Somerset Medical Center is a nationally accredited, 355-bed regional medical center, providing a variety of comprehensive emergency, medical/surgical and rehabilitative services to Central New Jersey residents. The organization’s 650-member medical and dental staff represents all major medical and surgical specialties. To learn more about the novel governance structure at the hospital, HCI Editor-in-Chief Anthony Guerra recently spoke with CIO & Director of Strategic Planning Dave Dyer.
GUERRA: I read that you’ve embarked on a $10 million initiative to upgrade the clinical computer systems. Can you tell me about your software environment?
DYER: On the financial side, we’re Lawson for general financials and materials management. Following that, we selected Cerner and put in all the Cerner applications including scheduling, registration, EMR. We have about 20 different applications now, so all clinicals are running on Cerner. We did a big-bang rapid implementation approach back in 2002 where we came up with 14 of those applications at that time, and then we’ve been adding on to that since. And then on the billing side, we retained our McKesson billing system, and we’ve been wrapping around contract management and physician support through McKesson as well. Those are the three main vendors we have.
GUERRA: Some people spend the money and go full-boat Epic. Was that not in the financial cards for you or is that just not an attractive solution for other reasons?
DYER: When we were doing the evaluation – I got here in June of 2000 – we were woefully inadequate in our IT infrastructure. We really needed to rebuild everything from the ground up, from the network on up, and most of the applications that we had were installed in the mid-’80s. So we really needed to do a lot of heavy lifting here.
When we were doing the evaluation process, we looked at everybody, we looked at McKesson, Eclipsys, Epic, and, at that time, Epic and Eclipsys did not have a pharmacy package. In my opinion, and our organization’s opinion, you need to have an electronic medical record and order entry for pharmacy all in an integrated platform. If you want to be successful doing CPOE and eMAR or nursing documentation, all of that has to be integrated. At that time, neither of those products had an integrated pharmacy solution that was live and available (or not in beta testing) at that point in time. That’s why they fell off the list when we’re initially looking.
GUERRA: How many physicians do you have that are employees?
DYER: The majority of our physicians are very independent practitioners. We have about five hospitals that are in a 20-mile radius of us, and most of them have admitting privileges in multiple hospitals. We do have a family practice residency program and we have six faculty there and 21 residents that are employed, one practice that’s an employed physician, and then we have a sleep lab in which we employ the physicians. Outside of that, we have an outside hospitalist group that we contract with to do work for us and we contract for cardiology EKG reads and then traditional radiology and ED services, but everybody else is an independent practitioner.
GUERRA: Any idea of how many independents refer into the hospital?
DYER: We have 700 on our medical staff, of which about 400 or so are active admitters (10 or more admissions a year).
GUERRA: Sounds like a sticky CPOE situation, is it not?
DYER: It certainly is.
GUERRA: Tell me about your CPOE strategy and what you’re doing around Stark.
DYER: Well, let me start with the CPOE piece of it. We came up with Cerner in 2002 and then we launched the CPOE initiative as a phase two of our two-phase contract with them. And so we came up with CPOE in January of 2004 on a pilot site, and then we were planning to roll it out unit by unit.
Our strategy was to provide enough content within the electronic medical record that the physician would see the benefit. So we installed PACS, and we installed EKGs, we interfaced vascular lab reports and lots of other reports into the system and kept building on the content, hoping to entice the doctors to do orders.
We had some very strong positive people within our medical executives committee back then who helped get it off the ground, and then over the last three years or so, we’ve been slowly rolling it out. We fought back and forth to the board level and the med exec level about having it as a mandate, and our medical executive committee has not accepted being told what to do. So we’re at the 65 percent mark right now with CPOE. So 65 percent of our medication orders are put in via CPOE and 35 percent are either telephone orders or written orders, and of that 35 percent about half of those are telephone orders for admitting.
We also provide remote access to our electronic medical record to every physician, hoping that would entice them to do orders from their offices. And then with the gain sharing program that we launched this year, if they want to collect money from the program, they have to make progress on their journey towards CPOE.
There’s a few hospitals around us that are starting CPOE as well so the circle is shrinking, and they know they’re going to have to do it at some point in time.
GUERRA: So HITECH has helped organizations get CPOE buy-in because the doctors will run out of places to hide.