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Medical Group in the Cloud

June 13, 2011
by Mark Hagland
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Springfield Clinic supports its clinicians across multiple sites in downstate Illinois

Springfield Clinic, a multispecialty medical group located in Springfield, Illinois and surrounding communities, encompasses 340 clinical providers (among them 240 physicians) practicing in 40 specialties, and employs 1,900 clinical and administrative staff members, serving a population of nearly one million patients in more than 20 medical offices across central Illinois.

Springfield Clinic, a multispecialty medical group located in Springfield, Illinois and surrounding communities, encompasses 340 clinical providers (among them 240 physicians) practicing in 40 specialties, and employs 1,900 clinical and administrative staff members, serving a population of nearly one million patients in more than 20 medical offices across central Illinois.

Given its large number of clinicians working in numerous different physical sites, it’s not surprising that Springfield Clinic would naturally be attracted to cloud-based computing services. In fact, Springfield Clinic’s leaders have been working with the Andover, Mass.-based NaviSite, Inc., using NaviSite’s managed application services offering in order to support the clinic’s operations.

James Hewitt, CIO at the Springfield Clinic, spoke recently with HCI Editor-in-Chief Mark Hagland regarding his organization’s strategies and tactics regarding cloud-based computing in a multispecialty medical group context. Below are excerpts from that interview.

Please tell us about your clinical IT implementations and their infrastructure foundations.
I’ve been at Springfield Clinic for a little over five years now; they had acquired [the core electronic health record (EHR) solution from the Chicago-based) Allscripts two years prior to that, but had only implemented a document repository, and were taking lab results and transcribed documents, and aggregating those into that repository. But physicians didn’t even have computers on their desktops.

When did the EHR actually begin to be used?
Right when I came, we did a full review, and selected Allscripts. I had been the CIO for Allscripts for about six years. The enterprise product that Springfield Clinic implemented, I had been responsible for.

James Hewitt

When did you begin going live with the core parts of the EHR?
It was almost immediate. We spent a few months doing the contract and preparing, and then quickly went live. Instead of a “big bang” implementation or a modular implementation, we did what we called “mini-bangs.” So we would take one location at a time and bring it up on all the modules and components. At that time, there were 22 locations; we have more than that now.

We also have outreach, where our specialists move into outreach locations, and there are 43 outreach locations. Those could be in a hospital, or another doctor’s office; they just need connectivity and a nurse; it’s usually within another healthcare facility. The whole concept is that since we’re in rural Illinois, we send our specialists out to those locations. There are about 20 physicians who work out of that location where I am in Hillsborough, Illinois. It gives great benefit to the communities when we drive our specialists down there. So we did these “mini-bangs.” And we went with pure “slates—pure slates, just a thin slate device. It’s kind of like an iPad, but bigger.

So you’re totally mobile, basically?
Yes, 100-percent mobile. We use slates from [the Austin, Tex.-based] Motion Computing. We were one of their largest implementations. And so the doctors and nurses can go anywhere. We have somewhere around 900 slates, or tablets, within the organization.

How big an IT team do you have?
The size of our current team is 44; we had about 30 during the implementation phases.

So you’re totally in the cloud now?
Our EHR implementation is not currently within the cloud. We have different cloud implementations. Just as I was coming on board, the corporation selected [the Brisbane, Calif.-based] Stentor [now a part of the Amsterdam, Netherlands-based Royal Philips Electronics] as their imaging solution, and that was one of their first totally outsourced projects. They handle all of our digital imaging, including their PACS [picture archiving and communications system]. And managing all that infrastructure, storage, bandwidth issues, that’s a huge issue; but Stentor took that entirely off our hands and manages that. So we don’t worry about storage or anything. That has worked really, really well for us, and it’s totally hosted. That came about, about six years ago. And then we had selected, on the operational side, we run [the Redwood Shores, Calif.-based] Oracle (it was PeopleSoft when we signed on with them). And, partnering with NaviSite, we were able to move all that out into the cloud. And with the HITECH Act, everyone upgrading the new systems in order to get the meaningful use dollars, it’s important to not have to worry about all that. So NaviSoft is hosting all our financial and human resources IT operations, in the cloud. So I don’t have to worry about our data center or the growth of our data.

The Stentor/Philips imaging informatics is hosted separately?
Yes, that’s right. And in both cases, both of those organizations also manage disaster recovery for us. So I don’t have to worry about disaster recovery or the upgrades for those solutions.

How should medical group CIOs think about issues around hosting, the cloud, and infrastructure?
It really does depend on the composition of the individual group. We’re out across about 14 counties in central Illinois. So being able to implement an infrastructure that gives us the access to data that we need, is very important. The cloud can do a lot of things for you; you don’t have to worry about whether you have enough bandwidth, enough storage, enough processing power. One of the inherent advantages of the cloud is what they call elasticity. I really wish we could get the EHR into the cloud; but those solutions need to have a certain infrastructure.

If the infrastructure isn’t there, you’re living in two worlds, then?
There are companies that will host your data center; but some of the functionalities of true cloud computing don’t necessarily exist yet in the EMR space. Some of that development will take place over time.
For the clinic, we’re just slowly dipping our collective toe into the cloud. We’ve done imaging, and our HR and financial IT operations, and the next will be our help desk; so we’ll continue to move services into the cloud over time.

Are your physicians are happy with the EHR?
Not everyone is happy; change is hard. But our EMR utilization is one of the top in the nation in terms of transactions through the EMR, among Allscripts. Allscripts has what they call a Delta process, looking at prescriptions prescribed, documents created, etc.

And you’re in their top five percentile in terms of EMR use among Allscripts customer organizations?
Easily. We have 340 providers, plus we have an MSO [medical services organization] group of another 70 providers, so nearly 400 providers are utilizing Allscripts across all specialties; it’s a very large implementation. And one of the fun checkpoints for me personally is that our medical malpractice insurance carrier came in, and you can get a malpractice discount if you’re using an EMR solution. And they came in and looked at individual physicians, and said, great that you have an EMR, but are you actually using it? They analyzed our use based on individual analyses of our physicians, and 100 percent passed.

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