One-on-One with Dublin Methodist Hospital CIO Michael Krouse, Part III | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

One-on-One with Dublin Methodist Hospital CIO Michael Krouse, Part III

May 5, 2008
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In this part of our interview, Krouse talks about his feelings on the best of breed vs enterprise approach.
Dublin Methodist Hospital is a part of OhioHealth, a not-for-profit, charitable healthcare organization consisting of 15 hospitals and 20 health and surgery centers throughout a 46-county area. The new 94-bed hospital, which opened in January, can expand to 300 rooms if demand increases in its northwest corner of central Ohio. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to chat with CIO Michael Krouse.

Part II

AG: Is e-prescribing and pharmacy also covered by McKesson in your hospital?

MK: It is. It’s called Admin-Rx. Our PACS is Fuji Synapse.

AG: Is there a RIS that sits on top of the PACS for workflow?

MK: Yes, it’s a GE RIS system, Centricity. You asked an interesting question about the electronic medical record. I don’t know if you’re interested, but in the private practice environment, the EMR is a whole different ballgame. The EMR is more often than not a single product, a vendor product, like NextGen or Allscripts. Really what they’re saying is that in a private practice environment, it’s everything that billing and practice management don’t do. So it’s all of the scheduling. It’s all of the tracking of the information on the patient. It’s the problem list. It’s all of that bundled up together. That’s the electronic medical record in the private practice setting.

AG: The revenue cycle management part is McKesson?

MK: Correct. It’s what we call STAR, kind of our core patient billing system.

AG: Now that’s the patient billing, and then you also need enterprise resource planning and business intelligence.

MK: We do. We have a company called PeopleSoft from Oracle.

AG: It seems like people either pick PeopleSoft or Lawson.

MK: Correct, within healthcare that’s probably true.

AG: Do you use any aggregation product, like Microsoft’s Azyxxi (now Amalga)?

MK: No, we have a homegrown product here. It’s called Ohio Health Results Browser (OHRB), and it’s as close to a physician portal as you will ever see. But it sits as a viewer over the top of all of our back end systems. It allows our physicians and our clinicians to go to a single place to see all relevant information about a patient, slice and dice it any way you want, look at and run reports, see past lab results, pull up images actively, read remote strips, whether they be EKG or other components, see all of that. That has been built and running and continually enhanced probably for the last 12 years. We’ve got about twelve years worth of data on our patient population that is at the fingertips of anybody that has the authority to get in and see it. That, in essence for us, is probably the solution, at least for the time being, that we’ll continue to run with, that front end viewer. It’s pretty slick. It’s a Web-based tool. You can get access to it wherever you happen to be that provides Internet access and again, through appropriate provisioning, allows you to see what you need to see.

I talked earlier about the positive ID function, and I talked about the mobility of supporting our physician community. One of the things that I’ve implemented is when you’re at home today, for example, it’s 2:00 in the morning, and you want to place an order, you can. We worked with the State Board of Pharmacy such that, at home you may not have a biometric scanner and the State Board of Pharmacy requirements are: “something you have, something you know, or something you are.” If you meet two of those three, you, in essence, meet their requirements for a positive identification. So at 2:00 in the morning, a physician doesn’t believe it’s necessary for them to jump in their car and drive down to take a look at the patient because they’ve got access to the NICU and all they need to do is place an order, whether that be a test or a lab or a med.

So what we did was we introduced a company called PhoneFactor, which is like CellPhoneFactor. Every one of our physicians either has a Blackberry or a cell phone and it’s always with them. If they’re on call, then they certainly have it on their hip or they have it on the nightstand. And what they do is they go down to their desktop and they’ll log on to the Ohio Health site with something they know, a single username and password, and the something they have will be that cell phone or that Blackberry. The way the system is programmed, it will ring, place a call to that device and the individual will open it up and press the # key and that is the second factor for them to be uniquely identified. So the idea of trying to remember multiple passwords or trying to Citrix in through the wireless pack, those are gone. All I care about is your ability to get to the Internet. If you can get to the Internet, then I can positively identify you and you can place your order. Again, it goes to that "how do I simplify my environment to make the physicians’ lives easier?"

Another classic example, it’s the definition of art versus science and technology. People historically have been very good about the science of technology. There is a requirement from the government to lock down computer screens so the patient information doesn’t get into the wrong hands. The science is well understood. I can timeout your desktop after five minutes of nonuse or a minute of nonuse. The art of that technology is that in not all cases do I need a uniform one minute timeout. If I’ve got a desktop that’s sitting behind three locked doors with the front desk receptionist, it’s ludicrous for me to suggest that I need to apply that same kind of science. The art says understand the workflow of the individual, understand the security, and develop principles that both meet the federal requirements, but also give you the ability to support their workflow without being a hindrance. That PhoneFactor is a classic example of being able to roll that out in a way that simplifies people’s environment, rather than making it more complex.

AG: Tell me what you’re doing around EMPI?

MK: We have logic built into several of our applications for managing algorithms. Where the EMPI really comes in handy for us, and we’re going to be making an investment in the very near term on this, is positioning ourselves for a use-case scenario where I’m reaching out into the private practice arena and I want to pull relevant meds, allergies, problem list information on a patient who has shown up in my ED, but they can't really tell me anything about themselves. We’ve never seen them in the hospital before, but they’ve lived in the community for quite some time. So let’s say that individual’s name is John Smith. John Smith has never presented, so even though we’ve got this robust set of patient information, because he’s never been in Ohio Health before, we really don’t know anything about him. And yet he’s lived in the community for the past 15 years, is being taken care of by a private practice physician who has current information on their allergies, their meds, their problem list. What we want to be able to do is go out and reach out into that environment and pull forward that relevant information. The only way for us to be able to ensure that we’re grabbing the right person is via the EMPI, a matching algorithm that ensures that with a lot of John Smiths out there; you’re getting the right one.

AG: Are you working with a vendor on that?

MK: Yes. We’re actually looking at a couple different vendors right now. We also deploy EMPI technology in pieces that we already have today. For example, we have this robust set of information, and our physician community will place an order for a lab test or for something else to be done, maybe a medical image to be taken. And today, often what happens is that lab test is then faxed back to their office, so that the physician can see what’s going on. Because we’ve got more of our physicians that are making investments in their own electronic medical records, why is it that we’re still faxing paper? So we take those results and, real time, as soon as we get the result, we populate their electronic medical record with that result. The only way to do that, again, is with matching algorithms to ensure that the John Smith lab result that we’re sending on over to you matches properly to the John Smith on your database side. So without the EMPI, it’s a crapshoot.

EMPI algorithms, as you probably know, vary widely in the marketplace. Everything from simple matches on Social Security number, dates of birth, etc., to more sophisticated matches that go after telephone numbers, addresses, and various things. The degree to which you make that match allows you to set your threshold for when you can feel very comfortable that you’re 99.9 percent sure this is the same person. You also have to decide when you require some manual intervention to say, ‘Before I match, let somebody look at this and make sure it’s really the same person.’

I think it’s important to understand that there is a lot of product out there, and they incorporate different matching algorithms. There are probably three or four that people have settled on, and depending upon how big, how complex, and what you’re trying to do with the EMPI, you require varying things, and then you’ve got to build all the appropriate processes around setting the expectation. ‘When do I have manual intervention and when do I allow the computer to make that decision for me?’

AG: What are you using in the ED?

MK:

We have Horizon Emergency Care, which is another application module from McKesson. I wouldn’t call it part of the core. Most people refer to their core HIS as the patient billing, the STAR financial component, the clinical documentation component. That’s kind of what you refer to as core. And then you’ll hear people talk about ancillary, then they’ll talk about ED. And so for us, depending upon how you define HIS, certainly, McKesson is it and ED is a piece of that.

AG: What are you using for staff scheduling?

MK: We have Kronos. That is our application here for staff scheduling purposes, and that’s all running directly tied through PeopleSoft for productivity and tracking purposes.

AG: How was that integration handled?

MK: Very carefully is probably the best way to say it (laughing). But it was deployed out at Dublin, and done in a way that it integrates with all of the wireless technology necessary for scanning and logging in or starting your shift, if you will.

AG: Laboratory?

MK: We use McKesson’s Lab System Solution, so again, part of our core.

AG: Anything specifically for surgery?

MK: Yes. We introduced that at Dublin for the first time, Horizon Surgical Manager, and that is another application of McKesson. You can see what we’re trying to do is get a standard on as single a vendor platform as possible. We do it as catch as catch can. That’s, again, the value of Dublin; you can do all the things you want to do. We don’t have HSM at the other facilities. We are rolling that out as we speak.

AG: And do you have speech recognition for the docs to use?

MK: Yes. We’ve deployed a product called SpeechQ (MedQuist) that is widely utilized by our imaging environment resources, and we’ve actually got stats that I report on that talk about literally decreasing turnaround time by half, from the transcription to the actual report.

AG: So you’ve worked out the best of breed versus enterprise approach that CIOs struggle with?

MK: My general philosophy is that I want to standardize on a core. We talked a lot about core in the past, but everywhere I can standardize on that core, I want to. But I do think that the simplicity of interfacing with disparate systems is actually becoming easier because of the standardization.

I’ll give you an example. Many hospitals today say I want to help the broad physician community digitize their private practice environment. And with the relaxation of the Stark regulations, I’m now allowed to do that legally. And so they say I’m going to go pick Vendor A. Let’s say it’s NextGen. And I’m going to go out and offer that up to the community and say to them, ‘Here’s the one thing I want everybody to standardize on in their private practice arena.’ Well the reality is that no single product is going to support the needs of the various specialties that are out there. So I actually think it’s quite easy to tie and connect with a wide variety of products that are in the marketplace, and I really don’t have any energy or time to try and standardize something that is pretty easily linked.

So part of the issue is determining which components are critical to the core, understanding where the workflow overlap exists in the applications, where the application is unique and does not, for example, say, ‘Well, I do a certain form of patient documentation in this product, and guess what, I’m doing patient documentation in another product, as well.’ That’s a problem. That’s where you want to standardize, because what happens is if you’re doing it in two different places, then it makes it very difficult to get an entire view of everything that’s going on with the patient. And that documentation might lead you to place orders, and now you’re ordering in separate systems. So where you see the functional overlap, I think you need to try and standardize. Where the product is addressing a specific need of an organization without that functional overlap, I think that the interfacing is more than fine, and I would leave that environment alone before I would go out and cut my teeth trying to standardize on it.

AG: What are your thoughts on leadership?

MK: I am a big champion of the concepts of leadership development. I’m very passionate about it. I’m in the process of writing my own book on the subject. A lot of the things that I talk about in terms of transitioning the art and the science of technology deployment and the evolution of the CIO to a business person, medical representative, if you will, I’m pretty passionate about it.


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