With its carrot-like incentives, HITECH has placed severe demands on healthcare providers throughout the country to adopt electronic medical records and computerized physician order entry. And while paying for such systems is difficult, inducing clinicians, especially independent physicians, to use them can be the highest hurdle in the race to leave paper behind. One institution grappling with these challenges is Warsaw, N.Y.-based Wyoming Community Health System, comprised of a 63-bed acute care hospital, a 12-bed mental health facility and a 160-bed skilled nursing facility. Recently, HCI Editor-in-Chief Anthony Guerra spoke with IT Director Jane Beechler about her plans for clinical IT implementation and adoption.
GUERRA: Tell me about your staff, how many people are working for you?
BEECHLER: We only have four full time FTEs and one of them is an AS/400 programmer. The other three consist of myself and two other individuals.
GUERRA: Who do you report to?
BEECHLER: The CFO.
GUERRA: Can you tell me what your IT budget is?
BEECHLER: $255,000 a year.
GUERRA: Has that dramatically increased over the last five years?
BEECHLER: No, it’s been approximately that.
GUERRA: So, the $1.5-2 million to purchase the new system comes out of a separate budget, the capital budget?
BEECHLER: Yes, that’s right, out of capital.
GUERRA: Are they letting you augment your staff to facilitate the roll out?
BEECHLER: I hope to, yes. The CFO had a conversation with me over a year ago and he said, “Let me know when it gets to be too much, and I’ll work with you.” They’re going to be supportive of it.
GUERRA: Do you have any idea what a right-size staff would be, how many people, including yourself, for the actual roll out?
BEECHLER: I’d like at least three more. If they’re just temporary that would be fine, but at least three more.
GUERRA: And I would imagine it’d be nice to have people that had some experience working with the system you’ll be rolling out.
BEECHLER: Yes, absolutely.
GUERRA: Any chance you could tell me the two finalists?
BEECHLER: CPSI and McKesson.
GUERRA: Can you tell me who your pharmacy and lab systems are from?
BEECHLER: Pharmacy is from Meditech, and lab is Psyche.
GUERRA: If you pick McKesson or CPSI, what would happen to your ancillaries? Would you replace your existing ancillaries with products from the vendor you chose for your core clinical?
BEECHLER: Yes, we would replace both.
GUERRA: So, either way you go, you’re going to replace both.
BEECHLER: That’s correct.
GUERRA: So, there will be some retraining there too.
GUERRA: You have a lot of work ahead.
BEECHLER: I know, and every time I start thinking about it too much, I have to take a pill. (laughing)
GUERRA: This phone call is going to necessitate a pill.
BEECHLER: Yes, it sure is.
GUERRA: You started to focus on these issues before the HITECH legislation came out, but how has the act influenced your plans?
BEECHLER: It slowed down the CEO for a little while. He was a little nervous about meaningful use and he wanted to be sure we were headed down the right path and not spending money that we shouldn’t be spending. He’d love to know what meaningful use is. We’re just listening and hoping that we qualify based on our work.
GUERRA: So far, the preliminary definition of meaningful use requires 10 percent CPOE in addition to other things. There’s some serious business in there that must be done by 2011.
BEECHLER: Right, and that the 10 percent is scary, but we have to hammer that home to the physicians.
GUERRA: And you don’t want to get to that 10 percent by having nurses put the orders in for the doctors, as that creates a step where a medication error can occur.
BEECHLER: Right, absolutely. It’s crucial we make them understand why they must put their own orders in.
GUERRA: I would imagine you’ll have to do some counseling with your nurses so they aren’t intimidated, because physicians can be intimidating people. Do you have some thoughts about giving nurses the resources they need to hold the line?
BEECHLER: Just thoughts, but nothing is concrete, we haven’t written any policies down but we definitely want them in place before we start. We want the physicians to know what we told the nurses too. There’s a ton of work as far as just the preliminaries before it even comes in the building.
GUERRA: Tell me a little bit about your CEO and CFO’s attitude towards IT. In relation to that, do you feel like you’re on the hook to get the stimulus money? Do you think other CIOs and IT directors may feel that way?
BEECHLER: I do feel a little bit of that, and I want them to make this decision soon because I want to start moving forward on it. I don’t want it to come down to just having six months left to make good on meaningful use.
But both the CFO and CEO here are in agreement and are supportive of moving forward. It’s more the CEO than the CFO, for obvious reasons, but it’s been really since that first meeting that they told us to go to Chicago in August of 2007 (for a vendor road show). It’s been since then that they’ve both had time to go through this process and get used to the idea. They both went to a lot of the meetings that we set up between the four vendors. Just by their presence there, it showed that they were supportive of us going forward and getting an EMR.
I feel confident, I just want it to happen now. Actually I do and I don’t. I told somebody I feel like a freight train headed right for a mountain. J We’ll just do the best we can.
GUERRA: I suppose your job is to make it as clear as possible to the CEO and CFO what is at stake and what these kinds of things require, how much work is involved.
BEECHLER: Absolutely. I do have the benefit of the CEO just going through this, I think it was seven or eight years ago. He knows what that hospital went through, and he even tells me stories of what went on. I really think I have their support, and if I need more, I think I could get it.
GUERRA: If you were talking to David Blumenthal, M.D. (national coordinator of healthcare IT) or John Glaser (special advisor to Blumenthal), what would you want them to know?
BEECHLER: Don’t forget how many of us there are. There are a lot of small community hospitals out there, and we’re the ones that feed to the larger facilities. They’re going to want us to be on board with them and able to communicate electronically with them. Just remember, that we don’t have the resources that they have. We’re just small town hospitals and we need a lot of money just to keep up with the electronic portion. It’s important that they don’t forget about us and give us the resources we need. There are a lot of people out in these smaller communities. And when they need serious medical attention, they’re usually not going to stay here; they’re going to go to the city, to the larger facility. We’re going to need the resources here to do that, to communicate, have the same EMR or the same avenues to communicate with them.
GUERRA: It sounds like your message would be don’t set the bar too high too quickly – something like that?
BEECHLER: Absolutely. Remember what we’re dealing with is just a handful of physicians, and it’s going to take us awhile. We have older physicians on staff that have been here for years that are going to be probably our toughest sell, as far as CPOE.
GUERRA: It says quite a bit that when you did significant outreach to 40 physicians, you only got three to really participate – that says something right there about what you’re up against.
BEECHLER: And we really worked hard at that too. We sent out flyers – we tried to entice them with food, we put stuff in their lunch room where they eat (they eat separately from the staff), and we made phone calls. Even the physicians that were on board tried to get their colleagues to come, and they still wouldn’t do it. They’re just too busy, I guess.