North Country Healthcare includes three critical-access hospitals and an affiliated home health and hospice agency located in northern New Hampshire. Healthcare Innovation recently spoke with the health system’s CIO, Darrell Bodnar, about unifying all three hospitals on Meditech’s Expanse EHR and being named to CHIME’s Digital Health Most Wired 2023 list in both ambulatory and acute-care categories.
Healthcare Innovation: What are some of the biggest challenges you face as a CIO of a smaller rural health system these days? What's top of mind for you?
Bodnar: Top of mind for me is always staffing. I have 31 IT employees. We’re responsible for data analytics. We're responsible for some of the the ancillary services within imaging. We have boots on the ground at all of our locations, which spreads us out thinner. So staffing is probably my biggest concern, and not just IT staffing. I believe the solution to improving the overall shortage of clinical staff is technology, automation, and innovation. I think it's the only way we're going to get there, and it's overdue. There are a lot of processes, whether they're driven by regulatory compliance or not, that need to be improved. We have lots of opportunity.
HCI: Besides automating certain tasks, do you think whether the EHR is perceived as user-friendly by the clinicians is important to clinical staffing?
Bodnar: Absolutely. In my personal opinion, EMRs were originally not designed for the physician but rather as a financial tool that was pushed to physicians and clinicians. Today clinicians are documenting an encounter with the patient and that has effectively made them coders and billers, too. Physician workload is something that we really need to be cognizant of. So, though there is some resistance to AI and some of the automation that we're putting in, I always say it enables the providers and clinicians to be their best. It's not there to replace them. It's there to replace that work, but enable them to be their best. We seem to have gotten quite a bit of traction in doing so by presenting it to them that way.
HCI: I understand that North Country came together in 2015. When did the deployment of the shared Meditech Expanse EHR happen?
Bodnar: In the middle of COVID so, December 1 of 2020 is when we launched it. And we're coming up on three years. Previously, we had a total of five EHRs excluding home health. We had three for primary facilities, and then we also had an ambulatory module for one of those organizations. And then there was another separate ambulatory module for one of the other affiliates, so we had multiple EMRs.
HCI: What were some of the biggest challenges about the transition period?
Bodnar: We had not done a lot of the legwork it would take to collapse that many organizations into a single EMR. I’m talking about defining best practices, defining order sets. So in the year prior to the go-live as part of our build, we started to work on those. This was not just a technical process. As an organization, we weren't ready for it culturally. So there was a lot of negotiation that went on post-go-live that probably should have been done in advance.
The other lesson I learned was that sometimes it's easier to build a new house than renovate the one that you're living in. We collapsed all of these organizations into one of the EMRs that was currently in place, which was in Androscoggin Valley Hospital. They were a Meditech customer for many years. It was the best platform to move to, but they had 25 years of baggage that came with that EMR. There are always things that are leftover or residual in the EMR, that we've now introduced to the others. Maybe it would have been wiser to start brand new, and then go from scratch to our migration. But we decided to try to take advantage of it. It made sense at the time.
HCI: You must have seen quite a few benefits from having all three hospitals and ambulatory settings on the same platform. You were named to the CHIME’s Digital Health Most Wired 2023 list in both ambulatory and acute-care categories.
Bodnar: It is night and day, even with the challenges we still have. We have a single pane of glass over acute and ambulatory across our entire continuum of care. That was something we didn't have before. We have that visibility now. The processes of how we do care transitions are seamless. Our physicians work in multiple places. They may not even have what they would call traditional home anymore. With multiple EMRs, it was almost impossible for them to function And for our patients, if we had five EMRs, they needed to have five patient portals. Now they can use one single patient platform to be able to access information.
HCI: You mentioned analytics and reporting earlier. Is that made much easier with a unified health IT system?
Bodnar: Our goal is high reliability. We're looking to be a just culture where we can improve our processes. We have hired a chief quality officer who's really driving these efforts. Every ounce of that effort is based on data that three years ago was completely disparate and was not available to us. Now, it's just a matter of mining it, looking at it and interpreting it to get to the point that we want to understand. And we're uncovering a lot of cultural and workflow issues. Having data and analytics provides us the insight to get to that.
HCI: What about interoperability issues? I don’t think New Hampshire has a strong statewide health information exchange. Are you using CommonWell and other national health information networks?
Bodnar: In New Hampshire, the motto is ‘Live Free or Die.’ Due to legislative efforts, we do not have an HIE and we were not permitted to under law because we could not store that information. It i manifests itself in horrible ways like with an immunization registry that was not present during a pandemic, which made it really challenging. But interoperability with Meditech has been great. We've partnered with a lot of our organizations for point-to-point VPN tunnels where we would do HL7 exchanges of information as part of our workflows and continuum of care. And we are able to use CommonWell across the board. We tend to get a lot of travelers we have snowbirds who used to live here, and go to Florida or come back.
We also have people who come here to ski. Having those records come in has been instrumental in us being able to provide care quickly. And surprisingly some of it pertains to the ED but a lot of it has been in primary care.
HCI: Did your organization move to a lot of telehealth during the pandemic and has that continued since?
Bodnar: We did move to telehealth. We had leveraged Zoom like a lot of people did and got the secure licenses and then built workflows around that and it actually worked fairly nicely. Now we are implementing a Meditech module to help us with that. We saw the uptick and and we saw a little bit of a drop-off. But the area where it has stuck is behavioral health. We have a fairly significant behavioral health population, and they seem to prefer that platform, and honestly the clinicians delivering care do as well. We're working with Meditech now and a third-party vendor called Phreesia to make sure that we facilitate the documentation, the onboarding of those patients and consents through an electronic format so that they may never have to step foot in facility unless it's for some some blood work or something along those lines.
HCI: Is there anything else in your health IT strategy on the drawing board for the next year?
Bodnar: We're definitely moving forward with with Microsoft's relationship with Nuance. I think it's gonna be Nuance DAX Copilot. That's one of the technologies that I think that will enable our clinicians to be their best. We have a variety of automation projects on the clinical side as well as the financial side. We're scheduling an optimization review this coming year, focusing a lot on the revenue cycle side, but we're also looking at acute and ambulatory services. We built it during COVID. A lot has changed since then.
I think the biggest thing that I'm seeing is a move toward automation, a move toward the the slow but methodical adoption of artificial intelligence and machine learning where applicable, and making sure we look at mature vendors, not those promising things that could really put us in a vulnerable position. There is a partnership between Meditech and Google that is extremely exciting for us, particularly when you look at the depths of the medical record and what that search capability would look like.