Caritas Christi Health Care System – the largest community-based hospital network in New England – is in the second phase of its EHR rollout. A few weeks ago, the organization completed an extensive nine-week training regimen with its 1,200-member physician group to lay the groundwork for CPOE adoption and proper use of the EHR. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with Rothenhaus about how the current federal policy initiatives were effecting his plans.
GUERRA: Tell me about your health system.
ROTHENHAUS: We have six hospitals, two of which actually have house staff and graduate medical education programs; plus St. Elizabeth’s Hospital (Boston), which is actually a tertiary-care hospital. We do hearts there and most other stuff; we don’t do super special neurosurgery and stuff like that, but it’s a regular tertiary-care hospital.
We have about a total of about 15,000 beds throughout the health system. We have about 12,000 employees and about 1,300 doctors … actually our physician landscape is a little funky in that we have four flavors of doctors. We have about 400 employed physicians, about 1,300 physicians who are affiliated with Caritas, in one of seven IPAs. So we have a total medical staff of about 2,300 when you add it all up.
GUERRA: How many physicians have privileges at one of the hospitals that aren’t part of the big IPAs you mentioned?
ROTHENHAUS: Well that’s about 1,000. So there’s 2,300 physicians … 1,300 of them are in the IPAs and another 1,000 are not in our IPAs, so they’re just in somebody else’s IPA, whether they’re part of Partners Healthcare or Children’s Hospital IPA or whatever, but they admit their patients and have staff privileges at our hospital.
GUERRA: And that’s not including the 400 employed doctors.
ROTHENHAUS: Right. And out of the 1,300, 400 are employed.
GUERRA: So you’ve got the full spectrum to deal with.
ROTHENHAUS: Exactly. As customers, that’s what I call the four flavors of physicians. One of those I don’t think we give a lot of attention to these days is physicians whose patients come to the hospital but they’re not even part of our medical staff.
There’s a lot of physicians out there who don’t even pay to have staff privileges or they may be on somebody else’s staff but their patient lands in our ER and gets admitted to our hospital. From an IT standpoint, there is communication that should go on with that group but doesn’t. So I’m thinking a lot about it because I’m thinking a lot about customer relationship management, and there’s that group of people we know exists, but we haven’t really identified because we don’t know what their names are.
GUERRA: So these people, these doctors are not in an IPA, they don’t even have privileges at the hospital, but you’re talking about how you can better be prepared when one of their patient lands in your ER.
GUERRA: That is interesting.
ROTHENHAUS: Right. So if it’s an employed doctor, we can use some inter-provider messaging, or they’re just going to log onto the information system and they’ll see that the patient was in the ER the previous day.
We have a contractual relationship with the IPA’s affiliate physicians through an entity known as Caritas Christi Network Services, and those folks I have an interoperability solution with, in that we get them discharge summaries in one way, shape or form. We are trying to make that an electronic process where it goes to the EHR.
And then there’s this third group of people who are on the medical staff, they get the discharge summaries too for the patients that get admitted. This is a fax thing. They have another EHR, and we are trying to solve that integration piece as well.
And then the fourth one is, for example, let’s just say you’re a Beth Israel doctor here in town and your patient gets admitted to Caritas; there’s a communication that should occur when that patient leaves the ED or leaves the hospital after an admission. In that case, it requires the medical record going out, and we don’t like to do that unless we have a preexisting relationship. So those patients don’t get the benefit; it would be the patient’s responsibility, or their doctor could call medical records and request that discharge summary. But that gets complicated under HIPAA.
So I just think it’s an interesting thing. We had been thinking a little bit about CRM in the classic sense and thinking about how it’s about patients, but it’s also about our referral base, and that last segment is a group that I think is under-recognized. We haven’t done the study yet, but when we finally do the analysis, there are a lot of people who get admitted whose doctor doesn’t pop up as a coded entry in one of our lists.
GUERRA: Interesting. Why don’t you give me an idea of your overall plan. I know you’re in the second phase of an EHR roll out. Why don’t you take me back to the beginning of that.
ROTHENHAUS: I’ll take it up a little higher. Right now, we have a few major projects that we’re doing. We’re doing hospital information systems – what we call advanced clinical systems roll out. So we’re doing CPOE, we’re doing staff documentation and bedside medication verification with barcoding. Those projects are ongoing at Caritas and we’re moving through with a completion date for that project in March of 2010.