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: Have you taken advantage of the Stark Legislation changes to underwrite EMRs for the practices in your area?
GROCHALA: Not immediately, no. We’re working with a thing called the Trenton RHIO. There are four partners, us, another hospital, City of Trenton, and a qualified healthcare provider, Henry J. Austin. The four of us are trying to strategize and come up with one ambulatory EMR, and one of the partners has already started with a company called EHS out of Alabama. It’s like a Keane product, it’s functional, it’s solid, but it’s not glamorous and it’s not overpriced. It’s a good product. So, we’re looking at that now, and we are trying to incorporate it into our strategy. Maybe we will roll this out to our own physicians, and with that $44,000 I hope they cover all or a good portion of it.
GUERRA: But that $44,000 goes directly to the practices, that wouldn’t come to you unless you arranged for it somehow.
GROCHALA: Well, it depends on who owns the practice. We own 40 practices. There are also independents out there that work with our hospitals, and then the Trenton RHIO. But when you think about it, we’re trying to normalize data and make everything interoperable, right? If we get everybody on the same platform, that resolves a lot of issues. That’s the kind of leverage we keep looking for. It goes back to what you were saying, if you minimize the number of vendors without jeopardizing quality, it takes a lot of challenges out of the process.
GUERRA: You sound like one of the more savvy business-type CIOs that I’ve spoken with. I interviewed someone the other day and they made the point that while there are incentive payments on the back end of this, an organization’s operational costs are necessarily going to go up permanently. Additionally, the goal is to reduce duplicate tests and admissions, diminishing revenues further. Do you have any thoughts on that?
GROCHALA: Yes, a lot. I think the past commissioner of health in New Jersey said the best hospital to go to is a low-cost hospital because that place gets the patients out quickly. The hospitals that are buying the $50 million computer systems and keeping the patients for seven days instead of three, they are the hospitals you don’t want to be in. That’s where you going to get some kind of nosocomial infection. The longer you’re in the hospital, the more you’re exposed to things.
Now I’m a little excited. I’m getting into this interview. I guess I still have a lot of passion about what I’m doing here.
GUERRA: Based on what we were saying, doesn’t payment reform have to go along with the goal to decrease services and length of stay? Otherwise, you’re just decreasing revenues and increasing costs.
GROCHALA: Well, I’ve been in this business for 30 years. It’s business as usual. It’s just part of the job. I don’t see much change in that.
The biggest problem for me is with ARRA. On the one side, it’s like they’re going to give us money to put more information together and make it interoperable and transfer it to payers, but we could also call this HIPAA 2. They’ve got so much regulation in there.
Now, each and every occurrence of a patient that involves a release of information -- even if I release your information from the general practitioner to the specialist as a referral -- I have to keep a log of that, a record of that, and upon demand from the patient I have to provide that log. I don’t have that system in place. We do database logging, we do a lot of things for HIPAA compliance, but an actual tracking mechanism that tracks when it was released, who released it, and why they released it, a mechanism that will then give you the whole audit log on demand, that’s something which has to be built, and so it’s going to cost money.
GUERRA: We also don’t know how you’ll report to qualify for meaningful use, what kind of data you’ll have to pull together. That could be another major issue.
GROCHALA: Yes, it could. At this point CMS is the biggest parent in the world and they just say, “Follow our leads, whatever we do,” and everybody has to do it. I mean, I would make things a lot simpler for guys like me. We’re all sitting back trying to just live through it and sustain ourselves.
We rely on our vendors to help us meet new demands. Keane has to get the CCHIT certification first. Without that, we’re dead in the water. Once they get their certification, then the burden is on us to implement all the products and do the statistics.
GUERRA: So you’ve been in this business 30 years. Is this the most challenging time? How would you describe what is going on right now?
GROCHALA: I think it is the most challenging time. There’s so many different demands put on IT.
We need to talk about the medical stuff. We’re sitting below this data center, 2,300-foot data center, and we’re saying at least 40 percent of it is going to hold clinical equipment in there from a nurse call system that has a whole rack of servers. Security systems, fire alarm systems, all that stuff runs over the network now, so we have to support all that stuff while we’re trying to do things like direct patient-care applications too.
I think the real difficulty is with the speed of change that’s happening right now. It’s not just the amount of change, it’s how fast. That’s really a challenge for me now, too. I’m just jumping around from one urgent problem to another, to the RHIO. We’re supporting all the clinical information systems in our data centers, trying to integrate all this in it, trying to come up with one common vendor, too. It’s like casting a big net and catching as many fish as we can. But I love it. It’s a lot of fun.
GUERRA: It should keep us all working for awhile.
GROCHALA: Keep us all working and probably kill us in the end. (laughing)