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One-on-One With Northeast Hospital Corporation VP & CIO Robert Laramie, Part II

October 12, 2009
by Anthony Guerra
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Robert Laramie says CPOE success depends on keeping clinicians at the head of the project.

Northeast Hospital Corporation (NHC) represents the acute care hospitals of Northeast Health System, Inc. (NHS), an integrated network of hospitals, behavioral health facilities, long-term care and human service affiliates offering Massachusetts North Shore residents general and specialized medical care. NHC hospitals include: Addison Gilbert Hospital in Gloucester; BayRidge Hospital (psychiatric) in Lynn; and Beverly Hospital in Beverly. There are also two outpatient facilities in the corporation: Beverly Hospital at Danvers, Medical and Day Surgery Center; and Beverly Hospital Cable Center in Ipswich. Recently HCI Editor-in-Chief Anthony Guerra had a chance to talk with CIO Robert Laramie about his work to strengthen NHC’s infrastructure so point of care applications are always available.

(Part I)

GUERRA: When did the hospital first engage Meditech?

LARAMIE: We’ve had Meditech for over 20 years.

GUERRA: So we’re not talking about you selecting a system?

LARAMIE: No, we are not. It was Meditech, and we’re going to use Meditech.

GUERRA: Did you have to show the clinicians that you’re doing everything possible to make this system work for them?

LARAMIE: Absolutely. We needed to make sure that it was focused on the way they thought it best, in terms of how they worked. We spent a lot of time in those two months talking about workflow, talking about how they think about their orders, and how they’d like to see them processed. We got agreement in the departments on order sets and the flow of those, and so arrived at a unified approach to what we’re going to do, and we did that throughout each floor as we did our rollout implementation plans.

GUERRA: Did you, at any point, need to engage outside help for this rollout?

LARAMIE: We did. We engaged a few consultants at specific times. We had a project manager who was a consultant, and we had a consultant who was a PA and did a lot of the doctor training.

GUERRA: Can you name any of those organizations?

LARAMIE: Our consultants were from Navin, Haffty. That’s a local firm up here in Massachusetts that has a strong Meditech practice.

GUERRA: Tell me about your decision to bring in consultants. I would imagine some people try and save the money, but pay in the long run.

LARAMIE: Well, I think the key for us was we were doing this for patient safety and patient quality. My experience has taught me, and also hearing from my peers, that CPOE is one of the more difficult applications to implement. We engaged someone who had significant experience doing CPOE implementations to guide us and do a trainee/trainer program and transfer knowledge to some of our key management staff, because none of our management staff had done a CPOE implementation before.

GUERRA: And you said they’re experts in Meditech.

LARAMIE: Yes. It’s actually in Massachusetts where 70 percent of the community hospitals are Meditech hospitals.

GUERRA: I’d like you to talk about the importance of giving the physicians wireless capabilities. I’m not sure how Meditech presents on a handheld, but what can the doctors do with it on a handheld, why is it important to empower them wirelessly?

LARAMIE: Well, it’s not just Meditech that we did the wireless environment for; it’s for any clinical application that they may want to view. Right now, CPOE, in general, does not lend itself to being on a handheld PDA. The screen is just not large enough for a clinician to effectively put in the orders and see everything they really need. What we wanted to do with the wireless is make it easier for our clinicians, if they are comfortable with different form factors, to be able to use them for our applications whether its Meditech or PACS or our Picis OR scheduling system.

We also did it for our patients so they could get on email or look things up on the Internet or communicate with families. It’s a patient satisfier to be able to do that, and it’s been a resounding success with the patients and the families.

There was a multitude of reasons for doing the wireless infrastructure. One of the main ones was the technology at the bedside, and we have to allow for multiple form factors because, as we all know, people have different levels of capability with technology adoption – some are very advanced and we want to support that, and some would rather just sit in front of a PC at a desk and handle it that way.

GUERRA: Another CIO told me that adding wireless capabilities eventually means you need a more robust wired network, because it all comes back to the wired network. Does that make sense?

LARAMIE: I’m not sure I follow that logic, because the wireless then travels through your wired environment, but we have a public and a private wireless. All of our patients and families go through a public one which is separated from our current one. So, if they are doing it through the wired, it gives them more capability to utilize your bandwidth where previously they hadn’t. So I guess I could see where the rationale would be there.

GUERRA: Have you had discussions about which devices you’re going to support?