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SMALL HOSPITAL SPOTLIGHT: One-on-One With Northern Inyo Hospital IT Manager Adam Taylor & HIS Manager Linda Goodwin

October 1, 2009
by root
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Taylor & Goodwin say small hospitals are in no position to order physicians around.

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 Northern Inyo Hospital, a 25-bed critical access not-for-profit district hospital in Bishop, Calif. Recently HCI Editor-in-Chief Anthony Guerra had a chance to talk with IT Manager Adam Taylor & HIS Manager Linda Goodwin about how HITECH has effected their plans.

GUERRA: Tell me a little bit about the hospital: how many beds do you have; what is the patient mix in terms of Medicare and Medicaid?

GOODWIN: We’re a critical access hospital with 25 beds. We have a high mix of Medicare and MediCal. I can’t give you any percentages; we’d have to get that from fiscal, but I know we have a lot. We’re a retirement community, actually.

GUERRA: Are any physicians on staff or are they all independent?

GOODWIN: They’re pretty much independent.

TAYLOR: We have one doctor on staff who is the head physician in our rural health clinic, otherwise all physicians are independent.

GUERRA: Approximately how many physicians refer patients to the hospital?

TAYLOR: I would say 20 to 25.

GUERRA: And the IT staff is just the two of you?

TAYLOR: No, Linda is focused exclusively on the hospital information application, the one main one. As far as staffing goes, we’ve got three helpdesk technicians – me, the manager, and two who we call infrastructure people (dealing with networking systems).

GUERRA: Linda, do you report to Adam?

GOODWIN: No, I report to the CEO.

GUERRA: Adam, who do you report to?

TAYLOR: I report to the CEO.

GUERRA: Some organizations have people in your position reporting to the CFO, but you report to the CEO.

TAYLOR: Actually, the person I report to is CEO/CFO.

GUERRA: Tell me about your IT environment.

TAYLOR: For a while now our feeling has been that QuadraMed is not a good fit for our small environment, their Affinity product. When you also consider that they are going through some major changes right now, we wanted to be aware of other options, feeling that the changes involved with Affinity were going to be about as painful as switching to another hospital information system anyway.

Linda and I attended a vendor/buyer seminar in Las Vegas last year, and we really felt that H.I.S. Professionals (a consulting firm) could offer us a good value to come in and look at how we’re using QuadraMed, look at how we’re using Affinity, and help us decide if that was a good path to stay on, or if they can make recommendations for a different way to go. In addition, they came and looked at our IT environment in general and produced a report for us that, as far as hospital information systems go, they pretty much recommended QuadraMed was probably not the best way for us to go.

Our CEO/CFO John Halfen recently attended a leadership conference put together by McKesson. He was impressed with them. I think he is starting to feel like we need to get rolling on this, based on the availability of HITECH funding. Before that, we had our HIS review on the backburner, primarily because we’re in the middle of a big construction project. But now we’re kicking off our search for a replacement.


GUERRA: Did the opening come because QuadraMed was doing a conversion from one main product to another, and you were going to have to switch anyway?


TAYLOR: That was the initial portion, but I have to stress that we’re in the middle of a major building construction project. Basically we demolished about half the hospital and are building up a brand new two-story facility. We were concerned about money, that maybe we shouldn’t do this until after the construction project is complete, but I think the availability of the stimulus funds has moved it forward.

But I would agree with you, with all the major changes at QuadraMed, we felt the pain was going to be about the same as moving to a new product anyway, so we might as well open up our vision to other things.


GUERRA: What’s the name of the new product they were trying to switch you to?




GUERRA: So you had no choice in the matter?


TAYLOR: I think they’re sun-setting quite a bit of their products, so they’re not giving us an option to stay with the old stuff.


GUERRA: Have you decided on McKesson?


GOODWIN: No. We’re going to look at several. We love McKesson (Paragon), but that’s a pretty high dollar amount and we are in the middle of that big building project, so we are going to look at others.


GUERRA: Can you tell me any other finalists?


TAYLOR: It has been recommended that we also look at CPSI, HealthLand and HMS. At a higher level, we were directed to Meditech in addition to McKesson. At this point, I’ve asked Vince (Ciotti) to provide me with a proposal whereby his company will help us with the RFP, help us with selection; and help us with contract negotiations.


GUERRA: What’s your budget for a new system?