University Health system is the public hospital district for Bexar County, Texas. As the primary teaching hospital for the University of Texas Health Science Center at San Antonio, University Hospital is a regional Level I Trauma Center.
Q: What was your reaction when you heard about your Stage 6 designation? You don’t apply for these things, right?
A: You kind of do. You submit an annual analytics profile, and so I saw the announcement for Stage 6, and I actually called and said, “Hey we’re up there, I’m at the top of Stage 6. Can you look at me?” and they called back and said, “You’re right.”
Q; Can you fudge getting to Stage 6?
A: There’s no fudging it. I knew from other studies of EMR adoption, anywhere from 3 percent to 50 percent of users so I knew statistically that numbers were very low, and I knew from sheer volumes in our integration that we were there.
Q: When you heard the news did you use your bragging rights for your employees and for the community?
A: We have an internal newsletter that come out once a month and we announced it there, at our executive meetings, at our board meetings and so we announced it in a lot of forums. Externally we didn’t do a lot. But we do a lot of site visits and now my first slide always says, “We’re a Stage 6 hospital!”
Q; When did you first become an Eclipsys Sunrise customer?
A: Several years ago, and in ‘05 we started a baseline very early ambulatory type of rollout and then in March of 06 we started very hard and we started rolling out by lines of service. So if we did the inpatient OB floor, we then did the outpatient clinics associated with that. Because we’re a local county government hospital and we have many ambulatory clinics. We’re staffed at 404 beds. Our primary goal is to take care of the indigent, we’re a Level I trauma and we cover 22 south Texas counties.
Q: How much of admissions come through the ED?
A: About 70 percent. We also do the healthcare for the local jails too. You want to talk about leading the country--I have the Sunrise product in the jails taking care of the inmates—there’s no one doing that. We’re coming in the magistrate court and the detox facilities. We already have the jails so now we’re getting that whole continuum, and we’re getting magistrate court and their clinic. And then if they’re detoxed they’ll be on the EMR, and we serve the jail for inpatient and for outpatient. And then when they come out of jail they normally come back to our environment so that’s the continuum of care in our community.
Q: What are the missing pieces right now in connecting?
A: We really don’t have any. We are up in everything from all of our inpatient, all of our ambulatory, we even have contracted clinics that we provide the physicians in, that we don’t own, that are up on our Sunrise system, and now we’re working with the local mental health provider and we brought one of their clinics up on the EMR.
Q: For your Stage 6 designation, how much is IT and how much is process? What are you doing right?
A: I think it’s kind of mixed. My biggest thing is integration. Without integration I don’t care how big of an EMR you have or what vendor, you really have nothing. So everything evolves around integration. So in our EMR I’m trying to give that physician the experience going one place and you get all the information you need to take of that patient. So you don’t have to bounce in and out of various systems. So we integrate into our EMR everything from ADT to PACS to stress tread mills, lab results.
Q: What percentage of your IT budget goes for integration and support of all those interfaces?
A: I view it as this: When I look at budget and I look at the EMR, everything that I buy and every step I move forward on is to enhance the EMR. So as we continue to move forward I’m looking at products that will alert the nursing staff when new orders hit the EMR instead of them having to look. And looking at new smaller devices. So everything we do we look at integration forward and we look at add on technology to improve the EMR. So from a capital budget standpoint of view, I would say that a majority of my capital budget is going to clinical systems and almost every clinical system will either integrate or enhance our EMR. We’re even integrating Alerus smart pumps, wireless EKG, you name it, endoscopy, colonoscopies.
Q: Understood, but what about the cost of those interfaces? Do you have a percentage of your budget set aside for that?
A: It’s small money because we’re so far along. Every year we set aside $300,000-400,000 for interfaces. It would be a very small percent. If you look at that, when we buy a product, like a RIS product for example, one of my line items in our RFP is that you will provide an interface into the Eclipsys Sunrise product. And then I put this small money aside for things I might not have thought of, like point-of-care testing, the glucose machines. So those things that come up that we weren’t thinking about, pulmonary function. Right now we’re thinking about turning on the Cerner Copath product, an new implementation to get digital slides. When we bought that, first thing we had in there was that it must be fully integrated and implemented into Sunrise, so those images are going to pass into Sunrise.
Q: How involved were the physicians in the IT process, especially CPOE?