Ronald N. Riner, M.D. is chief medical officer of Health Management Associates (Health Management), a Naples, Fla.-based hospital management company that manages 70 hospitals in 15 states, for a total of 10,500 licensed beds. The company operates primarily in the Southeast U.S., along with a smaller number in Pennsylvania, the Midwest, and the Pacific Northwest. Health Management Associates manages smaller community hospitals in rural and semi-urban markets; the average bed size of a Health Management-managed facility is 125 beds. Health Management recently signed a contract with the Watertown, Mass.-based athenahealth for an ensemble of practice management, electronic health record (EHR) and patient communication solutions.

 From Dr. Riner’s standpoint, moving forward across the entirety of the Health Management  health system was of paramount importance, with ease of use for end-user physicians a key consideration. Dr. Riner spoke recently with HCI Editor-in-Chief Mark Hagland regarding his organization’s automation strategies, and his perspectives on the strategic IT challenges of smaller hospitals and physician groups. Below are excerpts from that interview.

Your organization is now live on athenahealth?

Yes, we are. We have about 10,000 physicians using health management facilities, and of those 10,000, about 1,200 are in an employed position. In terms of selecting an EHR, we wanted to go through a process in which the physicians would feel comfortable. As you know, many hospitals and health systems go through a selection process and then hand it to the physicians. We elected to involve about 250 physicians and subject experts, and those 250 people were actively involved in the selection process. We went from about 10 products down to about three. And then through a series of teleconferences, webinars, and site visits, we ended up choosing athenahealth for the employed physicians.

Ronald Riner, M.D.

So how many physicians are using the solution right now?

It’s a small number at this point in time. We’ve made presentations in about 25 communities. I’m the CMO, but I’ve had the privilege of working with Patrick Easterling, the president of Health Management Physician Network, which encompasses all the employed physicians. That’s headquartered in Naples as well; it’s a division of the company. And Mr. Easterling and his team have been actively engaging our physicians in this technology deployment throughout the company.

What were the key qualities you were looking for?

As you can imagine, one of the most important key qualities was that it meet the needs of the physician users in terms of ease of use and clinical relevance. The vast majority of these physicians are primary care physicians. And interoperability was another quality. And service and assistance in implementing the system and maintaining it were other areas that people had interest in.

The solution is totally web-based?

Yes, we refer to it as cloud-based. And as it turns out, that turned out to be a feature that many of the physicians felt was advantageous. The ability to implement the system without having to upgrade hardware over time was seen as an advantage. In fact, there was a good number of folks who felt that that was without question the focus of the future.

When did you go live?

We start going live on December 1, 2012, though we’ve been having folks use electronic health records antedating the selection of athena. But candidly, our mission is to enable America’s best local healthcare; and in fact, there were challenges with previous systems, as you can imagine. And it was felt that this was an opportune time to re-look at things, and that was what led to this process, and to athena being selected.

What has the physician reaction been so far?

It is just going live, but the physicians visited with during site visits have had very positive reactions. And the company has been delightful to work with, so much so that we’re now offering this solution to all the physicians not only employed by but also affiliated with, Health Management Associates.

What have the lessons learned been around the selection process?

The number-one lesson is that it’s tremendously helpful to include as part of the process the people who are going to be using the system. It was tremendously gratifying to see how many physicians were involved, and their input was great. So that’s the number-one lesson.

How quickly will all 1,200 physicians be going live?

I’d have to defer that answer to Mr. Easterling, but within 18 to 24 months, I think we’ll see not only all 1,200 employed physicians, but a good percentage of affiliated physicians also live on this.

Do you think that hospital-based people tend to underestimate the differences in the inpatient and outpatient environments in terms of automation and EHR implementation?

Yes, absolutely. The business metrics are different, and the processes are different between the two environments. And the vast bulk of care takes place in the office-based setting. And the people who function in the context of the hospital environment do underestimate the differences; and the needs of a hospital-based electronic record are different from those in the hospital, and those needs need to be understood in order to be useful.

One of the most common complaints we see are around a solution not being useful. And as you know, most of this technology is disruptive at first; and that in my mind, is not fully appreciated by people working in the hospital environment. And there are many dire consequences of that. And a lot of the interoperability issues are also absolutely critical.

Do you have any explicit advice for CIOs and CMIOs based on your early experiences so far?

My advice would be, do your homework, look carefully at the products you’re assessing; make sure they’re applicable to the environment in which your people will be working; and plan heavily for the disruptions that will inevitably occur. And make sure that you communicate with a capital ‘C’ all along the process. And it’s my own personal feeling that it also helps for individuals such as CMIOs have credibility from having worked in practice, so that they understand the nuances of this technology.