Mercer County, N.J.-based Capital Health – a two-hospital, 589-bed regional health network, including an ambulatory facility – recently completed the implementation of an EMR from Boston-based Keane. Comprised of Mercer and Fuld hospitals in Trenton, N.J. and the Capital Health in Hamilton outpatient facility, the organization is expanding, with construction underway for a new hospital in Hopewell Township, N.J. as well as an expansion of services at its Fuld hospital, both scheduled to be completed by 2011. Add to all that the goal of qualifying for HITECH stimulus funds and it’s no wonder CIO Gene Grochala has his hands full. Recently, HCI Editor-in-Chief caught up Grochala to talk about how he’s managing all these challenges.
GUERRA: When did you go live on Keane?
GROCHALA: It was April Fools’ Day 2009, a few months ago, though we signed the contract in 2007.
GUERRA: Take me back to the 2006 timeframe and tell me how the conversation started.
GROCHALA: In 2006, we were running HBOC Series.
GUERRA: And they were bought by McKesson, right?
GROCHALA: That’s right. We had it running in two different hospitals, and we had that primarily as our orders results documentation system, but we had a series of other systems that were independent – pharmacy, OR, ER. We went to Beacon Partners out of Massachusetts and we asked them to help us develop a three-year IT plan. We got together our physicians, nurses, financial department and we went offsite. We did this over a couple of months and laid out what a typical day in the life of somebody at the hospital would be to figure out what kind of information we needed to bring together.
With that, we created a very nice document, and it really showed we wanted a single-source vendor. The people we had brought together wanted to have a comprehensive view of information in the form of an online electronic medical record, and they really wanted a big system that communicated patient data easily and transparently. They didn’t say it had to be without interfaces or integration, but they wanted it to be transparent for themselves, and the technical problems were on us.
With that, we took the document to our board and asked for some capital funding to go out and search for another vendor, another product which was more state-of-the-art. We looked at a lot of vendors and did site visits, primarily it was clinicians that went. We did have some IT representation but IT was in the background because we really wanted the end user to pick the system.
I believe it was our director of nursing informatics who found the Keane system, while at the same time we were building a $700 million hospital. So, my director told us to do more with less. That is, we couldn’t go out and spend $50 million on a clinical information system. We had to find something that would do the job, but also have some real ROI. It has to be reasonable, but it also had to deliver.
Coincidently, myself and three other people from the organization were going for a Patient Safety Fellowship at the American Hospital Association. So, we were really focused on patient safety at that time.
We were also three years into our first CPOE system. Again, it was more of a standalone system. It was really for medication only and we had about 45 percent utilization on CPOE for medication. We’re still at that figure. So again, we wanted total CPOE, including diagnostic orders as well as our pharmacy orders.
So, with all this in mind, we brought Keane in and found it to be it a diamond in the rough. We found it to be a sleeper. We kept asking, “Why don’t they market this stronger? Why don’t they have a bigger presence in the marketplace?” I think they are like 12th in the clinical systems and acute care settings, and they’re just really happy with what they have and very proud of it. Every time we threw a question at them or a problem at them, they would bring the system in and show us how they handle the issues. We were still disbelieving. We then put a criteria list together, about 100 points of things that we wanted out of a system, a quick checklist, and they scored – again this was done by the clinicians – 93 out of 100. Pretty good score, better than I did in college. (laughing)
GUERRA: What was your budget for the project?
GROCHALA: We were trying to keep it under $5 million for two hospitals as a project budget, not just what we spent for software.
GUERRA: That cut a few contenders out right there?
GROCHALA: Yes, that’s true. We were not going to look at the high-end guys.
GUERRA: Do you still use some McKesson products?
GUERRA: Tell me about your software environment now. You said you have some McKesson products, you’ve got Keane, can you give me the lay of the land?
GROCHALA: Well, we really wanted to focus on clinical applications, so we left our admissions, registration, medical records, and billing in place. You have to think of the patient flow for billing admissions and medical records, the DRG coding, we didn’t want to touch that. We really focused on orders and results, clinical documentation, vitals, EMRs, pharmacy CPOE, electronic medication administration that works right out of the box with any kind of Palm or Blackberry, and we wanted the single comprehensive view of patient data. So, while we taught a physician or a nurse how to use it in a hospital, the physician could use it in his office, the physician could use it in his house. We wanted to make sure that once they were taught, they would know how to use everything.
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