DEVENUTO: To be honest, I’m still trying to figure it out. I’m following, I’d say, an eclectic group of people just to see. How did I get into it? A friend of mine had been talking about it for awhile. But I went to a social media boot camp here in town recently, and Mark Ragan from Ragan Communications was talking about Tweeting, so I started out by just following him. And then I added you and HIMSS and Jack Welch and Suzy Welch and of course, being in Louisville, I’m following Rick Pitino and John Calipari. I’m following the governor because he’s Tweeting now. It’s just a combination of different things. Like I said, I’m still trying to figure what’s the deal or how to use it to get value.

GUERRA: Could it be useful to keep your IT staff and other members of the hospital team informed of what you’re up to?

DEVENUTO: I don’t know. Currently, I have a blog on our Intranet and I’ll write something every so often if the mood hits me. I try to put a Tweet out regularly, although the last couple of days have been out of control, but I try to Tweet at the start of the day about what’s going on or what I’ve been thinking or what I’m working on, those kinds of things. So I do that more often than I blog, because a blog tends to be more involved. I’m still trying to figure it out. Plus our organization is just trying to figure out how much access to Twitter or Facebook and all those kind of things that the organization should provide to the employee pool. And so between our HR department and communications department, they’re having an internal debate on how that should work.

GUERRA: I supposed you could get into HIPAA issues. We know of organizations that have Tweeted surgeries and such, but you must have to navigate those waters on patient privacy very carefully.

DEVENUTO: I only know of a handful of people internally in the organization that are actually Tweeting at all. And most of them don’t even Tweet, they’re just following a bunch of people. I mean, reading that Jack Welsh is at the Red Sox/Yankees game doesn’t do a whole lot for me, but then when he references a management theory or whatever, then that’s a different value proposition.

GUERRA: It can be confusing when people mix their professional and work lives in one Twitter account. One of our bloggers, Gwen Darling, has written that it’s best to keep those two elements separate with two separate accounts.

We’ve got the social media angle covered. Let’s get into a little bit more of the traditional CIO issues. I looked at the Norton Web site; it looked at first glance like you have five hospitals, is that correct?

DEVENUTO: We’re at 4.75 right now. We have a new hospital, our fifth hospital, opening on August 26 at 6 a.m.

GUERRA: If you rolled up all those beds, what are we talking about?

DEVENUTO: Well, I think we’re about 2,000 licensed, and we’re probably about 1,500 staffed right now.

GUERRA: Do you have five different core clinical systems or do you have one that’s in all five hospitals?

DEVENUTO: We have one that’s in all five hospitals.

GUERRA: And who do you use?

DEVENUTO: We use Meditech Client Server. That’s been deployed in the four facilities and day one will be turned on in the new hospital. We brought the first two hospitals live in 2003.

GUERRA: Were any of these hospitals acquired or were they all organic growth?

DEVENUTO: Two have always been Norton. One is Norton Hospital and the other one is Kosair Children’s Hospital. Two of our community hospitals, Suburban and Audubon, were acquired from Columbia HCA in about 1998. And then the new hospital is being built – Kentucky is a CON state, and so we have acquired a third hospital from Columbia called Southwest. And about two years ago or three years ago we closed it, but kept the beds to move to this new hospital.

GUERRA: The two that were acquired, were they on an information system?

DEVENUTO: They were on Meditech Magic.

GUERRA: Did that make it easy, or was it still difficult because we’re talking about two different Meditech systems?

DEVENUTO: It’s a different set of opportunities. The downtown hospitals, when we brought them live in 2003, they had an old system that was mostly order entry and a lot of best-of-breed standalone systems with minimal interfacing between them. So there was a whole challenge there around the basics, even “point-and-click” kind of stuff.

At the other side was the Magic system, they had been using it – I was at Columbia when we deployed it at Audubon and Suburban in 1990-ish kind of timeframe. They’ve been on this system for so long, they knew exactly the keystrokes to hit, where they needed to go back and forth, etc. Ultimately, we’ve interjected a completely new system and process, so there was a learning curve for them. And a lot of the data doesn’t convert from Magic to Client Server. Even though they’re both Meditech, a lot of the data doesn’t convert.

GUERRA: Did you roll out client sever to those two hospitals?

DEVENUTO: Yes, sir. They came online in 2005.

GUERRA: Was that just as much of an ordeal as it would have been if they were on McKesson and you wanted to put them on Meditech?

DEVENUTO: Well, hopefully it was just a little easier, because a lot of the nomenclature was similar. But from a workflow and use perspective, it could have been anything.

GUERRA: Was that part of your philosophy, or the organization’s philosophy, that you wanted to get everybody on the same system?

DEVENUTO: Yes. That was an organizational philosophy from the beginning of the clinical system/hospital system selection process; they wanted everybody on one platform.

GUERRA: You’ve got five hospitals, all on Meditech Client Server. Does each hospital have its own patient database of information?

DEVENUTO: They have. We have a common MPI across all five hospitals. While there is some facility specificity within the system, by and large, Meditech has a concept called CMS (Community Management System). So basically we key in a task code, and then it pushes it down to all the hospitals. Now, at Kosair Children’s, we’ve inactivated all the adult-based tests, so we’ve only kept pediatrics facility tests available. As a carrier in that hospital, I don’t have to worry about accidentally picking an adult test. So we try to help keep the systems as streamlined as possible for the users in those hospitals.

GUERRA: Are you at the point yet where a patient could walk into any of your four or five hospitals and the same record would be pulled up, or is that something you’re working towards?

DEVENUTO: We’re there right now. Basically, if I walk into the hospital and they do an MPI look up based on the name Joe DeVenuto, my birthday, etc, it pulls me up. Once I select that patient, I can look at their episodic history and see, ‘Okay, you were at Audubon for an ED visit, you were at Suburban for an inpatient visit, you did an outpatient procedure at our diagnostic imaging center, you were seen in our employee practices, also.' They also currently feed in clinical data, but they feed in episode information, so they know when I was in a doctor’s office as well. So then you can see that continuity-of-care record within any Norton entity, now across the system.

GUERRA: You mentioned ambulatory practices. What is Meditech’s solution on that side?

DEVENUTO: They have partnered with, and have part ownership in, a company called LSS. That’s what we currently deployed to our employee physicians as their practice management system. Let’s be clear and separate the practice management from the ambulatory record part. So currently we have LSS deployed as a practice management system in all our practices. We currently don’t have the ambulatory record component turned on yet.

GUERRA: So you’re contemplating eventually turning on that component for the owned employed docs?

DEVENUTO: Yes, sir. Our intent is to turn on the ambulatory record within our employed physicians, yes.

GUERRA: Have you formulated a Stark strategy? Have you been underwriting for the community docs?

DEVENUTO: At this point, we have not. I think part of that is because I couldn’t really offer them a full-blown ambulatory record and practice management system until I’ve had something that I thought was the total value proposition, I didn’t think it made sense to go into that space. We also haven’t gone in to sell our IT services to say, ‘Okay, you’ve got Allscripts in your practice right now, we’ll manage your service and equipment and desktops for a fee;’ we haven’t done any of that yet, either.

Part II