Methodist Hospital, founded in 1903, is a 460-bed, not-for-profit hospital serving the central San Gabriel Valley in California. The JCAHO-accredited organization provides acute care services such as medical, surgical, perinatal, pediatrics, oncology, intensive care (neonatal and adult), and cardiovascular, including open-heart surgery. HCI Editor-in-Chief Anthony Guerra recently had a chance to chat with Marx about her work.
AG: Tell me about your IT architecture. You mentioned your work with Eclipsys. Is that your core clinical vendor?
KM: Historically they have been a Quadramed Infinity organization here. They have run that probably for 12-13 years. It’s been a great solid app here. They had all their modules filled out. But right before I came, when they did an internal selection and picked Eclipsys, the driving force was not really CPOE as their first initiative, but nursing documentation to improve quality and patient care. The Quadramed architecture didn’t necessarily support clinical, it didn’t support as robustly as they wanted. So that’s why they went with Eclipsys, and we only signed on for a handful of clinical applications. The reason that I say that is I prefer to consider us of a more best-of-cluster organization, where we savor our existing relationships on new acquisitions, but we would never be monolithic. If it makes more sense to keep the Quadramed financials, then that’s what we’ll do. We have Quadramed financials and Eclipsys clinicals, and then we have our other big systems — Picis surgery, and we have McKesson Pharmacy, and we have SoftLab (from SCC Soft Computer) in the lab.
KM: DR PACS is our PACS, and they’ve been a partner here since 2001. We did step outside our comfort level and started a new relationship with a company called MedPlus. That is going to be our document imaging vendor with our ChartMaxx applications. Because of their best-in-breed status, we felt that it did override our looking at our other partners. We will occasionally make exceptions if it’s compelling enough.
AG: How difficult is it to integrate data flows between applications from different vendors?
KM: I think that if I had my choice and I could have a dream environment, I would have as much integrated as possible. I do believe in integration from a single vendor, but I think you have to kind of pick your battles and your value. Sometimes certain interfaces are really not that challenging, and it’s okay to have them interfaced. But in other areas, there are particular interfaces which I just would not want. So it really depends on the scenario and the value of how that application stands alone. The functionality, the reputation, the stability, and price, and all these things of why we pick a vendor is that more powerful than the challenge of integration. If the interface has been successful in the past, I’m willing to take that risk to get the stronger application to meet my strategic goals. Each time, we look at it that way. For instance, with MedPlus, we purchased MedPlus as our document imaging vendor, and we’re going to use it in HIM and in PFS (Patient Financial Services).
We’re going live in the spring. We purchased their portal. The reason that we purchased their portal is because it’s a physician portal. The physicians are going to be doing remote electronic signature and deficiency analysis. It’s the same vendor, ChartMaxx does the in-house e-signatures and chart deficiency. It made sense to the organization that we would also pick their portal product to be the front facing to the physician population because then we have more opportunity to hold that vendor accountable. So for my physician population, that’s extremely important, so that’s why we didn’t pick some other vendor.
AG: What would it be about an application that could make you refuse to integrate it into your current environment?
KM: What we did when I came onboard is we did develop an IT strategic plan, and part of that includes the IT Guiding Principles. We wrote guiding principles that have been adopted by the organization that state we will always give preference in a selection to an existing partnership or relationship. We’re a bit risk averse, so another thing is we are not an early adopter, but we like to consider ourselves a fast follower. We require that a vendor have three to five successful installs or interfaces that match our environment to get them to be considered.
AG: How difficult is it when one vendor upgrades their product? Do you have to retest all the interfaces?
KM: We run everything in test environments whenever possible. Most of our upgrades are just tested in test and, hopefully, we don’t have to remap a lot of stuff. It really just depends on the level of the upgrade, and its variable.
AG: Can you tell me some of the major projects you are working on this year.
KM: I almost feel like I have to tell you what we just finished because it leads into what we’re doing. We got a ton done in a short period of time. We took the organization up a significant road to get in on the current state of technology. In the fall of November, we went live with Eclipsys, a physician portal. The whole hospital went wireless with three wireless networks, which is a staff wireless network, a physician wireless network, and a visitor/guest network. We also implemented an EMPI when we did our full medical records clean up before the Eclipsys project.
This year, we are doing the ChartMaxx implementation, which is the document imaging in the two departments I mentioned. We also have two new selections occurring, which is a risk management performance improvement initiative and then HR payroll selection. In our longer range, we have pilot groups looking at other technologies.
AG: The wireless network, who are you using for that?
KM: Cisco for all three networks.
AG: And EMPI?
KM: Initiate. Quadramed had an offering, but we went with Initiate because the whole big picture was a better strategic decision for us.
AG: The risk management performance, is that an application?
KM: Performance improvement as a department actually covers a lot of different areas. They do incident event tracking and infection control and peer reviews. It’s actually defined differently sometimes in different organizations. But we collectively refer to it as performance improvement and will partner with a company that hopefully can support all of those areas.
AG: Is Initiate the company?
KM: No, we haven't asked them yet, but we’re in the middle of a selection. It’s interesting because our major vendors that we partner with today, we have Lawson for materials management, they don’t necessarily have their own (risk management/performance improvement product). We’re kind of forced to go out and scan the market.
AG: Who do you use for HR payroll?
KM: Currently we are using Quadramed.
AG: Any other projects you want to talk about?
KM: We have a lot of future projects in which we are planning; we are looking at barcode meds administration for next year along with an RFID project. We’re also looking at voiceover IP technology and then CPOE, and we are building a new tower simultaneously. We’re one of many California hospitals that’s faced with a capital building project, so that’s occurring simultaneous to all our other efforts.
AG: What exactly are you using Eclipsys for right now? You said you are working on a CPOE project, so you're not using Eclipsys for that currently?