Mercy Medical Center is a fully-accredited 445 licensed-bed regional hospital located in eastern Iowa. After surviving flooding in 2008, vice president and CIO Jeff Cash had to figure out how his organization was going to survive a move to CPOE and electronic documentation with his Meditech Magic system. Cash wound up turning to PatientKeeper as a way to enhance Meditech’s front-end user interface while keeping his core system intact. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with Cash about these and other issues.
GUERRA: Could give me a quick tutorial on a major versus a minor upgrade?
CASH: Sure. So, an application upgrade would be our existing servers storing the next version of Magic, for example. A major upgrade would mean converting from Magic to a new version of Meditech, like Client/Server or Focus, but only some of the data converts. So there was a period of time when you may have had to keep both systems running in parallel. They’re fixing most of those upgrade challenges by going to the Focus platform and giving you a migration patch. We haven’t done the new planning exercise to know what that looks like. So the dependency would have been: how does your clinical data move? How did all your reports migrate over?
Today, we’re heavily interfaced with Meditech, so how do we migrate all of those interfaces to the new system? It does change the technical infrastructure quite a bit in the sense that, right now, everything from Meditech runs on a suite of about seven servers. In the new environment, it’s more typical of what you’d find in a different health information system architecture, in that there are significantly more servers that you need to run the system because they break out different pieces of the system. They have background processors and reporting servers, and they use different pieces that add a little more complexity to your architecture. That really didn’t put us off. We would’ve been okay with that. It was the conversion itself that we weren’t quite prepared to take on.
I’ll give you an example of another important element. We were using Picis before Meditech had a full surgery suite. Picis writes their applications integrated into a particular version of Meditech. So we were on the Magic platform of all the Picis applications, and that was a pretty expensive migration to get them all to Client/Server; and we could not migrate Meditech’s Magic without migrating all the attached Picis products, because they were version-dependent. Picis is written in such a way that you can migrate it to their version of Client/Server and they’re backward compatible with the Magic version of Meditech and the new version of Meditech, but their old versions, like their Magic versions, are not forward compatible with Meditech’s Client/Server.
So as we looked at our migration path, we had to migrate not just Meditech, but we had all of these connected applications – if you want to think about it that way, predominantly the Picis products at the time – that we had to migrate in one fell-swoop. And we had LSS, which was the physician component that we use in our practices, which would have to migrate at exactly the same time as well.
When we looked at this simple physician request of, 'give us a different interface before you start putting all of your information online,' we knew we would have to migrate all 90 of our physicians and the LSS system that they use, our operating room, our quality group, our dietary group, our medical credentialing group – they would have all come along at the same time just because of the way they interfaced with the Meditech Magic system. So that was a much bigger process than just migrating Meditech by itself.
GUERRA: What would the upgrade have to offer in order to warrant all that work?
CASH: Primarily, for me, it would be the workflow for our clinicians. One of the things that they’ve done with the newer versions of Focus – and a little bit with Client/Server, but primarily with Focus – is they’ve changed that interface significantly for the clinicians; they’ve really flattened it out. So, for example, if you’re in the Magic version, you can go into nursing, or you can go into medical records or you can go into lab, things like that. So you’re kind of moving around between the different applications to find the data and work with what you need. With the newer versions, they’ve flattened that out quite a bit, so all of the related applications that you may need to get to – when you need a bit here and a bit there – are all generally built around a common user interface.
I think there’s significant advantage of the clinicians being able to access more information from a single screen, and make it more intuitive and more navigable for them. And that would be the reason that we would jump forward. To a large extent, Meditech Magic works really well for us in the hospital. It’s stable, it’s relatively inexpensive for us to manage now because our investment is now just in support, along with adding some applications, and the good thing is they keep enhancing the Magic application.