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

October 29, 2009
by root
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In this part of our interview, Garcia says acute/ambulatory integration must be discussed at the product, not vendor, level.

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 IT for the 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.

(Part I)

GUERRA: You said you’ve largely gotten away from free texting? How do you eliminate it completely when we’re talking about physician and nursing documentation?

GARCIA: Some of the elements are structured into a field, for example, with certain options to be put in there. There’s still a component of free text, but primarily it is discreet data elements. There’s a data dictionary that says, “Here’s where you enter, here’s the field that keeps track of the particular medication description,” let’s say. It gets populated with that, and then there’s a field that’s pretty much free text that might be the physician’s comments as they’re doing their notes. We do very little scanning. Maybe 10 percent of our records are scanned.

There may be other medical centers out there that say they have CPOE, but it’s optional. Some of their physicians use it, some don’t, or a section of their medical staff uses it, et cetera. For us, that is not an alternative. If you look at one of our digital facilities, that is the way they’re going to practice. So, it’s not an option, it is mandatory. Two, others may scan a lot of their record, so they have what might be called a hybrid or a heavily scanned electronic record. In our case, we don’t scan that much. We only scan about 10 percent of our record and that tends to be information that comes in with the patient, let’s say, a patient who’s being transferred from a nursing home to one of our hospitals and the patient is coming in with some medical information. We may scan that, or we may scan forms that require their signature, and that’s the extent of our scanning in the record.

GUERRA: So scanning is a necessary evil, but it should be minimal?

GARCIA: Correct, because I cannot do searches on scanned documents. I can look at it – and there are sections within the EMR that open access to scanned documents so I can find release of information forms, for example – but it’s not searchable.

GUERRA: So, you said you have 15 of the 40 ambulatory practices on an EMR?

GARCIA: Correct. Those are running AllScripts EMR solution, TouchWorks.

GUERRA: Do you have any integration between the Cerner inpatient system and the AllScripts ambulatory?

GARCIA: Not to those practices. We have to prioritize. About a year and a half ago we recognized that communicating with physician practices in an electronic fashion was important for a number of reasons. As such, we invested in a technology that allows us to interface from our EMR to a multitude of physician practice EMRs. At the time we were doing this, we signed with Novell. Once we acquired the technology, we also prioritized practices within our market that had an EMR and had significant volume with us. We then put in place an interface to those practices to streamline the process of patient information exchange between the two EMRs.

We did that with 10 owned practices. The reason we did that is we understand we’re running those practices, so we expect referrals coming from our own facilities to a Baptist facility. What we wanted to do was to promote additional growth by improving the process of patient information exchange and therefore adding value to the practice when they refer to us. At the same time, the patient also benefits.

I can give an example from a physician, ob-gyn physician, who happens to be a board member now at one of our hospitals. At that time he was chief of the medical staff and they had an EMR in their practice. We put in place the interface and he shared with me how once that interface was in place, one of the first things he noticed was that he was able to see order a mammogram in the morning and see the results in the afternoon.

He actually took time to send me an email and make sure that I understood what that meant. That meant the lady who had gone through a mammogram in the morning was able to get, not only the results from him directly, but get them within the same day. The good news is the results were OK, but there is a clear benefit to the patient, in addition to it streamlining the operations between the practice and the hospital.

Going back to the strategy for communicating outside the four walls, we have done interfaces to the old A4 product which is now AllScripts. We’ve done interfaces to eClinicalWorks, we’ve working on an interface to NextGen and Greenway. There’s a list of EMRs that we’ve interfaced with.