One-on-One With Caritas Christi SVP & CIO Todd Rothenhaus, M.D., Part I

ROTHENHAUS: I’ll take it up a little higher. Right now, we have a few major projects that we’re doing. We’re doing hospital information systems – what we call advanced clinical systems roll out. So we’re doing CPOE, we’re doing staff documentation and bedside medication verification with barcoding. Those projects are ongoing at Caritas and we’re moving through with a completion date for that project in March of 2010.

We’re also doing a pretty substantial cardiology imaging project. We already have regular PACS installed, and we’re doing the C-PACS portion. We have our EHR project which is what most people want to talk about these days. And then we also have some business intelligence projects and some pretty substantial interoperability projects that get the systems to talk to one another. So that’s my portfolio right now.

From a strategic perspective, principally we have the traditional information systems applications approach to the portfolio. You’re just trying to get stuff out there. There’s a second piece which is interoperability, a third which is business intelligence. The fourth is around customer relationship management.

I spend about half my time worrying about the inpatient project and about half my time worrying about the outpatient project in terms of keeping the wheels moving.

But on the ED chart, Caritas started in 2005.

We were one of the three – our Brockton market where we have our Good Samaritan Hospital and the Good Samaritan IPA – that were awarded one of the MAHEC grants in Massachusetts. That grant, that IPA group – like all the other IPAs – chose eClinicalWorks as the EHR. As we decided that we’re going to install an EHR in all our other markets, the decision to use eClinicalWorks was pretty much based on the fact that it was such an overwhelming favorite of the physicians.

We did some roll outs in 2007 and 2008, and we were doing about 40 doctors a year, and when my new CEO, Ralph de la Torre, who is a heart surgeon, joined Caritas about a little over a year ago, he looked at all these projects and he said, “You know, at the rates you’re going, it’s going to take forever. So let’s really ramp that up.” And that was about the time I got the job as the CIO, and we went back to the drawing board, scratched our head and asked how we were going to double or triple or even quadruple the rate of what we were doing.

This is when I brought in Concordant. They have a track record of doing EHR implementations locally. It’s just so hard to find talented people and put together such a large team to take that on. So we brought them in to help us initially. What we’ve been able to do with them is as we recruit new people who are part of our team, they gracefully will reduce their staffing so that we can maintain what’s a pretty tight waterfall of kicking off two practices a week for the next couple of years.

The EHR project itself has gone pretty well, though it’s had a few bumps and bruises. I think the principle thing that makes it most difficult for Caritas is the fact that we have such a distributed environment. Amongst our employee group, we have about 100 sites where those 250 or 300 physicians work and then amongst our non-employed-but-IPA-affiliated physicians the median number of doctors in an office is really one or two.

So it’s a lot of work just getting out to these sites. To handle that, we did a couple of things. The EHR project could be run as part of the physician organization and we pulled it into IT, and what we did is essentially created hot zones around our different hospitals and created a more distributed approach to how we do the roll outs. We did this because of our map – we have a hospital within about 10 miles of the New Hampshire border and one within 10 miles of Rhode Island, so it’s 110 miles between the northernmost and southernmost hospital, and you just can’t do it completely and sensibly with a centralized team.

The other thing that we’ve made a fairly conscious decision to do around the long-term strategy for EHRs is developing and working on long-term support for these physicians. So it’s a little bit different from some of the stuff you’ve seen with these demonstration projects around EHRs. If I have one pet peeve, it’s that there are all these for-profits and nonprofits out there that will help physicians implement EHRs, but what it takes to support somebody long term and what it’s going to take to help those groups get meaningful use out of their EHRs and those types of things has not been addressed because we’re so focused on implementation.

So we have four verticals in our EHR program. We have an applications group, a training group, a helpdesk group and we have an implementation group. We’ve been pretty successful at keeping this team moving forward and doing the best we can to support the physicians.

We do tier 1 through tier 3. We do tier 1 support for all of our physicians, including our non-employed docs. We’ll handle the tickets, and we’ll work the tickets with the application vendor. We’ll actually even work with them on their break-fix support for the hardware; that’s actually been the more complicated and challenging piece of the puzzle. I think it’s almost easier to implement EHRs than it is to support them in a cost effective fashion long-term.

Part II