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One-on-One with Florence Chang, SVP & CIO, MultiCare Health System

December 1, 2009
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As MultiCare rolls out more applications and expands its award-winning EHR system, data storage is becoming a high priority.

Based in Tacoma, Wash., MultiCare Health System is an 818-bed organization made up of four hospitals - Allenmore Hospital, Good Samaritan Hospital, Mary Bridge Children's Hospital and Tacoma General Hospital - as well as primary care and urgent care clinics, multispecialty centers, and hospice and home health services. The health system serves patients at 93 locations in Pierce, South King, Kitsap and Thurston. Recently, HCI Associate Managing Editor Kate Huvane Gamble spoke with Senior Vice President and CIO Florence Chang about how IT is moving the organization forward, and how her data management strategy is evolving.

We've laid a foundation, and the most important piece now is how you get the data out of the system and become much more proactive to help our physicians take care of patients.

Florence chang

Florence Chang



KG: MultiCare received the 2009 HIMSS Organizational Davies Award for the MultiCare Connect EMR. Your organization began implementing the system in the clinics about a decade ago - what's the status now?

FC: MultiCare is a four-hospital system; the fourth hospital was affiliated with us about three years ago. Currently, all three of the original hospitals are up and running with the EHR, together with all our clinics. The fourth hospital will be up and running by May 1, 2010. We're in the process of changing the existing system to the Epic system.

KG: Do you think it was beneficial to implement EHRs in the clinics and have that in place before going live in the hospitals?

FC: Absolutely, because of two things. Number one, getting the clinic up and running with the electronic record is the best way to introduce technology. You're not in the acute care setting, which is a much more critical, 24/7 type of environment, and I think that's a great way to do it. And number two, if you look at the maturity of the software, whether it's Cerner, Epic, Meditech - they all started with more of the clinic modules first. So even from a software technology perspective, the clinic module is much more mature than a hospital system. The hospital systems, for any of those major vendors, really did not become a mature product until about eight to nine years ago. And for us, it was great because by the time we came up with the hospitals, we had over 10 years of records in our system already. We have 1.5 million patients in our database right now.

KG: How are you utilizing all that data? Are you doing data mining?

FC: We're using the data to improve decision support and to better manage our chronic disease patients. And the way I see it, what we've done is just the beginning. We've laid a foundation, and the most important piece now is how you get the data out of the system and become much more proactive to help our physicians take care of patients. Because of the intelligence of the technologies that we have in place, this whole decision support piece becomes probably the most important component of the EHR system. We want to make the EHR system not just transactional, but much more dynamic, where the data becomes a real-time decision factor for the clinicians.

We use data mining to help manage our chronic disease patients. We have about 8,000 patients with diabetes, and we monitor those patients with the data we have to make sure they do things like get regular check-ups. Every provider has a report to tell them how compliant their patient is, and with the MyChart portal, patients can enter their glucose monitoring data from home and download it to us.

KG: What other systems do you have in place? Do you have CPOE?

FC: We do. We went live with CPOE in October of last year, and I'm so proud of our physicians. The CPOE rate across the nation is only 7 percent, according to Leapfrog data released in April, but within our organization, we have 80 percent of our docs entering orders directly into the system. That's amazing.

KG: How do you think your organization was able to achieve such high adoption ratings?

FC: By engaging the doctors from the very beginning. We put in place a very comprehensive physician adoption methodology where we involved the physicians in helping us build the order sets. And we did a lot of road shows, going into the community to show them the product, asking them for their input, and providing a lot of training and support.

KG: So with all of these IT systems in place, has your strategy changed in terms of being able to store and retrieve data?

FC: Absolutely. As part of our efforts with the EHR, we're also looking at our data strategy, and more importantly, our disaster recovery and business continuity strategy. Because now, we're dealing with mission critical data. So from the very beginning, it's been about our overall strategy, not just about implementing an EHR.

I tell my CTO, I'm looking five years ahead - you need to look much further than that because the infrastructure needs to be able to support the system for at least a minimum of five to 10 years.

And there are a few key things. One is that all mission critical data are stored in duplicate servers with full backup. We also have offsite tape storage. We're able to restore our service within 12 hours for the hospital system, and 48 to 72 hours for administrative systems like time and attendance or financial systems, which are second tier. But we'll be able to pull immediate patient data within 12 hours in case of any major disaster. Everything has redundancy and backup. And we also have two data centers with separate physical locations so we'll be able to store our data.

KG: What about imaging storage?

FC: With imaging, both for cardiology and radiology, the storage is incredibly high, as far as how quickly we can store the data and how much data we can store in the system. We did a very elaborate projection of what is going to happen in the future, looking two to three years and even five years out, and are planning our storage appropriately.

The other major component is that Multicare has the largest sleep center in the western region, and because of that we have to store video. Right now, we have about 10 terabytes of video, and we currently manage about 75 terabytes for the imaging studies that we have.

Normally, radiologists like to see a prior study to compare a current image. So our strategy is to keep 18 months worth of studies online for them for quick retrieval, and the rest we put into an archive system.

KG: How much growth are you seeing each year?

FC: We're looking at a growth of about five terabytes per year. I have a very strong technical team led by an excellent chief technology officer. I tell my CTO, I'm looking five years ahead - you need to look much further than that because the infrastructure needs to be able to support the system for at least a minimum of five to 10 years.

He also needs to be nimble and be able to change quickly as the technology develops. So now, we have virtualization, virtual servers and virtual data warehouses in place - all of that using the latest technology. He needs to be in front of me, and be agile so that we can quickly adopt the latest technology and reduce costs. We have to be able to take advantage of technology.

KG: A lot of organizations have been heavily impacted by the recession. How much has MultiCare been affected, in terms of having to push projects to the backburner?

FC: We are very fortunate within our organization. When our board and our senior executives met last October, we looked at what we want to continue to do moving forward, what are the key strategic advantages for our organization, and what projects can we hold back.

We're very fortunate in that we all have the same vision, and that is to provide the best care to our patients in our community. We realized that an electronic health record is a competitive advantage and it enables us to transform the way we deliver care. It's that type of forward thinking - of utilizing technology to reduce costs, to become much more effective, to reduce redundancies and to reduce variation - that will move us toward our goal of achieving quality patient care. None of our major projects, including the EHR and the pharmacy medication bedside management system were held back.

However, we did hold back some projects, and we took a deeper dive within our organization to look at how we can reduce costs. For example, I looked at all of my major vendors to renegotiate our contracts, and we've been able to save $1.6 million already. And across our organization, we came up with 400 different initiatives that can reduce costs. So this year, we will be achieving somewhere in the neighborhood of $20 to $30 million savings.

There are so many things that we want to do better than we did yesterday; how can we reduce costs while providing the highest quality of care? You have to have a tool to accomplish that, and we think that investing in technology will help us achieve our goals.

Healthcare Informatics 2009 December;26(12):22-25

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