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SMALL HOSPITAL SPOTLIGHT: One-on-One With Crittenden Health CFO Joe Swab & IT Director Reese Baker

September 28, 2009
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Crittenden Health has a message for David Blumenthal: mandating CPOE is easier said than done.

Joe Swab Reese Baker

With its carrot-like incentives, HITECH has placed severe demands on healthcare providers throughout the country to adopt electronic medical records and computerized physician order entry. And while paying for such systems is difficult, inducing clinicians, especially independent physicians, to use them can be the highest hurdle in the race to leave paper behind. One institution grappling with these challenges is Marion, Ky.-based Crittenden Health Systems. Composed of Crittenden County Hospital, Marion Home Health Agency and Crittenden EMS, the organization is striving to qualify for stimulus funds while staying on track. HCI Editor-in-Chief Anthony Guerra recently spoke with CFO Joe Swab and IT Director Reese Baker about the challenges ahead.


GUERRA: Give me some background on your organization.

SWAB: I think our name (Systems) may be a little misleading. At one point, we did have a hospital, two nursing homes, ambulance service and home health, but a few years ago we sold off the two nursing homes. Now we’re just a fairly small rural hospital, but we still have the EMS and home health.

GUERRA: How many beds?

SWAB: This is licensed for 48.

GUERRA: Can you give me a sense of your payer mix? Is it a lot of Medicaid, Medicare?

SWAB: We’re probably over 50 percent Medicare, 10 percent Medicaid, maybe closer to 60 percent Medicare, I’d say, and maybe 5-10 percent self-pay. The rest have some form of commercial insurance.

GUERRA: Let’s talk about the physician population; are they all independent community doctors that have admitting privileges at the hospital or are there any employed physicians?

SWAB: We don’t have any employed physicians. We have some employed nurse practitioners who work for one of the clinics and an employed physician assistant who works in the emergency room.

GUERRA: How many community physicians send patients to the hospital?

SWAB: I’ve got about six who regularly admit. It’s a pretty small medical staff, and we have several doctors who come in and do procedures on an outpatient basis.

GUERRA: Reese, you report to Joe?

BAKER: Yes, sir.

GUERRA: How many people do you have under you, Reese?


GUERRA: One person. Can you tell me your annual IT budget?

BAKER: Not enough. (laughing) We run about 130 PCs and about 13 servers.

SWAB: We probably, on a routine basis, spend about $100,000 a year on capital, but that’s in a routine year. With all the stimulus money out there, we’ll probably spend $1 million or so next year.

GUERRA: What’s the yearly operating budget for the IT department?

SWAB: I’m trying to pull it up on the computer, it will just take a second. It’s huge. (laughing)

GUERRA: Massive, I bet. Reese, tell me about your IT environment, prior to specific HITECH work.

BAKER: Currently, we do have CPSI, but we do not have the systems at the point of care. We do have order entry, and we do have all the financials.

GUERRA: When did you get that?

BAKER: 2000.

GUERRA: Are the physicians now, and have they been, putting in their own orders electronically?


GUERRA: Are you looking at a new system today?

BAKER: We are looking at a new system and/or looking at adding to the system we currently have. CPSI does have point of care functionality, does have all the modules that it’s going to take, but we’re looking to add on the rest of their stuff or to go with a new vendor.

GUERRA: And that’s what you’re working with Vince (Ciotti) on?

BAKER: Yes, and our current vendor is one of those vendors that’s in the selection process. Going back to your other question, our operating budget is about $300,000 a year.

GUERRA: So that’s going to go up as well as the capital budget?

SWAB: Yes. We’ll have more expenditures just to maintain the enhanced systems.

GUERRA: Are you looking for a new system because of HITECH?

SWAB: More or less. I came from another hospital, and in 2000 we had a “year 2000 noncompliant system” and we hired Vince to help us through the selection process to get a compliant one. This time around, I called Vince again.

GUERRA: How many vendors have you narrowed your search to?

SWAB: We’ve got five. We’ve got, of course, CPSI, we’ve looked at Meditech, we’ve looked at IntraNexus, Opus, and we’re going to bring in Medsphere. We haven’t brought them in yet. That’s the last one. Regarding the last three, we would just be using their clinicals (with CPSI financials) if that’s the route we went.

GUERRA: What do you looking to spend on this project?

SWAB: I’m hoping to keep it under $1 million.

GUERRA: Regarding your six admitting physicians, have you had any preliminary discussions with them regarding the software you’re considering? Do you think they will embrace the idea of putting in their own orders?