Parkview Adventist Medical Center is a 55-bed, faith-based community hospital located in Brunswick, Maine. It has been serving the healthcare needs of the residents of midcoast Maine since 1959. Affiliated with the Seventh-day Adventist Church, Parkview is one of about 70 acute care Adventist hospitals in the United States and about 200 worldwide. Earlier this year, Parkview became one of 24 hospitals nationwide recognized by HIMSS Analytics for achieving the Stage 6 award. Recently, HCI Associate Editor Kate Huvane Gamble spoke with Assistant Vice President and CIO Bill McQuaid about what it took to realize this accomplishment, his plans going forward, and the importance of involving clinicians in discussions and making it as easy as possible for them to access patient data.
KG: A few months ago, Parkview became the smallest hospital to earn the HIMSS Analytics Stage 6 designation. How did you get this whole process started, and what were you looking at when you first started at Parkview?
BM: When I started nine years ago, I actually came here as a network administrator. They just had the bare minimum — your simple lab, radiology, pharmacy, registration and billing and materials management. They didn’t even have e-mail.
Four years later, I started taking over. But I was the guy supporting all those interfaces and trying to make things talk, and I kept thinking to myself, this doesn’t make any sense at all. I’m hearing all this talk about what people want in the future, and thinking, there’s just no way this is ever going to happen in this scenario. Well luckily for us, things started coming off maintenance. Vendors were being acquired by other vendors, so we had to make a decision. So with the hospital in 2004, we decided to go single-vendor. I said, I could do this with myself and with a small team, but it has to be one vendor, so that I can use my same good people throughout the whole project.
KG: Which vendor did you choose?
BM: We went with the Meditech client server.
We buy every module they sell — we’re even doing HR and payroll, scanning and archiving, physician practices. The only thing we don’t have that they sell is long-term care, because we don’t do long-term care at our facility. And every module they sell we have live.
KG: Are you doing CPOE?
BM: We are at about 60 percent. We’re 100 percent in the ER, and a little over 50 percent in the hospital, on the in-patient side. And in the last few months, a lot of our doctors started to do all their own documentation as well.
KG: Was it a situation where clinicians were on-board from the beginning, or did it take some convincing?
BM: Actually, it went really well for us because all of the success we were having with the doctors. Back in 2005 we made it so that everyone had to go e-sign. The docs were all starting to utilize the EMR, so when all that success happened, we were kind of getting pressure from the docs, saying, when are we going to go?
And CPOE is a funny story. I had two doctors that agreed to be my first go-lives; one was our hospitalist and one was an internal medicine doctor. Well it just so happened that on the week we were going to go live, one had to go away for a family emergency, and the other forgot they were going to be on vacation. So our most seasoned doctor — who has been there forever and is over 70 years old and said he’d never use a computer — came up to me and said, I’ll go first. He was live that day and hasn’t stopped since.
We were all in a frenzy, and he stepped in and things just came together. What are the odds that would happen and this guy would come out of the woodwork?
KG: That’s pretty amazing. I guess you just can’t predict what’s going to happen in these situations.
BM: Exactly. Now the reason we’re not at 100 percent is we don’t have a full-time hospitalist program, and some of our doctors only call one in every three months. I don’t have the staff for someone that can just get them in there and work through the bugs. But we’ve actually just started what we’re calling an HCIS Physician Advisory Board. So a bunch of the doctors will meet monthly, and just by forming that group and getting the doctors all talking together, we saw our numbers go up four percent.
A lot of the doctors see the benefits that others are realizing. They see how it makes their lives easier. So now our problem is figuring out how to get support for the doctors that want to go live that aren’t here at the hospital.
KG: How is that going to work?
BM: With the doctors’ support, what we’ll probably do is for the next month, we’re going to have a full-time hospitalist program. Just that alone is probably going to put us probably to 78-80 percent. And we have to get the OR live — that’s been tough because we just need a lot of manpower to get in there and to do that project. So as we do our next upgrade, we’re going to focus a lot on the OR and getting 100 percent CPOE. I think it’s very doable because we already have all the key players doing it.
It’s just a matter of training the docs. And it’s tough because a lot of them aren’t employed, so they get in and get out. These are a lot of the nonemployed physicians — specialty surgeons, etc.
KG: That must make adoption tougher, having physicians who aren’t employed by Parkview.
BM: Yeah, and it’s not that we can’t do it, it’s just that I like to prioritize where I can get the most bang for the buck and then go back there and give a lot of resources to that so that you can cater right to them. Right now I’m catering to the people that want it badly — we’re focusing on those people.
KG: Tell me a little bit about your organization. You’re located in Brunswick — is that a fairly rural location?
BM: It’s about 20 minutes from Portland. We’re in a great location. We have Boden College right there.
KG: And are there physician practices that are part of Parkview?
BM: We own five physician practices — we own a family practice, pediatrics, OB-GYN, oncology and pulmonology. We current have the family practice, pediatrics, OB-GYN and oncology all fully live on EHR. The only practice we don’t have electronic is pulmonology. At our oncology clinic, we have the COWs and they’re even doing bedside medication verification where they scan the bracelet and meds and it all adds up. It’s pretty cool to see that when you go in there. When the new oncologist started, she saw all the technology from the ground up. She’s actually using physician templates and using Dragon to dictate right in, so all her stuff is goes right into the system in real-time.
Two weeks ago I was in the ED, and there was a doctor in there. He said, ‘Bill, this is beautiful.’ It was one of the notes that the oncologist dictated in the system, and he asked why he wasn’t doing it. I called Jane, my clinical person, and she came and trained him the next day, which was Sunday, and he was live soon after. Just letting him see how nicely it worked — how it pulled in all their meds and how nice the note was laid out — that was huge.
KG: So seeing really is believing — once doctors see how well others are doing with the technology, they want in.
BM: That’s kind of the secret to our success. We don’t force anyone to do anything. We don’t roll anything out until I know 100 percent that it’s not flopping. We work with the people who want to be worked with and let them come to us. We haven’t had to mandate anything to our physicians. We’ve been building a lot of momentum; it’s gone very well.
KG: And it’s also critical that the technology isn’t too difficult to use.
BM: Right, and that’s where Imprivata came in. It the beginning, everyone wasn’t all warm and fuzzy when they found out this is what we were going to be doing. We were going to want doctors to do their own dictation and templates and do CPOE. This was back in 2005. So when we were bringing in the doctors, they were saying, ‘there’s no way I can always log in, there’s no way we’re going to be able to remember all these passwords.’
So we did some research and we ended up using OneSign. But what we did is we don’t do single sign-on; we do zero sign-on. We use biometrics. So what we did is we went live with this product and just gave access to a few people. And when others saw them use it, they all wanted to do it. But until they signed up for training and went through the whole process, they couldn’t utilize biometrics, so our signup sheets went through the roof. All the nurses and doctors wanted biometrics so we used that as bait to bring everyone right in. Plus, it took care of all my security issues. I had a whole list of things that I was worried about and it all went away. So this thing right here solved all my headaches.
And the doctors loved it. So we use this in all of the physician practices, as well as the MedSurg, ED, and ICU.
I already had single sign-on with one vendor — I needed zero sign-on. And even now I’ve created virtual desktops for a few doctors so when they log in remotely, they log in once and they’re getting the security of single sign-on. So they get their own desktop — they can print orders, they can do whatever they want from anywhere the country. They love it.
Part II coming soon