Four years ago, Davies Award-winning Citizens Memorial Healthcare overhauled its IT structure to operate more efficiently, improve patient care and manage rising costs. Today, a fully integrated, 100 percent paperless healthcare information system connects the 74-bed hospital with five long-term care facilities, 16 physician clinics and home care services across southwest Missouri. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with CIO Denni McColm about how such a small hospital accomplished such great things.
AG: I’m not asking you to name any names, but did you have any situations where some of the more high-powered, higher revenue-generating physicians went to the CEO or CFO and said, ‘I don’t want to do this?’
DM: Yes. I would be surprised if that doesn’t happen in almost every hospital, and our CEO did a really good job with that. He didn’t say, ‘We’re going to do this no matter what.’ He said, ‘I want you to be sure to let IS know, and the team know, what it is that you feel strongly about, but we’re moving forward. I’ll get with them too and make sure that we get solutions to your problems.’
He was always proactive, and on the back side of that, he would come to us and say, ‘OK, Dr. Smith said he’s got this issue. What can we do to solve his problem?’ So he wasn’t just saying, ‘We’re going to do this no matter what,’ to the doctor, but he was saying, ‘We’re going to solve your problem, and we’re going to move forward.’ So I think that part of the cultural nature of this change. If you had a CEO that didn’t back you, that would be a tough position.
AG: You’ve got to figure that with what the industry’s going to go through over the next few years, a lot of CIOs are going to deal with that struggle, and they may not have as much support from the CEO level. It’s going to be difficult.
DM: Well, now there’s money attached. There wasn’t any money attached when we did it. I think that the stimulus will make that part of it easier because the CEO will now be able to say, ‘We don’t have any choice. We’re going to start getting a penalty if we don’t do this.’ I think that will make it easier. It’s easy for me to say, because I’m not going to have to deal with it.
AG: Do you think that we could have a situation where CIOs are accountable for making sure the organization is qualified for the stimulus money, but they might not have been given the resources or the support to put the systems into place?
DM: I can only say what I’m going to do. We’re at stage six (HIMSS Analytics), we’re close to a stage seven. We don’t have a paper chart. We have CPOE completely. I mean, we are as close as you can be without knowing what the definitions are, but I expect when the definitions come out that there’s going to be some things we’re going to have to do. Our systems are all integrated for the interoperability piece, but I think I will still probably have to go request some more resources. Hopefully, CIOs will know to frame that question in an appropriate way so they get the resources they need, because I do think that’s going to happen.
AG: What do you use for your core clinical, for EMR/CPOE?
AG: A solid system without too many bells and whistles, is how I heard it described.
DM: It is a solid system that works. I get to talk to people who are evaluating a lot of vendors, and it seems like there’s one end where there’s no customization and then there’s the other end that are way more expensive that are all about customization. I see Meditech as falling in between.
With Meditech, you have some flexibility to customize it, but then if you want to do something else you have to ask for some kind of custom programming, but it is a workhorse. You know why we selected it – their user interface is getting better and better all the time, and they were really the only ones who could do the sole integration between the hospitals, the home care, the long-term care, and the physician office.
If you think about what a patient’s electronic record looks like at our hospital, you go into my record and if I’ve been in all four of those locations, I have a visit for each one, and a provider can look at either one of those or they can combine those all into one record and trend across all of those settings. From my understanding, that’s fairly unique to Meditech. That was one of the big things for us, and the integration has paid off.
AG: I heard that you spoke at HIMSS about downtime solutions?
DM: Yes. Of course that’s a big deal when you don’t have any paper charts, it’s definitely a big deal.
AG: Take me through what your solution has been.
DM: We do all the traditional stuff with the second copy of the electronic medical record and alternate data centers and all that. We discovered right off the bat that we had to be ready for anything – what happens right now if the systems go down on the floor, if the nurse needs to know what medications the patient is on, when they last had their medications, what some of their recent lab orders and results were. There’s some immediate information, particularly the medication, that a nurse needs to know, and they can’t wait for us to figure out what happened.
We live in a pretty rural area, and one of the likely scenarios that happened to us, not frequently but occasionally, is we get cut off from one of our long-term care facilities. They can’t wait for us to figure out how to get that information to them. They have to have that information. So what we use is Boston Software – it’s a scripting tool and it’s a keyboard emulator, and so it pretends that it is a user, and it runs the reports that those nurses would need on a local PC, and it saves them on a local hard drive over and over and over all day long.
It’s very simple, it’s very cost effective, and if we have a situation where one of our long-term care facilities is cut off, we can immediately get into that machine and they can get a medication administration record, not only to see what the patient has had, but to start documenting on it until the system comes back up. We use it for a lot of other things too because you can just script back and forth, in and out of Meditech.