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One-on-One With Mercy Medical Center CIO Jeff Cash, Part III

November 3, 2009
by root
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In this part of our interview, Cash says expecting physicians to learn multiple inpatient EMRs is a recipe for disaster.

a 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 Medtech 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.

(Part I, Part II)

GUERRA: And really what this is about, at certain level, is keeping the independent physicians happy. So, you might say that, if you have physicians referring patients to your hospital and you’re asking them to interface directly with the CPOE capabilities in Magic 5.63, but your competitor has a nice slick PatientKeeper front end, it’s not going to be tough for them to figure out which hospital they’re more comfortable interacting with.

CASH: Especially if we make it mandatory that they use it, which is what’s coming under HITECH. But we have taken a step beyond that, for what it’s worth, from a collaborative perspective in the community, to say we know they’re not going to learn to use a bunch of systems. Our competitor hospital uses CareCast – they were acquired by GE (Centricity), so they’re still CareCast but it’s under the GE name. The physicians, at least in our community, are going to be less inclined to figure out how to use CPOE and everything that goes with it in Meditech, and then walk across the street and do exactly the same stuff in the other hospital in a different system.

Instead, what we’ve done is PatientKeeper sits in both hospitals, we can do whatever we want with our own PatientKeeper platforms, but once you’re trained to use it in one location, it works the same in the other location, and the more we work together to create these common interfaces for our physicians – CPOE, whatever it might be – the better chance we’ll have for physician adoption in the community. If they ever split, and we’re two hospitals with two different physician user bases, it’s a completely different story, but I don’t see that coming.

GUERRA: Everyone has to do CPOE, but not all CPOE is created equal. There is a huge chance here to lose physician alignment.

CASH: The truth is we still don’t have to do CPOE. If we were willing to give up the stimulus reimbursements under ARRA, and accept the degraded Medicare payments, we don’t have to do CPOE. And if our choice was to have a much higher physician user base here at the hospital that’s still willing to provide services, but not at our competitor hospital because they’ve mandated CPOE, I think that’s an interesting concept to explore.

Don’t take this the wrong way. We’re going to do CPOE. But I guess what I’m sharing with you is that the stimulus payments are supposed to encourage us to do a whole bunch of things, including CPOE. And then there’s a 1 percent, 2 percent and 3 percent reduction coming in Medicare if we don’t, but I’m not aware that there is a legislative mandate out there that says we have to use CPOE. So if it meant we lost business with our physicians, you can do an ROI to decide how long it takes before you give up 30 percent of your surgeons because you required them to do CPOE, versus kept them on board and kept your surgery a robust part of your business. I think there’s some interesting conversations that’ll happen around that.

GUERRA: I think every CFO and CIO would want to have that conversation.

CASH: I think so too because we’re talking millions in terms of the overall revenue to the hospital, whether it’s surgery-related or the downstream side of surgery, the inpatient business or the outpatient business. We’re talking a lot of money in terms of the reimbursement from the stimulus act and a lot of money we could lose in Medicare if we don’t follow the path they’ve asked us to do. Steve Lieber (HIMSS CEO) and I had this same conversation. I said, “You go to that real senior group that’s not inclined to do CPOE, and what are you going to do with them? Are they going to retire because they don’t want to do it or are they going to go somewhere else, or are they going to move to practice and just work in their office and not work at a hospital anymore? What are they going to do?” It’s an interesting challenge coming our way with that group of doctors.

GUERRA: That reminds me that we won’t even know how this information has to be reported to CMS until next year.

CASH: But even reporting for the payments is just reporting to prove what you’re doing. So I agree with you. But that’s assuming you choose to do what you’re supposed to be reporting.

GUERRA: With so much at stake, I wonder if we won’t see people gaming the system, especially if it’s simply attestation.