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One-on-One With Baptist Health SVP & CIO Roland Garcia, Part I

October 16, 2009
by Anthony Guerra
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Garcia says three of his five hospitals are “fully digital,” with the rest soon to follow.

Jacksonville, Fla.-based Baptist Health is one of the leading providers of healthcare in Northeast Florida and Southeast Georgia. The organization provides its acute services through a network that includes four medical centers (Downtown, Beaches, Nassau and South), the area’s only children’s hospital (Wolfson Children’s) and a number of outpatient diagnostic and therapeutic services. Heading up the IT for sizable enterprise is CIO Roland Garcia. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with Garcia about all the projects in his pipeline.

GUERRA: Tell me a little about your organization.

GARCIA: We are an integrated delivery health system in Jacksonville, one of five in the Jacksonville area and the largest with about 30 percent market share. As a health system, we’re composed of five hospitals, one of which is the only children’s regional hospital in the area. Additionally, we have 40 or so primary care, family practice centers, a home health agency, and retail pharmacies. We have our own inpatient as well as outpatient clinics. So, we cover pretty much the whole spectrum of healthcare outside of nursing homes or long-term care.

GUERRA: And you said the organization owns about 40 physician practices?

GARCIA: Family practices. In addition to that, there’s some specialty practices and then some of the urgent care centers as well.

GUERRA: And there would be, also, a population of doctors in the area that are independent but admit to the hospitals?

GARCIA: Correct. The majority are independent physicians. We have about 1,600 physicians with credentials to our organization, and we may have employed about 135 or 140, something like that.

GUERRA: So, vast majority are independent?

GARCIA: The vast majority of the health and medical staff are independent; that’s how we operate.

GUERRA: Are all five hospitals on the same electronic medical records/CPOE platform?

GARCIA: Yes. Let me give you some background on the technology. We have three of our five hospitals running fully digital, and our definition of a digital environment is discreet data element documentation, not only nursing documentation, but also physician documentation, which is different than many other settings. Obviously, CPOE is mandatory and par for the course. So, out of the five hospitals, three of our facilities are running with that environment. In those, there is literally no paper in the nursing units. So if you walk into the nursing unit, you do not see those metal binders that you typically find.

Beyond the hospital setting, we have pretty much automated our whole health system. Again, we have clinicians that are, at any given time, treating about 700 patients in the community. We have clinicians that go take care of these patients with laptop technology. So they have the ability to not only download the information for the care protocol that’s expected for that patient, but also document that information. After that, it’s all coordinated with the billing system.

In the physician practice world, when we began deploying EMRs two and a half years ago we had 23 primary care centers. We have grown to 40 today and continue to grow. So the challenge has been to keep ahead of that curve. Out of those 40 or out of the 23 original practices, we have 15 practices running on EMRs. These are outpatient clinics. There might be anywhere from two to eight physicians per clinic.

So when we hear about EMRs and the $19 billion opportunity with HITECH, it is not something that is new to us. We’ve been at it now since February of 2005 when we opened a brand new hospital with that footprint.

GUERRA: Tell me which vendors you’re working with.

GARCIA: For our hospital operating units, our primary vendor for the repository and the EMRs and those kinds of applications is Cerner. However, they’re not the only vendor that provides technology to support the digital environment. Additionally, we have GE for our PACS solution which is integrated within the EMR. We also have ProVation which is our standard across all of our hospitals which provides support technology for endoscopy centers and those operations. We have Philips which provides our obstetrics and delivery monitoring. Now, those technologies are deployed throughout the health system. All five hospitals have PACS. All five hospitals have same pharmacy system with McKesson cabinetry and medication-distribution system. The only missing component in the two hospitals that we say are not digital are CPOE nursing documentation and physician documentation.

GUERRA: Now, that’s done through Cerner in your other three hospitals?

GARCIA: Correct.

GUERRA: You mentioned that you use McKesson for medication cabinetry, explain to me what’s going on there between Cerner and McKesson.