Northeast Hospital Corporation (NHC) represents the acute care hospitals of Northeast Health System, Inc. (NHS), an integrated network of hospitals, behavioral health facilities, long-term care and human service affiliates offering Massachusetts North Shore residents general and specialized medical care. NHC hospitals include: Addison Gilbert Hospital in Gloucester; BayRidge Hospital (psychiatric) in Lynn; and Beverly Hospital in Beverly. There are also two outpatient facilities in the corporation: Beverly Hospital at Danvers, Medical and Day Surgery Center; and Beverly Hospital Cable Center in Ipswich. Recently HCI Editor-in-Chief Anthony Guerra had a chance to talk with CIO Robert Laramie about his work to strengthen NHC’s infrastructure so point of care applications are always available.
GUERRA: When did the hospital first engage Meditech?
LARAMIE: We’ve had Meditech for over 20 years.
GUERRA: So we’re not talking about you selecting a system?
LARAMIE: No, we are not. It was Meditech, and we’re going to use Meditech.
GUERRA: Did you have to show the clinicians that you’re doing everything possible to make this system work for them?
LARAMIE: Absolutely. We needed to make sure that it was focused on the way they thought it best, in terms of how they worked. We spent a lot of time in those two months talking about workflow, talking about how they think about their orders, and how they’d like to see them processed. We got agreement in the departments on order sets and the flow of those, and so arrived at a unified approach to what we’re going to do, and we did that throughout each floor as we did our rollout implementation plans.
GUERRA: Did you, at any point, need to engage outside help for this rollout?
LARAMIE: We did. We engaged a few consultants at specific times. We had a project manager who was a consultant, and we had a consultant who was a PA and did a lot of the doctor training.
GUERRA: Can you name any of those organizations?
LARAMIE: Our consultants were from Navin, Haffty. That’s a local firm up here in Massachusetts that has a strong Meditech practice.
GUERRA: Tell me about your decision to bring in consultants. I would imagine some people try and save the money, but pay in the long run.
LARAMIE: Well, I think the key for us was we were doing this for patient safety and patient quality. My experience has taught me, and also hearing from my peers, that CPOE is one of the more difficult applications to implement. We engaged someone who had significant experience doing CPOE implementations to guide us and do a trainee/trainer program and transfer knowledge to some of our key management staff, because none of our management staff had done a CPOE implementation before.
GUERRA: And you said they’re experts in Meditech.
LARAMIE: Yes. It’s actually in Massachusetts where 70 percent of the community hospitals are Meditech hospitals.
GUERRA: I’d like you to talk about the importance of giving the physicians wireless capabilities. I’m not sure how Meditech presents on a handheld, but what can the doctors do with it on a handheld, why is it important to empower them wirelessly?
LARAMIE: Well, it’s not just Meditech that we did the wireless environment for; it’s for any clinical application that they may want to view. Right now, CPOE, in general, does not lend itself to being on a handheld PDA. The screen is just not large enough for a clinician to effectively put in the orders and see everything they really need. What we wanted to do with the wireless is make it easier for our clinicians, if they are comfortable with different form factors, to be able to use them for our applications whether its Meditech or PACS or our Picis OR scheduling system.
We also did it for our patients so they could get on email or look things up on the Internet or communicate with families. It’s a patient satisfier to be able to do that, and it’s been a resounding success with the patients and the families.
There was a multitude of reasons for doing the wireless infrastructure. One of the main ones was the technology at the bedside, and we have to allow for multiple form factors because, as we all know, people have different levels of capability with technology adoption – some are very advanced and we want to support that, and some would rather just sit in front of a PC at a desk and handle it that way.
GUERRA: Another CIO told me that adding wireless capabilities eventually means you need a more robust wired network, because it all comes back to the wired network. Does that make sense?
LARAMIE: I’m not sure I follow that logic, because the wireless then travels through your wired environment, but we have a public and a private wireless. All of our patients and families go through a public one which is separated from our current one. So, if they are doing it through the wired, it gives them more capability to utilize your bandwidth where previously they hadn’t. So I guess I could see where the rationale would be there.
GUERRA: Have you had discussions about which devices you’re going to support?
LARAMIE: Actually, we are in a community hospital model. We have independent and employed physicians, so we’ll have to come up with a recommended few devices. I don’t think the organization, nor do I, wants to get into supporting every different PDA that’s out there. Certainly, if they have a PDA, they have the right to access our public Internet and go out and do whatever they want through that, but to access our environment, it’ll be specific, recommended handhelds or mobile devices.
GUERRA: How many beds do you have?
LARAMIE: It’s over 300 I believe, 315. We have another acute care hospital in Glouster, an outpatient center, and then we also have the psychiatric hospital. I am responsible for the whole system.
GUERRA: The outpatient center is on Meditech as well?
LARAMIE: That is correct.
GUERRA: So you have a mix of employed physicians and independents?
LARAMIE: Yes, we do.
GUERRA: Have you found a difference in the CPOE education process for the employed versus the independents? Do you have to be more nuanced with the independents?
LARAMIE: No. I think what we have to evaluate is their capabilities with technology adoption, for each individual. I think with our approach and the commitment that the organization made to this process, we actually had great response by our physicians. They’ve really taken to this. I think they’ve seen that the organization is committed to it and put the right resources in place. Their peers were telling them, “It’s not that bad. Just go to the training, they’re there for you whenever you need them,” and plus, we did the 24/7 support for two to four weeks depending on the unit. If someone had a question, it was answered almost immediately or was taken down and fixed for them. I mean, having a physician champion – actually, we had three of them towards the end – made a big difference also.
GUERRA: What is your strategy for integrating independent, but affiliated, physicians?
LARAMIE: We have a PHO that all of our doctors must belong to and we have implemented, with the PHO, EMRs for over 90 percent of our PCPs. Almost 70-75 percent of our specialists have an EMR. In certain instances, we actually host their EMR in our data center, and we also have integration to them that gives them all the ancillary inpatient results and summaries sent to their EMRs.
GUERRA: What are they on?
LARAMIE: The vast majority of them are on GE Centricity, and some early adopters have some different flavors of EMRs out there; there are probably six to eight other standalone EMRs.
GUERRA: So you’ve managed to do a nice integration between the GE Centricity ambulatory product and Meditech?
LARAMIE: That’s correct.
GUERRA: Meditech has an affiliated ambulatory product. LSS?
LARAMIE: That’s correct.
GUERRA: Any of the physicians using that?
LARAMIE: Not to my knowledge. The majority are using GE Centricity.
GUERRA: You don’t want to get into a game of having to integrate with every ambulatory product under the sun.
LARAMIE: We’re so close to being done with the physicians that it’s not an issue for us, the vast majority have gone with Centricity. For 80-85 percent of our docs, they’re on Centricity. So we don’t have to really fight that battle any longer.
GUERRA: But if somebody’s on Allscripts or something more obscure than Allscripts, you’re not going to write an interface for a one-doctor practice, right?
LARAMIE: Well if they are referring patients to us we would, because we want those results to be in that physician’s EMR for the care of the patient, for the continuity of care. If we’re talking about an EMR someone made in a back room, which couldn’t accept an HL7 message, then we might have a problem.
GUERRA: Otherwise, you’re going to get it done; you’re going to write that interface?
LARAMIE: It’s the right thing for the patient care process, so that’s why we would do it.
GUERRA: When you do your upgrade from Magic 5.62 to 5.64, or any future upgrade, does that necessitate an adjustment to all the interfaces to all the ambulatory systems out there?
LARAMIE: Not usually, not for this type of release, going from .62 to .64. When we go to 6.0, then we would have to reevaluate all those, yes.
GUERRA: It gets complex.
LARAMIE: It certainly does.
GUERRA: Is there anything else you want to touch?
LARAMIE: Well, I’d like to make it clear that Beverly Hospital and Northeast Hospital Corporation has taken a multidisciplinary approach to implementing CPOE to improve patient safety and quality of care. We’ve done the things that I outlined, such as made sure the project was clinically focused. We made sure we have the right physician champions in place. We got the organizational commitment to make sure this was a priority and that all individuals and departments knew that throughout the organization.
We had a strong support structure, engaged the nurses and the clinicians in that process so that they could better educate us about where things needed to be changed to correspond to what they do when they’re caring for patients. We had a strong focus on workflow, whether patient flow or what happens on all the individual floors. All of that has allowed us to get to 96 percent of all of our orders going in through CPOE, which puts us in the top tier of any CPOE implementation in the nation.
GUERRA: If there’s one major pitfall to avoid, it sounds like it would be, “Do not let this become an IT project,” you have to involve the clinicians.
LARAMIE: The clinicians absolutely have to be involved.