Four years ago, Davies Award-winning Citizens Memorial Healthcare overhauled its IT structure to operate more efficiently, improve patient care and manage rising costs. Today, a fully integrated, 100 percent paperless healthcare information system connects the 74-bed hospital with five long-term care facilities, 16 physician clinics and home care services across southwest Missouri. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with CIO Denni McColm about how such a small hospital accomplished such great things.
AG: It sounds like you’re very far along, especially for a small facility. Being in that position, what do you make of the HITECH Act and the direction things are going? Everyone’s trying to envision how this is going to play out. What are your thoughts on that, especially for 100- to 200-bed hospitals?
DM: If I was at a hospital that didn’t have a strong foundation, I would be starting to get worried, and there are certainly some things that they could even be doing now. To a degree, I have the luxury to wait until the definitions come out and I hope that’s soon. Some institutions, if they have to change vendors, if they don’t have a vendor who can take them to an EMR that has the functionality that’s going to be required, it’s going to be a challenge. There’s going to be a big rush to implement. What I see — I’m more in tune with the under 100 bed facilities — is the DON in that facility is probably just the best nurse in town, the only one willing to take the job. She doesn’t know anything about computerization, and now her administrator or CEO is coming to her saying, ‘Hey, there’s stimulus funding, and we need to implement electronic medical records.’ Where is she going to start? Those little facilities, they don’t even have an IS department, much less a whole support system. I think it’s going to be a scramble for the next few years.
AG: Would you agree with the statement that your facility is probably ahead of 90 to 95 percent of comparably sized hospitals in the country?
DM: Oh yes. We’re (HIMSS Analytics) Stage Six.
AG: You’re probably more advanced than 99 percent of the hospitals in the country under 100 beds.
DM: Probably. I would say so.
AG: I fear a lot of smaller organizations will be forcing in systems by people that aren’t familiar with such work, let alone knowledgeable about how to rearrange workflow. I fear that there could be some real disasters.
DM: I think you’re right. I think 10 years from now there’ll be some really slick best practices. There’ll be evolutions of the software, where the software will all be better, the implementations will all be better, but it’s still clumsy now. I mean, frankly it is, and I see that too. There’s eventually going to be penalties associated with the stimulus, so you can’t afford to just say, “I’m not going to go for the incentive because I don’t think I can do it.” You can’t afford to do that.
AG: Do you think the incentives and penalties are enough to create movement?
DM: I’d hate to leave the money on the table in those first years. I guess I’m a little bit more optimistic. If they don’t have anything and they have to start from scratch, I think they’re in a precarious position, but there’s a lot of them that do have a core vendor that could go from where they’re at to where they need to be. Maybe with less than $2 million that they’re going to get.
AG: You wouldn’t say that perhaps they have a revenue cycle management system and maybe a lab? Do you really think a lot of them have a core clinical system out there?
DM: Forty-five percent of the hospitals have Meditech. I don’t know what percentage have CPSI. If you are a small hospital with Meditech you can probably get what you need to qualify for less than $2 million dollars. I don’t know what their pricing is for a small hospital. I know the few small hospitals that are not in good shape because they have some kind of funky revenue cycle product from the ’70s, and they’re going to have a hard time because they’re going to have to start from scratch.
AG: So, what’s your best advice to the under 100-bed crowd that probably don’t even have CIOs?
DM: I think the first thing they need to do is a readiness assessment about where they are and what are their options. There aren’t that many vendors in this arena, let’s face it, who are certified inpatient vendors. It’s not like there’s a whole world out there that you have to go searching, so I would say start with a readiness assessment. They could get some outside help from a hospital like us. I mean, we do it all the time, help other hospitals decide where they’re at and where they want to go. It would be a little risky to jump too far in if it wasn’t a major vendor, I think, without having the definitions.