Mercer County, N.J.-based Capital Health – a two-hospital, 589-bed regional health network, including an ambulatory facility – recently completed the implementation of an EMR from Boston-based Keane. Comprised of Mercer and Fuld hospitals in Trenton, N.J. and the Capital Health in Hamilton outpatient facility, the organization is expanding, with construction underway for a new hospital in Hopewell Township, N.J. as well as an expansion of services at its Fuld hospital, both scheduled to be completed by 2011. Add to all that the goal of qualifying for HITECH stimulus funds and it’s no wonder CIO Gene Grochala has his hands full. Recently, HCI Editor-in-Chief caught up Grochala to talk about how he’s managing all these challenges.
GUERRA: You mentioned you had worked with Beacon Partners back in 2006-2007 to help you with the system selection process. Did you get help with the actual implementation?
GROCHALA: It's us and Keane. There are no third parties involved. We had formal training classes for all the staff, and we did four hours sessions, two sessions a day, five days a week. Keane flew in here for three days a week and helped supplement the manpower for all that training. Physicians were trained completely one-on-one. We did not do any classroom formalized scheduled training with them. We had a team of nurses. They wore a lot of peach-colored stuff that they’d be recognized in, and they were called Peachy Keane. They actually chased the doctors, physically chased them down the hall and said, “Hey, let me show you this.” And then we kept a massive list of who was trained, how many hours, what the comments were, and all that kind of stuff.
The same thing with follow up, after we went live, we still ran around on the units grabbing the docs and showing them and teaching them. They understood the transition. It was amazing. I’ve been in this business for 30 years and I was amazed at how smoothly this thing went, how little resistance and screaming we got from the medical staff or the nurses and the ancillaries, too.
GUERRA: What do you think it was about your approach that was so successful?
GROCHALA: We put a lot more money in people than we did in hardware and software. The actual roll out and the cost of Keane was $1 million, and we licensed three facilities with that. We licensed Mercer Medical Center, Helene Fuld Medical Center, and then we have a huge outpatient facility in the suburbs, and all three of them came up at the same time. We’re taking about 120 people.
GUERRA: How many people are on your IT staff?
GROCHALA: In total, we have 38 people, full time.
GUERRA: Did you take on more people temporarily for the implementation?
GUERRA: Is 38 the right number or did you feel strapped?
GROCHALA: I could use 38 more, absolutely. But see, the Keane product runs on the IBM iSeries. So, what we get out of that is integration simplification because it does everything for us. It does the database administration, so we don’t need a database administrator. The operating system that people look to for virtualization today, the iSeries, has had and does have it today. Everything is streamlined. It has its own SANS system, so we don’t have to contract and buy a different SANS system. It’s never had a virus, never had a single incident. I don’t have a lot of spamware, the malware kind of virus protection on that, so I don’t have to think of hiring a systems administrator or a security administrator. The database is all integrated to the operating systems called DBX-400, 64-bed power processing. It’s a single level object storage. It’s such a beautiful box and Keane runs on it.
Here is an example – I did a Meditech installation one time and all of the vendors have their strengths and weaknesses, and Keane and Meditech are the same in that they started with a patient account number. That was their database and they grew it out. So, it’s still one monolithic port. By contrast, McKesson is a company of purchased products, so it’s a nightmare if you ever try to interface all those different products, operating systems, database systems. McKesson bragged that they have the largest R&D development of any software company, right? But when you look under the covers, most of it was spent trying to get their different products to talk to one another seamlessly, but they always seem to be working on that.
With Meditech and Keane, like I said, it’s one system underneath the covers where you could encounter a lot of those complications for the IT departments trying to get information flowing back and forth. We don’t deal with it. We don’t have that headache. It does come with an interface engine built into it for that $1 million. So, I don’t have two to three interface engine analysts over here. I just pull it up from my regular programming staff. There you are again, a lot simpler, a lot easier. If I want to shoot ADT information all over the place, I read it one time in some format and if I knew the lab system, I knew all other systems. I just shoot it back out into the trash cans through the same way. It’s pretty standard. So, that eased a lot of the pain and a lot of the work and management on our side.
Regarding anything with Keane, we do a lot of the system management behind the scenes, like table building, file building, maintaining the master files, controls parameters, such as when we purge and how we purge, when we do backups, anything like that is handled in the IT department. We keep that away from the clinicians, and it’s a pretty good plan. The clinicians appreciate it, they recognize what we do for them and all we ask them to do is to help us continuously enhance and improve. We want to add more assessments and flow sheets to it, design things for the physicians such as order sets that are user friendly. We need to use their operational knowledge of healthcare and apply it to that application. But we leave the backend support in IT and try to make it all work together.
The front end is all Windows which is in all PCs out there. So, I hope the docs and nurses are happy with that. They’re familiar with these Windows environments. On the backend, we managed it with the iSeries, and it seems they work out pretty good.
Today we talk about doing more with less, but that’s really hard to do unless you’re creative. Our mortgage will go up tremendously when we open a new hospital around 2012, and we’re really watching every nickel, every dollar. So, we must do more with less, and we must make it work. I think there’s a lot of guys out there like me who are saying they’re not going to take on millions and millions in debt. You read about Sutter Health System which spent $500 million with Epic and failed. There’s no way we’re going to do that. Quite honestly, there’s no way you could ever get any ROI on something so massive. I agree you need an EMR, but at what price, $10 million, $50 million, $100 million, when it’s just not there? You’d be better off to hire 1,000 clerks and buy 1,000 PCs and type everything in.
GUERRA: Well, let’s talk a little bit about CPOE. I think you said 40 or 45 percent of the physicians are putting their orders in?
GROCHALA: Yes. In 2003, we had Mediware for pharmacy. We consolidated it at our two hospitals and our one pharmacy platform is called WORx.
We had heard that what happens is the pharmacy gets a paper prescription and they type the order in. So, we said to them, “Why don’t you just build a Web-enabled front end? We’ll give it to the physicians and let them bang in their own pharmacy orders.” It’s a great idea. They developed the product. We made it with them in 2003, and we’ve been using it ever since. We have about 45 percent of our orders put into the system, not 45 percent of our physicians. That’s a big difference. We’re an urban hospital and the doctors have a choice about where they send their patients. Sometimes it’s different if you’re in a bright suburban hospital and the docs like to go there.
So, we don’t try to force this, but we do have a residency program here. We do have emergency room physicians who work for us and we do have some elective physicians who’d like to use technology. They put in their pharmacy orders through the system. They can see all the yellow, orange, and red alerts, the allergies that are in there, so they can get the contraindications. We have the system floating around on the COWs.
The ones that try it really like it. As a matter of fact, they resisted using it initially but once they used it, it’s the next best thing to having a pharmacist next to them. These docs want to be rounding and they really want a pharmacist in tow. They’re talking about therapies, what they’re going to prescribe for the patient, and we’re adding products to our formulary every week. A lot of these drugs sound alike, so it’s a real opportunity for error. 40 percent of drug events happen at the time of order entry.
So, in terms of patient safety, we made a big hit with that. But again, it’s limited to drugs, which is really where you want to be, that’s your problem. We learned a lot from our first foray into CPOE, and then we moved it over to Keane. Keane can handle it. Keane handles everything they do. A doc can sit there and enter all of his orders electronically, sign everything, and he can do it from here, from his house, and get it done, the same with the nursing staff too and the IS clerks.
GUERRA: Did HITECH change any of your timelines?
GROCHALA: We started before Obama got in there, but now that he’s in there, we’re speeding it up. We ran the formulas for the two hospitals so we know how much potential reimbursement we could get out of ARRA, and it’s significant. It would easily cover our phase 1, 2, and 3 with Keane. It makes management very, very happy to hear this won’t cost new dollars, because when I go to capital budget meeting and request money for software or infrastructure, I’m competing with bricks and mortar and new beds and smart pumps and direct patient care stuff, and the patients come first. I think we’re going to be in a good position.
Part III Coming Soon