Lutheran Medical Center (LMC) is part of Brooklyn, N.Y.-based Lutheran HealthCare, an organization which also includes the Lutheran Family Health Centers network and Lutheran Augustana Center for Extended Care & Rehabilitation. LMC is a 476-bed Level I Trauma Center providing ambulatory surgery, cardiac care, neuroscience services, obstetrics/gynecology, spinal surgery, perinatology (maternal/fetal medicine) and oncology (cancer diagnosis and treatment). Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with CIO Steve Art about his facility’s plans to implement the VA’s VistA open-source software supported by MedSphere.
AG: And that would be a core EMR that also is useful in the ED?
SA: Correct. It doesn’t make sense to have multiple systems. So although we needed ED system for a number of years – and I don’t remember what year I bought that thing – when we bring up the new EMR, it will replace the old departmental EMR.
AG: Is it inevitable that, because you’re going with a wider system, you will lose a bell or whistle or two from that particular ED system? Will the ED folks balk at that loss of functionality?
SA: Absolutely you are right, that was a concern of mine. I told the ED early on that I would not make them move unless I can give them all the functionality that they had today. And that’s what we did. We started out with some kind of analysis system side by side to see what the gaps were, and we realized that the new system actually was going to give them more than the old system. It had much more functionality than the old system did, but there was one piece that was missing, and it was a tracking board.
There is a board that when you go in the ED and an outside attendant comes in, he can find out the bay or room the patient who he sent is in. So if you want to know that your patient is in 812, you go to the board, you find your name, you find the patient’s name, and you go to 812 and find your patient. So that component was not part of the system I bought. What we’re doing is we’re developing with my open-source vendor, the tracking board here, and then I will give it to them, they will QC it, and incorporate it into the product for all of their clients. That’s the cool part about open source; I have the software and I can develop it.
AG: So it sounds like CIOs have to be sensitive about taking away functionality from departments when they replace niche systems with larger core rollouts?
SA: Yes and the only caveat to that was all EMR systems require you to use their pharmacy, because pharmacy is the one piece that is a whole closed loop. You have to make sure that you’ve got the right drug to the right patient at the right time and all that the orders that flow into the pharmacy flow out correctly to the patients. I believe all of the vendors require you to use their pharmacy.
So this whole decision turned on the fact that I had to get the pharmacy to agree that the new system was no worse than their current system, or I couldn’t have done it at all.
AG: And were they on McKesson? The pharmacy?
SA: No, they were on Mediware. They’re still on Mediware. They are on the Mediware Pharmacy and they were the only ones I actually had to change because I could have figured out interfaces for all the others. The other ones were manageable. Pharmacy was absolutely critical to the process.
AG: So you’re saying they’re not on Medsphere pharmacy at this point?
SA: No, I’m not on Medsphere yet. I’m going to it. I’m going live. We don’t have the final lease of it yet.
AG: Okay, but you will be going to Medsphere pharmacy?
SA: We will be going to Medsphere pharmacy, yes.
AG: Because you’re saying you can’t go to a new system and not take the pharmacy?
SA: Yes. In our case, our labs guys objected, they didn’t like the lab system that Medsphere had. So we’re writing interfaces for them so they can stay on the SunQuest pharmacy product. The old Sunquest pharmacy is what we had here, and they're staying on that lab system. We built an interface between the lab system that’s in Medsphere and the lab system I have here, so people will order labs in Medsphere and labs and orders will go over to the lab system and the results will come back.
But pharmacy I couldn’t do that with. Pharmacy, we had to use the Medsphere Pharmacy. Like I say, I think that’s universally true of all EMRs, you have to use their pharmacy.
AG: Do you think it’s a losing argument for CIO to say to a department, ‘I’m switching you off your current system to another system, it’s better for the organization, but you’re going to lose some functionality?’ Is that too hard to sell to make?
SA: I always say it’s their decision. I always try to lead every department to the correct decision. I think I know what the correct decision is in terms of how these things all work together, but I try to give them the information that they need to make the decision, because if you tell them what you want them to do, most people won’t do it. You have to let them decide it. I try to give them the information they need and that’s what the process is, to bring these systems in, to let the departments make that decision. If it’s not a good decision for the department, then it’s not a good decision for anybody.
AG: That’s a good point.
SA: It’s really true. And so I can't dictate that. I don’t feel I have that much pull. I just can’t dictate that. Being in the business as many years as I’ve been in the business, I do know the hot buttons and I know how to sell this stuff to them and I know how to get the right guy in front of them and frankly, if it was rational, I wouldn’t have even brought somebody to them. They have to be rational.
AG: Let’s go back, because I took you off track a little bit. We’re talking about the fact that you had the ED system in place, and you were looking for a core system. Now, take me back to that point of looking for that core system.
SA: We had all these other systems in place. We’re ready to go. We then started getting educated about what the systems were and what they did so we could all start talking about it in the same terms. I’m going to take you back a second.
Some people thought that an EMR system was when you scan a paper record and index it into an optical system, where you can call up the old record because you received the paper and print it like a fax jukebox or something. There were people in the room that actually thought that’s what the EMR was. So to get them off that and say, ‘No, it actually has data and there’s a database.’ There was a big gap there in their understanding. So that took a bit of doing.
Once we got there and they understood what it could do, then we had to go through that fear stuff of, ‘Is it going to practice medicine? Systems don’t practice medicine; people do.’ We had to get rid of that stuff too. When those things were done, we then went out looking with an RFI and said to a number of vendors, ‘Please bid on this.’ What we’re looking for first was just CPOE. We wanted somebody who had a big system, but we wanted to only buy the CPOE part of it because we thought that was our biggest need, and we didn’t know that we had enough money to do it. So we got quotes back from the vendors and it just knocked our socks off.
AG: And these would be the usual suspects?
SA: The usual suspects – Epic, Eclipsys, McKesson, QuadraMed, Meditech – all the regular suspects. We sent this thing out to 10 vendors or something and they were all happy to bid, of course, but the numbers were outrageous. There was absolutely no way we were going to be able to afford it. We came to conclusion that either the systems were going to cheaper because more people were going to buy them and it was going to be easier, or we were going to have to do something else. That was our decision. And we pretty much were walking away from the whole idea of buying anything soon.
And then out of the blue we got a rate appeal from some charges that we put in years ago, and we got some money. We got a pot of money. When we got that pot of money, then the boss said to me, ‘Start looking again and see what you can find.’ Now, in the meantime, and I don’t remember what this year was – I think it was end of ’05/beginning of ’06, I read an article somewhere that under the Freedom of Information Act, the Veterans Administration software was available at no charge.