lab expertise has helped Memorial to maintain short turnaround times for Covid-19 testing, while partnering with long-term care facilities to improve their metrics.
Q&A with Tom Kurtz, Part 1
Gamble: Let’s start with a high-level overview of Memorial Health System – what you have in terms of the hospital offerings and where you’re located.
Kurtz: Memorial Healthcare is 162-bed hospital with about 30 practices. We have roughly 100 employed providers, and we cover six counties right in the middle of Michigan. If you drew a line between the cities of Flint and Lansing, we’d be right in the middle.
Two of our spotlight areas that have seen some pretty significant growth over the last five or six years are neurology and orthopedics. We have 11 providers in the area of neurology, with subspecialists focusing on multiple sclerosis, muscular dystrophy, stroke care, and memory management.
We’ve recently brought on some new orthopedic surgeons, and we’ve started doing robotic joint replacements. It’s something new for us as an organization. We have a 99-year history taking care of the healthcare needs of our community as an independent hospital. We’ve seen tremendous growth in the past 5 to 7 as we reach beyond that 6-county range — and far beyond it with our neurology offerings.
Gamble: In terms of that growth in neurology and orthopedics, are you looking to provide services that are difficult for patients to get in your area?
Kurtz: I think the growth in neurology specifically has been based upon a highly-talented provider who has built a group around his practice and expanded it to a multi-specialty group. He has that vision of growing our community hospital into something that can meet those needs for subspecialty neurology care in a multitude of settings. In fact, we’ve actually started to provide inpatient neurology coverage for other healthcare systems in our area, based upon that growth.
One of our biggest initiatives we’re working on is building a substantial new facility to house neurology, orthopedics and a new community wellness center. The new facility is geared toward patients who are coming from distance to seek care from our subspecialists. During their visit, they can do everything from getting MRI imaging done, getting their rehab assessment, or getting a physical therapy or skills assessment done. Patients can do timed walks, then see a neurologist to create a treatment plan that they can continue either with their primary care physician or the neurologist they see outside of our system.
That subspecialty care is something new for us; we’ve been building that over the last several years into quite a successful practice. We have a goal of being a high-quality, number-one inpatient care community hospital, and world class in one or two specialty service lines. We’ve been working toward that vision for the last several years, and we’re starting to see that come to fruition now.
Gamble: So a lot going on. How have these and other initiatives been impacted by the pandemic?
Kurtz: As many organizations across the country have seen, Covid has impacted healthcare significantly, and Memorial Healthcare is not immune to that. We’ve had several initiatives either delayed or postponed because of the different things we’ve done to make sure we’re prepared to meet the healthcare needs of our community. Again, throughout our 99-year history, it’s been our mission to provide those needs. We needed to ensure everything we were doing was to be prepared for our patients.
We did have to postpone a little bit of the building project. It’s now back in full swing, but it did get delayed for a time. We’ve had some other initiatives delayed in terms of some geographic expansion and some other practice startups to make sure we were doing the things we needed to do to serve our community.
There were several things we did to prepare our organization for Covid-19; we continually evaluate those initiatives to ensure that we’re meeting those needs and continuing to take care of our patients.
Gamble: I imagine that was the case particularly in the beginning, because this is such a unique situation. How did your team approach these situations — is there a process for that?
Kurtz: Absolutely. We have a very structured process. We follow the NIMS process for emergency management; and so, early on, we stood up our incident command center to address the needs for Covid-19. Those came in three larger buckets of initiatives, with the first being telemedicine.
Normally, we see roughly 1,000 to 1,100 patients per day in our ambulatory practices. How do we continue to provide care to those patients when they are unable or unwilling to come into those practices? We had to stand up telemedicine, and so we stood up telemedicine in the practices in four days. That was a rapid expansion to implement telemedicine in order to provide care for those patients.
Another bucket of initiatives was in hospital capacity. We added two hospital units; one was a Covid-specific ICU and another was a COVID-specific step-down unit where we added significant hospital bed capacity. Michigan is a Certificate of Need (CON) state; we got that, and so we were able to add hospital capacity to be prepared for the inevitability of inpatients coming into our facility.
The third strategic item for us to manage Covid was the creation of an alternative care site. We didn’t want to have those who were symptomatic and suspected of having Covid present to our ER and potentially expose other patients. We stood up a separate alternative care site right in our hospital where patients were able to report to a location that would do the assessment, check for flu, strep, and RSV, and clear those patients of Covid-19 before they either go into emergency care or any other area of our hospital.
That alternative care site was very important for us to make sure we could separate and isolate patients who are potentially Covid-positive and keep them out of other areas to ensure continuity of care for patients with conditions not related to Covid-19.
Right at the beginning, telemedicine, additional bed capacity and the alternative care site was a pretty significant rush for us to get prepared for our community. As I look at other healthcare systems in our state and beyond, I think Memorial Healthcare was ahead of the game when it came to being prepared for that first wave.
Gamble: Can you talk a bit about what it took to stand up the alternative care site? Was that part of a disaster preparation strategy?
Kurtz: It took pretty significant coordination from many areas. It took some of our ambulatory folks and practice managers getting involved for the registration, scheduling, and workflow of that unit to operate somewhat as a practice but somewhat as an emergency room.
It took the coordination of our infection-control folks to ensure we were keeping our employees, as well as the patients, safe in that alternative care site. It took the coordination of physicians and other medical professionals to staff that alternative care site 24 hours a day, 7 days a week. It took the facility staff to build it out and the emergency preparedness team to stand up beds in our temporary hospital unit inside that area. It took the IT group to create that location within the EHR, and to create the ability for patients to get registered and to have the test completed and done within the EHR. It was a significant team effort from across the organization to stand something like that up.
Gamble: It’s a lot of moving parts. Was there anything that stood out as being particularly challenging?
Kurtz: I think the most difficult challenge was standing up the in-house testing. Very early on, we issued purchase orders and established our own in-house testing. We were the third or fourth hospital in Michigan to be able to do in-house Covid-19 testing; and I think doing that at the pace that was necessary to meet the need was the biggest challenge.
It was everything from supply chain to the test being set up in our lab, being certified, being able to process those tests effectively, having the collection materials at hand, and being able to collect specimens to run through that testing. That has been, and continues to be, probably the most significant initiative throughout the entire COVID-19 strategy.
We’ve recently added an additional drive-thru testing clinic in another county. We’ve done a significant amount of work to provide the testing needs for our community. I think that was the single biggest initiative that we had throughout this process.
Gamble: I imagine being on the early side of the curve isn’t easy. Were there any organizations or individuals you could reach out to? How did you navigate that?
Kurtz: Navigating through it was challenging because every organization around us was navigating that same process. We have the advantage of having an extremely talented and experienced lab director who led the process and got us through to the testing and validation of that system. That helped significantly to have that expertise in-house to be able to stand up that equipment, get it certified, and get it moving along.
We also have a very talented and innovative supply chain team that was able to source the testing media and transport media necessary to get those tests to the testing equipment. It was very important for us to have that team around us to build that up.
One thing we’ve been very proud of is the fact that we have maintained, even to today, a 24- to 72-hour turnaround time. We rarely see a 72-hour turnaround time; most of our tests come back within 24 to 36 hours. We have partnered with many of our local extended care facilities and long-term care facilities that were seeing 9-day turnaround times with some of their testing. We created a team that has gone out to these locations, has done the collection, the processing, and the results reporting, and they’re getting their results in 24 to 36 hours, which was unheard of at the beginning and is still quite rare now.
Gamble: Absolutely. As far as some of the initiatives that were put on hold, you mentioned that building the facility is back on track. What was the process in determining it was okay to restart some of these initiatives?
Kurtz: We follow the guidelines that are shared throughout the healthcare community in terms of when it’s safe to go back to work and safe to have people working in that environment. Michigan was very early to have established strong restrictions for business operations. We’re following guidance from the CDC, from the Department of Health and Human Services, and from the state of Michigan.
When those folks arrived at the conclusion that it was okay for certain businesses to come back and establish their work again, we were able to continue as well. We’re still at the point of still erecting steel and putting in roof trusses and those types of things in the facility. We’re very early on in the process.
When we had to stop work, we made the construction site safe and we decided to pause until everyone — including the contractors themselves, the organization, the health department and the CDC — all said it was safe to go back to work.